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The evolving use of robotic surgery: a population-based analysis

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Abstract

Introduction

Robotic surgery has integrated into the healthcare system despite limited evidence demonstrating its clinical benefit. Our objectives were (i) to describe secular trends and (ii) patient- and system-level determinants of the receipt of robotic as compared to open or laparoscopic surgery.

Methods

This population-based retrospective cohort study included adult patients who, between 2009 and 2018 in Ontario, Canada, underwent one of four commonly performed robotic procedures: radical prostatectomy, total hysterectomy, thoracic lobectomy, partial nephrectomy. Patients were categorized based on the surgical approach as robotic, open, or laparoscopic for each procedure. Multivariable regression models were used to estimate the temporal trend in robotic surgery use and associations of patient and system characteristics with the surgical approach.

Results

The cohort included 24,741 radical prostatectomy, 75,473 total hysterectomy, 18,252 thoracic lobectomy, and 4608 partial nephrectomy patients, of which 6.21% were robotic. After adjusting for patient and system characteristics, the rate of robotic surgery increased by 24% annually (RR 1.24, 95%CI 1.13–1.35): 13% (RR 1.13, 95%CI 1.11–1.16) for robotic radical prostatectomy, 9% (RR 1.09, 95%CI 1.05–1.13) for robotic total hysterectomy, 26% (RR 1.26, 95%CI 1.06–1.50) for thoracic lobectomy and 26% (RR 1.26, 95%CI 1.13–1.40) for partial nephrectomy. Lower comorbidity burden, earlier disease stage (among cancer cases), and early career surgeons with high case volume at a teaching hospital were consistently associated with the receipt of robotic surgery.

Conclusion

The use of robotic surgery has increased. The study of the real-world clinical outcomes and associated costs is needed before further expanding use among additional providers and hospitals.

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Funding

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The parts of this material are based on the data and information compiled and provided by: MOHLTC, CCO and CIHI. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. This study was supported by the Surgical Innovation Program at the Ontario Ministry of Health and Long-Term Care. H.M is support by CIHR Vanier award and the Physician Services Incorporated award.

Author information

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada

    Hala Muaddi, Avery Nathens, Timothy D. Jackson & Paul J. Karanicolas

  2. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada

    Hala Muaddi, Therese A. Stukel, Charles de Mestral, Avery Nathens & Paul J. Karanicolas

  3. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada

    Avery Nathens & Paul J. Karanicolas

  4. Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Paul J. Karanicolas

  5. Division of Vascular Surgery, St. Michaels Hospital, University of Toronto, Toronto, Canada

    Charles de Mestral

  6. ICES, Toronto, Canada

    Therese A. Stukel, Charles de Mestral & Avery Nathens

  7. Division of Urology, Division of Surgical Oncology, Department of Surgery, Western University, London, Canada

    Stephen E. Pautler

  8. Juravinski Cancer Centre, McMaster University, Hamilton, Canada

    Bobby Shayegan

  9. Division of Thoracic Surgery, McMaster University, Hamilton, Canada

    Waël C. Hanna

  10. Division of General Surgery, Department of Surgery, Western University, London, Canada

    Christopher M. Schlachta

  11. Division of Urology, Department of Surgery, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada

    Rodney H. Breau

  12. Division of Oncology, Saskatchewan Cancer Agency, Saskatoon, Canada

    Laura Hopkins

Authors
  1. Hala Muaddi
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Corresponding author

Correspondence to Paul J. Karanicolas.

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Disclosures

Stephen E. Pautler is a mentor for Minogue Medical Inc and received no remuneration for this work. Waël C. Hanna is a speaker and consultant for Minogue medical and AstraZeneca, is a DMSB for Roche Genetech and has securities and stock with intuitive Surgical.

Authors Hala Muaddi, Therese A Stukel, Charles de Mestral, Avery Nathens, Bobby Shayegan, Christopher M Schlachta, Rodney H. Breau, Laura Hopkins, Timothy D. Jackson, Paul J Karanicolas have no conflicts of interest to declare.

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Muaddi, H., Stukel, T.A., de Mestral, C. et al. The evolving use of robotic surgery: a population-based analysis. Surg Endosc 37, 1870–1877 (2023). https://doi.org/10.1007/s00464-022-09643-7

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  • DOI: https://doi.org/10.1007/s00464-022-09643-7

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