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. 2020 Jan 3;3(1):e1918911.
doi: 10.1001/jamanetworkopen.2019.18911.

Trends in the Adoption of Robotic Surgery for Common Surgical Procedures

Kyle H Sheetz  1   2 , Jake Claflin  3 , Justin B Dimick  1   2
Affiliations

Trends in the Adoption of Robotic Surgery for Common Surgical Procedures

Kyle H Sheetz et al. JAMA Netw Open. .

Abstract

Importance: Increasing use of robotic surgery for common surgical procedures with limited evidence and unclear clinical benefit is raising concern. Analyses of population-based trends in practice and how hospitals' acquisition of robotic surgical technologies is associated with their use are limited.

Objective: To characterize trends in the use of robotic surgery for common surgical procedures.

Design, setting, and participants: This cohort study used clinical registry data from Michigan from January 1, 2012, through June 30, 2018. Trends were characterized in the use of robotic surgery for common procedures for which traditional laparoscopic minimally invasive surgery was already considered a safe and effective approach for most surgeons when clinically feasible. A multigroup interrupted time series analysis was performed to determine how procedural approaches (open, laparoscopic, and robotic) change after hospitals launch a robotic surgery program. Data were analyzed from March 1 through April 19, 2019.

Exposures: Initiation of robotic surgery.

Main outcomes and measures: Procedure approach (ie, robotic, open, or laparoscopic).

Results: The study cohort included 169 404 patients (mean [SD] age, 55.4 [16.9] years; 90 595 women [53.5%]) at 73 hospitals. The use of robotic surgery increased from 1.8% in 2012 to 15.1% in 2018 (8.4-fold increase; slope, 2.1% per year; 95% CI, 1.9%-2.3%). For certain procedures, the magnitude of the increase was greater; for example, for inguinal hernia repair, the use of robotic surgery increased from 0.7% to 28.8% (41.1-fold change; slope, 5.4% per year; 95% CI, 5.1%-5.7%). The use of robotic surgery increased 8.8% in the first 4 years after hospitals began performing robotic surgery (2.8% per year; 95% CI, 2.7%-2.9%). This trend was associated with a decrease in laparoscopic surgery from 53.2% to 51.3% (difference, -1.9%; 95% CI, -2.2% to -1.6%). Before adopting robotic surgery, hospitals' use of laparoscopic surgery increased 1.3% per year. After adopting robotic surgery, the use of laparoscopic surgery declined 0.3% (difference in trends, -1.6%; 95% CI, -1.7% to -1.5%).

Conclusions and relevance: These results suggest that robotic surgery has continued to diffuse across a broad range of common surgical procedures. Hospitals that launched robotic surgery programs had a broad and immediate increase in the use of robotic surgery, which was associated with a decrease in traditional laparoscopic minimally invasive surgery.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Dimick reported receiving personal fees from ArborMetrix, Inc, outside the submitted work and being an equity owner of ArborMetrix, Inc. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Temporal Trends in the Proportional Use of Robotic, Laparoscopic, and Open Surgery
Data are from the Michigan Surgical Quality Collaborative from January 1, 2012, through June 30, 2018. These data reflect practices at all hospitals included in the study.
Figure 2.
Figure 2.. Changes in Procedure Approach After Hospitals Began Performing Robotic Surgery
Proportional use of robotic, laparoscopic, and open approaches for general surgical procedures are shown in the 4 years before and after hospitals began performing robotic general surgery. From 2012 to 2018, 23 of 73 hospitals (31.5%) in the Michigan Surgical Quality Collaborative started performing robotic general surgery. These data are restricted to those hospitals.
See this image and copyright information in PMC

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