New research found no evidence of a difference in 90 day postoperative hospital days between robotic and laparoscopic ventral hernia repair. Here the authors of the paper discuss their findings and what this means for the future of surgery
We believe that robotics will become an integral component of surgery in the future, replacing endoscopic and open approaches in many settings. However, the transition should be carefully monitored, risks and benefits rigorously evaluated, and cost-benefit analysis performed to determine a safe role for robotics in each stage of its evolution and in different clinical applications. In order to ensure patient safety, care should be taken around adopting new technologies which are supported by low-quality research, as many innovations show no advantage over current practices when evaluated in properly controlled studies.
The use of robotic surgery is controversial. Many surgeons who advocate for the robot have strong feelings based on their anecdotal experience and perceived relative advantages, while others may have been influenced by industry marketing. Critics, on the other side, argue that users overstate the advantages of this technology and are unwilling to accept the limitations. Much of the published research supporting the use of the robot is derived from observational studies performed by authors receiving funding from the robotic industry. Financial relationships between industry and authors are associated with an enormously increased likelihood of publishing reports favorable to industry. [1,2] When evaluating the true benefit of any new technology on patient outcomes, such bias must be considered
While some innovations and technology have improved medical care and how it is practised, others have been proven ineffective or even harmful. In addition to our recent study, most randomized trials have demonstrated that current robotic platforms provide no measurable benefit in clinical or patient centered outcomes, but do increase cost and operative duration. [3] It is only through high-quality research that the value of new emerging technologies and treatment strategies can be rigorously assessed. Although most individuals in healthcare share the same belief, to our surprise, some do not. [4] It seems obvious that a new surgical device considered an “innovation” requires thorough evaluation through studies of the highest quality. [5]
How can robotic platforms evolve to become better, faster, and less expensive tools? By increasing competition. Competitive markets are a central aspect of technology improvement and innovation. [6,7]
Although the existing robotic platforms have an important role in other surgical interventions such as prostatectomies, we believe they are not ready for general surgery or hernia repairs. Clinical and economic benefit or at least equivalence must be demonstrated in following years. Until then, we advocate that robotic platforms should be utilized in centres actively performing randomized controlled trials.
Oscar A. Olavarria, general surgery resident, Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston. Competing interests: see research paper.
Naila Dhanani, general surgery resident, Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston. Competing interests: none declared
Mike K. Liang, associate professor of surgery, Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston. Competing interests: none declared
References:
- Criss CN, Maceachern MP, Matusko N, Dimick JB, Maggard-gibbons M, Gadepalli SK. The Impact of Corporate Payments on Robotic Surgery Research: A Systematic Review. Ann Surg. 2019;269(3):389-396.
- Cherla DV, Viso CP, Holihan JL, et al. The Effect of Financial Conflict of Interest, Disclosure Status, and Relevance on Medical Research from the United States. J Gen Intern Med. 2019;34(3):429-434.
- Prabhu AS, Carbonell A, Hope W, et al. Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair: The RIVAL Randomized Clinical Trial. JAMA Surg. 2020;
- Coster D. Enough With the Anti-Robot Rhetoric. General Surgery News. 2020. [Accessed 2020 May 18]; Available from: https://www.generalsurgerynews.com/Opinions-and-Letters/Article/02-20/Enough-With-the-Anti-Robot-Rhetoric/57203.
- Biffl WL, Spain DA, Reitsma AM, et al. Responsible development and application of surgical innovations: a position statement of the Society of University Surgeons. J Am Coll Surg. 2008;206(6):1204-9.
- Edwards G. The patent power struggle in surgical robotics. Med-Tech Innovation News. 2020. [Accessed 2020 May 18]; Available from: https://www.med-technews.com/features/assessing-patents-in-surgical-robotics/
- Frohman AL. Technology as a Competitive Weapon. Harvard Business Review. 1982. [Accessed 2020 May 18]; Available from: https://hbr.org/1982/01/technology-as-a-competitive-weapon