Is robotic surgery safer than traditional surgery

In some German clinics it is already part of everyday life: the patient lies on the operating table. Four robotic arms in sterile packaging hover above him. A few meters away from the table, the surgeon sits in a kind of cockpit, concentrating his head sunk into an opening in the apparatus, where he sees images of the patient's body at a magnification of up to ten times. The surgeon operates the robot's arms with control handles and uses them to perform primarily prostate, bladder and kidney operations. The logo always says "da Vinci" on the robots. The US company Intuitive Surgical has built a monopoly with this system since it was approved in 2000 and has done huge business.

Now, however, there is a whole series of robots in the starting blocks that will compete with da Vinci with more intelligence. One reason for this is that relevant patents have expired. With the upcoming robot boom, however, caution is advised: Surgeons say that the robots make some operations easier, but not all, and the high costs of a robot could induce the clinics to use the technology for reasons of balance, not only for the benefit of the patients .

Around 877,000 patients worldwide underwent surgery with the help of da Vinci last year. The manufacturer sold 684 of these systems in the same year - for up to two million euros plus a maintenance contract with another up to almost 150,000 euros per year, depending on the equipment. In addition, there are 500 to 3,000 euros in consumption costs per operation.

The use of the robots did not shorten the length of the hospital stay

The benefits of da Vinci are still controversial after 18 years. In the USA, clinics advertise it aggressively: there are fewer complications, less pain, less blood loss, and shorter hospital stays. But so far there are no independent studies that provide sufficient evidence for this. Benjamin Chung, urology professor at Stanford University, was unable to find convincing arguments for or against an operation with da Vinci in one of the few long-term studies.

Chung explained in a press conference that there were no significant statistical differences in either the outcome of the operation or the length of the hospital stay. The study covered a period of 13 years. What is certain is that the robot-assisted surgery costs more - around 2,000 euros more per patient. The probability of a longer operation time with a robot is also higher.

Researchers at the University of Illinois came to another conclusion with da Vinci: in 14 years there were 144 deaths, 1,391 injuries and 8061 device errors. Parts of the instruments that had become hot fell into the patients, the instruments carried out unwanted actions, there were system crashes and problems with the display of images. However, these reports concern older versions of the device. In addition, the study does not reveal how many complications there were in the same period without a robot.

Today surgeons say that the system actually makes it easier for them to operate, including Professor Sören Torge Mees, Executive Senior Physician at the Clinic and Polyclinic for Visceral, Thoracic and Vascular Surgery at the Technical University of Dresden. "We mainly use the robot in oncological operations when we have to work particularly subtly, for example deep down in the pelvis during a rectum resection - the removal of the rectum." Due to the spatial confinement and bleeding, the view can be significantly restricted. Da Vinci helps with his pictorial enlargement, but also with his four arms: one arm guides the camera, three arms work and an assisting surgeon at the operating table can also intervene.

In esophageal surgery, the seven so-called degrees of freedom of robotic instruments are useful for suture connections: the robots have more joints than a human hand and, according to Mees, are therefore clearly superior to classic minimally invasive instruments. The system is ergonomically advantageous for surgeons, as they can sit in a chair and do not have to dislocate over the patient, as is necessary in some minimally invasive operations.