Lunardi N, Abou-Zamzam A, Florecki K, et al. Robotic Technology in Emergency General Surgery Cases in the Era of Minimally Invasive Surgery. JAMA Surg. 159, 493-499 (2024).
Grimsley EA, Janjua HM, Herron T, et al. Patient Outcomes and Cost in Robotic Emergency General Surgery. J Robot Surg. 17, 2937-2944 (2023).
Sheetz KH, Telem DA, Feldman LS. Robotics for Emergency General Surgery—Selecting the Right Tool. JAMA Surg. 159, 500 (2024).
To help surgeons understand the trends in use and outcomes of robotic technology for management of patients with urgent or emergent surgical conditions, this commentary reviews the findings published in two articles and one editorial.
The first article by Lunardi and coauthors presented data comparing temporal trends and clinical outcomes in patients who were managed with robotic techniques or laparoscopic approaches. Lunardi and coauthors used data from a national database (n = 1,067,263) that contained inpatient and emergency department data. Included patients underwent urgent or emergent cholecystectomy, inguinal hernia repair, or ventral hernia repair. The data showed that use of robotic techniques increased steadily over the 8-year interval studied. The largest increase was in patients with inguinal hernia repair. Robotic surgery was associated with a significantly lower rate of conversion to an open procedure, as well as with a significantly shorter length of hospital stay.
In the second article, Grimsley and coauthors used data from a state clinical database (n = 60,733 emergency cases); included procedures were appendectomy, cholecystectomy, and inguinal hernia repair. Of note was the fact that robotic surgery patients had fewer ICU admissions and higher rates of discharge to home after cholecystectomy. Outcomes for appendectomy and inguinal hernia repair were equivalent for robotic and laparoscopic approaches. Hospital cost for robotic procedures was significantly higher compared to laparoscopic procedures. Increased costs were due to the need for trained staff to support urgent and emergent robotic procedures 24 hours/day.
The editorial by Sheetz and coauthors noted that surgeons who are skilled and comfortable with laparoscopic technique will not need to consider moving to robotics to achieve improved outcomes.
These data confirm that robotic approaches are increasing and are associated with acceptable outcomes but with a higher overall cost compared to laparoscopic procedures.
