A new study by Sheetz and colleagues from the University of Michigan Health Center, US, published in JAMA Surgery, a monthly peer-reviewed medical journal, calls into question the superiority of robot-assisted colectomy when compared to laparoscopic colectomy.
The colectomy procedure involves the surgical removal of all or part of the colon. This procedure may be used to treat diseases including colon cancer, Crohn’s disease and diverticulitis. Before robot-assisted colectomy, routine procedures included open surgery and traditional laparoscopic colectomy.
Laparoscopic colectomy is a minimally invasive procedure where small incisions are made in the abdomen. Robotic colectomy is also minimally invasive but uses robotic assistance to increase precision and control.
Despite the lack of evidence for enhanced effectiveness and safety of robotic colectomy, the proportional use of this procedure has increased significantly in the US. According to the article, the use of robotic colectomy increased from 0.7% in 2010 to 10.9% in 2016. Generally, robot-assisted surgeries are assumed to be less invasive, safer and more effective. However, according to the article in JAMA Surgery, this may not be the case for colectomy.
The article examined a total of 191,292 colectomy procedures performed in the US from 2010 to 2016. They included 23,022 robotic procedures, 87,639 open procedures, and 80,631 laparoscopic colectomy procedures. The researchers found that robotic colectomy had minimal safety benefits over open colectomy. However, there was no difference in complication rate or hospital stay length when robotic colectomy was compared to laparoscopic colectomy. It is likely the minimum advantage that robotic colectomy provides compared to open colectomy is its non-invasiveness, rather than its robotic assistance. Researchers also found that robotic colectomy had replaced a larger proportion of the minimally invasive laparoscopic procedures than open colectomy procedures.
While the use of robot-assisted surgery is increasing rapidly in the US, it may not be the best option for colectomy. This is especially true when costs are considered, as robotic surgery costs 25% more than laparoscopic colectomy.