Is Robotic Surgery Really Superior?

There is no shortage of hype when it comes to the marketing of medical technology nowadays. It seems like practically every day one hears about some new whiz-bang laser or non-surgical body reshaping device or – most sci-fi of all – the glorified surgical robot, known as the DaVinci.

The company that makes this $1.7M piece of equipment, Intuitive Surgical, has one of the world’s most impressive and aggressive marketing machines that has quickly blanketed every media outlet – from the TV show “The Doctors” to Lifetime to mainstream major networks and magazines – touting this minimally invasive approach to surgery as “the latest and greatest.”

But is “new and shiny” truly superior to “traditional” laparoscopy as a minimally invasive surgical option? Does robotic surgery really result in fewer incisions, shorter operating times, lower costs, and better clinical outcomes for the patient? In the specialty of gynecological laparoscopic surgery – and when performed by proficient surgeons – the answer is an emphatic “no.”

The question of exactly who would win the contest of “man versus machine” in the field of gynecological surgery was, in fact, recently tested and answered in a well-designed study published in the November 2011 issue of the highly respected journal, Obstetrics & Gynecology (download pdf of full article). The study compared the minimally invasive robotic approach, head-to-head, with the traditional, minimally invasive laparoscopic technique in an operation called a sacrocolpopexy, which basically is “tacking up” a prolapsed (fallen) vagina that sometimes occurs after a hysterectomy.

As many of the leading minimally invasive gynecologic surgeons in the country could have predicted, the traditional approach – which is most definitely considered minimally invasive if judged by no other criteria than the size of the incisions – won hands down in every meaningful comparison and outcome. This includes:

Despite the obvious clinical advantages of a laparoscopic approach, adoption of the technique for sacrocolpopexy – as well as many other common gynecological and pelvic surgeries, including hysterectomy – has been limited due to the steep learning curve in attaining suturing (stitching), knotting and other technical skills associated with its proficiency. Robotic surgical systems have been developed to facilitate these technically difficult procedures, thereby enabling surgeons to offer a minimally invasive approach to them. The truth of the matter, however, is that the claimed advantages of the robotic approach – primarily easier suturing and better visualization – evaporate in the hands of capable laparoscopic surgeons using modern traditional equipment.

At the end of the day, as with a lot of other things in life, what matters are the ultimate results, and not the instrument that gets us there. Operating with a robot will no more make a mediocre doctor into a great surgeon than driving a Ferrari will transform a lousy driver into Mario Andretti or Dale Earnhardt.