More and more surgical procedures are performed by, or with the assistance of, robots. The types of operations, and conditions, in which surgical robots are used are also growing. The benefits, such as greater precision in performing surgery, less invasive operations and faster recovery, are widely publicised. However, using an operating robot can also have drawbacks. At least that is what some surgeons at the University of Michigan Health have investigated. And specifically looking at the advantages and disadvantages of robotic (assisted) surgery for repairing an abdominal wall, or ventral, hernia.
When a patient needs surgical intervention for an abdominal wall hernia, it is usually done using a laparoscopic or open surgical technique. Increasingly, however, robotic surgery is also used in these operations. In both robotic and laparoscopic surgery, small incisions are made in the skin. The advantage of the robot is that it enables 3-dimensional vision and hinged wrist technology, allowing the surgeon to have a better view and work more precisely.
Pros and cons
The advantages of robot-assisted surgery are often widely reported: less invasive, faster recovery, more precise surgery and in places where the ‘human surgeon’ cannot reach. In fact, serious thought is already being given to whether surgical robots that can work fully autonomously could eventually help solve the staff shortage in ORs.
As there was hardly any talk about possible drawbacks of deploying an operating robot, some surgeons from the University of Michigan Health decided to research this. In particular, they looked at how often and in which patients the hernia returned after surgery.
Hardly any difference
For their study, sample data from patients who had undergone ventral hernia surgery were analysed. Although the study showed that hernia recurrences were higher in patients who had been helped by an operating robot, within 10 years after the first surgery, the difference compared with patients who had been helped by laparoscopic surgery was not shocking: +/+ 1.1 per cent. Compared with patients who had been helped by open surgery, the difference was +/+ 0.7 per cent.
However, the researchers did conclude that the small difference - to the disadvantage of the operating robot - shows that using an operating robot for ventral hernia surgery has no substantial clinical advantages. Moreover, research has also shown that robotic repairs take longer and that robotic technology costs much more than traditional laparoscopy.
Learning curve
However, what the researchers also want to highlight is the learning curve that surgical robots are currently still going through. This is true for any new technology and application. ‘The learning curve for robotics shows similarities with the curve that laparoscopy went through when that technique first made its appearance. We saw higher complication and hernia recurrence rates earlier then too. Ultimately, the new technique did lead to a paradigm shift in hernia care,’ said Brian Fry, M.D., M.S., a physician assistant in general surgery at the University of Michigan Health.
‘The robot may offer advantages for more advanced surgical techniques used to operate on very large or complex hernias, as these operations are rarely performed laparoscopically.’ According to Fry, robot-assisted hernia surgery is here to stay and it is up to surgeons to figure out how best to use the technology to maximise its potential benefits.
