Skip to main content

Advertisement

SpringerLink
Log in

Robotic surgery trends in general surgical oncology from the National Inpatient Sample

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Robotic surgery is offered at most major medical institutions. The extent of its use within general surgical oncology, however, is poorly understood. We hypothesized that robotic surgery adoption in surgical oncology is increasing annually, that is occurring in all surgical sites, and all regions of the US.

Study design

We identified patients with site-specific malignancies treated with surgical resection from the National Inpatient Sample 2010–2014 databases. Operations were considered robotic if any ICD-9-CM robotic procedure code was used.

Results

We identified 147,259 patients representing the following sites: esophageal (3%), stomach (5%), small bowel (5%), pancreas (7%), liver (5%), and colorectal (75%). Most operations were open (71%), followed by laparoscopic (26%), and robotic (3%). In 2010, only 1.1% of operations were robotic; over the 5-year study period, there was a 5.0-fold increase in robotic surgery, compared to 1.1-fold increase in laparoscopy and 1.2-fold decrease in open surgery (< 0.001). These trends were observed for all surgical sites and in all regions of the US, they were strongest for esophageal and colorectal operations, and in the Northeast. Adjusting for age and comorbidities, odds of having a robotic operation increased annually (5.6 times more likely by 2014), with similar length of stay (6.9 ± 6.5 vs 7.0 ± 6.5, p = 0.52) and rate of complications (OR 0.91, 95% CI 0.83–1.01, p = 0.08) compared to laparoscopy.

Conclusions

Robotic surgery as a platform for minimally invasive surgery is increasing over time for oncologic operations. The growing use of robotic surgery will affect surgical oncology practice in the future, warranting further study of its impact on cost, outcomes, and surgical training.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Yates DR, Vaessen C, Roupret M (2011) From Leonardo to da Vinci: the history of robot-assisted surgery in urology. BJU Int 108:1708–1714

    Article  PubMed  Google Scholar 

  2. Melstrom LG, Warner SG, Woo Y, Sun V, Lee B, Singh G, Fong Y (2018) Selecting incision-dominant cases for robotic liver resection: towards outpatient hepatectomy with rapid recovery. Hepatobiliary Surg Nutr 7:77–84

    Article  PubMed  PubMed Central  Google Scholar 

  3. Reuters Health News. Robotic-assisted surgery: more expensive, but not always more effective. 2018. https://www.reuters.com/article/us-health-surgery-robots/robotic-assisted-surgery-more-expensive-but-not-always-more-effective-idUSKBN1CT2U1 Accessed 7 Aug 2018

  4. HCUP Nationwide Inpatient Sample (NIS).Healthcare Cost and Utilization Project (HCUP) (2010–2011) Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/nisoverview.jsp Accessed 7 Aug 2018

  5. HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). (2012–2014). Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/nisoverview.jsp Accessed 7 Aug 2018

  6. Deyo RA, Cherkin DC, Coil MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619

    Article  CAS  PubMed  Google Scholar 

  7. Collins TC, Daley J, Henderson WH, Khuri SF (1999) Risk factors for prolonged length of stay after major elective surgery. Ann Surg 230:251–259

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Lawson EH, Louie R, Zingmond DS, Brook RH, Hall BL, Han L, Rapp M, Ko CY (2012) A comparison of clinical registry versus administrative claims data for reporting of 30-day surgical complications. Ann Surg 256:973–981

    Article  PubMed  Google Scholar 

  9. Wright JD (2017) Robotic-assisted surgery: balancing evidence and implementation. JAMA 318:1545–1547

    Article  PubMed  Google Scholar 

  10. Herron DM, Marohn M, The SAGES-MIRA Robotic Surgery Consensus Group (2007). A Consensus document on robotic surgery. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and Minimally Invasive Robotic Association (MIRA) Robotic Task Force. https://www.sages.org/publications/guidelines/consensus-document-robotic-surgery/ Accessed 7 Aug 2018

  11. Liang JT, Huang KC, Lai HS, Lee PH, Jeng YM (2007) Oncologic results of laparoscopic versus conventional open surgery for stage II or III left-sided colon cancers: a randomized controlled trial. Ann Surg Oncol 14:109–117

    Article  PubMed  Google Scholar 

  12. Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange-de Klerk ES, Lacy AM, Bemelman WA, Andersson J, Angenete E, Rosenberg J, Fuerst A, Haglind E, COLOR II Study Group (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372:1324–1332

    Article  CAS  PubMed  Google Scholar 

  13. Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR Jr, Maun D, Chang G, Herline A, Fichera A, Mutch M, Wexner S, Whiteford M, Marks J, Birnbaum E, Margolin D, Larson D, Marcello P, Posner M, Read T, Monson J, Wren SM, Pisters PW, Nelson H (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: The ACOSOG Z6051 randomized clinical trial. JAMA 314:1346–1355

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ, COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218

    Article  PubMed  Google Scholar 

  15. Straatman J, van der Wielen N, Cuesta MA, Daams F, Roig Garcia J, Bonavina L, Rosman C, van Berge Henegouwen MI, Gisbertz SS, van der Peet DL (2017) Minimally invasive versus open esophageal resection: three-year follow-up of the previously reported randomized controlled trial: the TIME Trial. Ann Surg 266:232–236

    Article  PubMed  Google Scholar 

  16. Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34:1350–1357

    Article  PubMed  Google Scholar 

  17. Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laproscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:S306–S311

    Article  PubMed  Google Scholar 

  18. Ejaz A, Sachs T, He J, Spolverato G, Hirose K, Ahuja N, Wolfgang CL, Makary MA, Weiss M, Pawlik TM (2014) A comparison of open and minimally invasive surgery for hepatic and pancreatic resections using the Nationwide Inpatient Sample. Surgery 156:538–547

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 318:1569–1580

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kim MJ, Park SC, Park JW, Chang HJ, Kim KY, Nam BH, Sohn DK, Oh JH (2018) Robot-assisted versus laparoscopic surgery for rectal cancer: A phase II open label prospective randomized controlled trial. Ann Surg 267:243–251

    Article  PubMed  Google Scholar 

  21. Kim HI, Han SU, Yang HK, Kim YW, Lee HJ, Ryu KW, Park JM, An JY, Kim MC, Park S, Song KY, Oh SJ, Kong SH, Suh BJ, Yang DH, Ha TK, Kim YN, Hyung WJ (2016) Multicenter prospective comparative study of robotic versus laparoscopic gastrectomy for gastric adenocarcinoma. Ann Surg 263:103–109

    Article  PubMed  Google Scholar 

  22. Fong Y, Woo Y, Giulianotti PC (2017) Robotic surgery: the promise and finally the progress. Hepatobiliary Surg Nutr 6:219–221

    Article  PubMed  PubMed Central  Google Scholar 

  23. Joyce D, Morris-Stiff G, Falk G, El-Hayek K, Chalikonda S, Walsh RM (2014) Robotic surgery of the pancreas. World J Gastroenterol 20:14726–14732

    Article  PubMed  PubMed Central  Google Scholar 

  24. Barbash GI, Glied SA (2010) New technology and health care costs–the case of robot-assisted surgery. N Engl J Med 363:701–704

    Article  CAS  Google Scholar 

  25. Turchetti G, Palla I, Pierotti F, Cuschieri A (2012) Economic evaluation of da Vinci-assisted robotic surgery: a systematic review. Surg Endosc 26:598–606

    Article  PubMed  Google Scholar 

  26. Higgins RM, Frelich MJ, Bosler ME, Gould JC (2017) Cost analysis of robotic versus laparoscopic general surgery procedures. Surg Endosc 31:185–192

    Article  PubMed  Google Scholar 

  27. Tarr ME, Brancato SJ, Cunkelman JA, Polcari A, Nutter B, Kenton K (2015) Comparison of postural ergonomics between laparoscopic and robotic sacrocolpopexy: a pilot study. J Minim Invasive Gynecol 22:234–238

    Article  PubMed  Google Scholar 

  28. Szeto GP, Poon JT, Law WL (2013) A comparison of surgeon’s postural muscle activity during robotic-assisted and laparoscopic rectal surgery. J Robot Surg 7:305–308

    Article  PubMed  Google Scholar 

  29. Mucksavage P, Kerbl DC, Lee JY (2011) The da Vinci(®) Surgical System overcomes innate hand dominance. J Endourol 25:1385–1388

    Article  PubMed  Google Scholar 

  30. Moore LJ, Wilson MR, Waine E, Masters RS, McGrath JS, Vine SJ (2015) Robotic technology results in faster and more robust surgical skill acquisition than traditional laparoscopy. J Robot Surg 9:67–73

    Article  Google Scholar 

  31. Lusch A, Bucur PL, Menhadji AD, Okhunov Z, Liss MA, Perez-Lanzac A, McDougall EM, Landman J (2014) Evaluation of the impact of three-dimensional vision on laparoscopic performance. J Endourol 28:261–266

    Article  PubMed  Google Scholar 

  32. Wilhelm D, Reiser S, Kohn N, Witte M, Leiner U, Mühlbach L, Ruschin D, Reiner W, Feussner H (2014) Comparative evaluation of HD 2D/3D laparoscopic monitors and benchmarking to a theoretically ideal 3D pseudodisplay: even well-experienced laparoscopists perform better with 3D. Surg Endosc 28:2387–2397

    Article  CAS  PubMed  Google Scholar 

  33. Son GM, Kim JG, Lee JC, Suh YJ, Cho HM, Lee YS, Lee IK, Chun CS (2010) Multidimensional analysis of the learning curve for laparoscopic rectal cancer surgery. J Laparoendosc Adv Surg Tech A 20:609–617

    Article  PubMed  Google Scholar 

  34. Jiménez-Rodríguez RM, Díaz-Pavón JM, de la Portilla de Juan F, Prendes-Sillero E, Dussort HC, Padillo J (2013) Learning curve for robotic-assisted laparoscopic rectal cancer surgery. Int J Colorectal Dis 28:815–821

    Article  PubMed  Google Scholar 

  35. de’Angelis N, Lizzi V, Azoulay D, Brunetti F (2016) Robotic versus laparoscopic right colectomy for colon cancer: analysis of the initial simultaneous learning curve of a surgical fellow. J Laparoendosc Adv Surg Tech A 26:882–892

    Article  PubMed  Google Scholar 

  36. Lamb MN, Bardakcioglu O (2017) The learning curve of robotic assisted laparoscopic colorectal surgery and how to start applying robotic technology in colorectal surgery. In: Obias V (ed) Robotic colon and rectal surgery. Springer International Publishing, Switzerland, pp 11–15

    Chapter  Google Scholar 

  37. Efanov M, Alikhanov R, Tsvirkun V, Kazakov I, Melekhina O, Kim P, Vankovich A, Grendal K, Berelavichus S, Khatkov I (2017) Comparative analysis of learning curve in complex robot-assisted and laparoscopic liver resection. HPB 19:818–824

    Article  PubMed  Google Scholar 

  38. Shakir M, Boone BA, Polanco PM, Zenati MS, Hogg ME, Tsung A, Choudry HA, Moser AJ, Bartlett DL, Zeh HJ, Zureikat AH (2015) The learning curve for robotic distal pancreatectomy: an analysis of outcomes of the first 100 consecutive cases at a high-volume pancreatic centre. HPB 17:580–586

    Article  PubMed  PubMed Central  Google Scholar 

  39. Napoli N, Kauffmann EF, Perrone VG, Miccoli M, Brozzetti S, Boggi U (2015) The learning curve in robotic distal pancreatectomy. Updates Surg 67:257–264

    Article  PubMed  Google Scholar 

  40. Wright JD, Tergas AI, Hou JY, Burke WM, Chen L, Hu JC, Neugut AI, Ananth CV, Hershman DL (2016) Effect of regional hospital competition and hospital financial status on the use of robotic-assisted surgery. JAMA Surg 151:612–620

    Article  PubMed  Google Scholar 

Download references

Funding

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award number NIH 5K12CA001727-20. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010-3000, USA

    Camille L. Stewart, Philip H. G. Ituarte, Kurt A. Melstrom, Susanne G. Warner, Laleh G. Melstrom, Lily L. Lai, Yuman Fong & Yanghee Woo

Authors
  1. Camille L. Stewart
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philip H. G. Ituarte
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kurt A. Melstrom
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susanne G. Warner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laleh G. Melstrom
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lily L. Lai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuman Fong
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yanghee Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Camille L. Stewart.

Ethics declarations

Disclosures

Dr. Camille L. Stewart has received consulting fees from Verb Surgical. Dr. Kurt A. Melstrom has received consulting fees from Ethicon. Dr. Yuman Fong has received consulting fees from Ethicon. Dr. Yanghee Woo has received consulting fees from Verb Surgical, Ethicon, and Intuitive Surgical. Drs. Philip HG Ituarte, Susanne G. Warner, Laleh G. Melstrom, and Lily L. Lai have no conflicts of interest or financial ties to disclose.

Appendix

Appendix

See Table 4.

Table 4 International Classification of Diseases (ICD)-9-Clinical Modification codes for diagnoses and procedures that were matched based on principal diagnosis for each site-specific malignant neoplasm
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stewart, C.L., Ituarte, P.H.G., Melstrom, K.A. et al. Robotic surgery trends in general surgical oncology from the National Inpatient Sample. Surg Endosc 33, 2591–2601 (2019). https://doi.org/10.1007/s00464-018-6554-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6554-9

Keywords

Search

Navigation