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The death of laparoscopy

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Abstract

Background

The introduction of laparoscopy in 1989 revolutionized surgical practices, reducing post-operative complications, and enhancing outcomes. Despite its benefits, limitations in laparoscopic tools have led to continued use of open surgery. Robotic-assisted surgery emerged to address these limitations, but its adoption trends and potential impact on open and laparoscopic surgery require analysis.

Methods

A retrospective analysis used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases from 2012 to 2021. The study encompassed various abdominal procedures, employing Vector Autoregressive (VAR) models to analyze the dynamic relationships between surgical techniques. The models predicted future trends in open, laparoscopic, and robotic surgery until Q2 of 2025.

Results

The analysis included 360,171 patients across diverse procedures. In urology, robotic surgery dominated prostatectomies (83.1% in 2021) and nephrectomies (55.1% in 2021), while the open approach remained the predominant surgical technique for cystectomies (72.5% in 2021). In general surgery, robotic colectomies were forecasted to surpass laparoscopy, becoming the primary approach by 2024 (45.7% in 2025). Proctectomies also showed a shift towards robotic surgery, predicted to surpass laparoscopy and open surgery by 2025 (32.3%). Pancreatectomies witnessed a steady growth in robotic surgery, surpassing laparoscopy in 2021, with forecasts indicating further increase. While hepatectomies remained predominantly open (70.0% in 2025), esophagectomies saw a rise in robotic surgery, predicted to become the primary approach by 2025 (52.3%).

Conclusions

The study suggests a transformative shift towards robotic-assisted surgery, poised to dominate various minimally invasive procedures. The forecasts indicate that robotic surgery may surpass laparoscopy and open surgery in colectomies, proctectomies, pancreatectomies, and esophagectomies by 2025. This anticipated change emphasizes the need for proactive adjustments in surgical training programs to align with evolving surgical practices. The findings have substantial implications for future healthcare practices, necessitating a balance between traditional laparoscopy and the burgeoning role of robotic-assisted surgery.

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Acknowledgements

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the sources of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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This research did not receive external funding.

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Author notes

  1. Davide Ferrari and Tommaso Violante have contributed equally to this work.

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA

    Davide Ferrari, Tommaso Violante & David W. Larson

  2. General Surgery Residency Program, University of Milan, Milan, Italy

    Davide Ferrari

  3. School of General Surgery, Alma Mater Studiorum, University of Bologna, Bologna, Italy

    Tommaso Violante

  4. Department of Statistics, University of Bologna, Bologna, Italy

    Marco Novelli

  5. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Patrick P. Starlinger & Rory L. Smoot

  6. Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Janani S. Reisenauer

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Dr. Davide Ferrari, Dr. Tommaso Violante, Dr. Marco Novelli, Prof. Patrick Starlinger, Prof. Rory Smoot, Prof. Janani Reisenauer and Prof. David Larson have no conflict of interest to disclose.

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Ferrari, D., Violante, T., Novelli, M. et al. The death of laparoscopy. Surg Endosc (2024). https://doi.org/10.1007/s00464-024-10774-2

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