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Robot Surgery No Better than Open Surgery for Bladder Cancer


July 24, 2014 — For patients with bladder cancer, robotic surgery does not improve outcomes compared to traditional “open” surgery, according to research published in the New England Journal of Medicine.

During robotic surgery, a doctor sits at a console and uses joysticks and foot pedals to control instruments on four robotic arms. In traditional “open” surgery, a doctor uses larger incisions and directly handles surgical instruments and organs.

Robots are used in about 15-22% of radical cystectomies (surgery to remove the bladder), according to the Wall Street Journal.

Given the growing popularity of the technology, researchers expected to find clear advantages. Instead, they found similar rates of major complications (about one in five patients, regardless of technique). Robotic surgery did not shorten hospital stays or improve recovery time.

In fact, the only major difference was that robotic surgery took about two hours longer than open surgery. Patients also bled slightly less, but not enough to make any clinical impact. The findings were so clear, the researchers stopped the study early.

Conclusions were based on data from 118 patients who had surgery to remove the bladder (radical cystectomy), including 60 who were treated with a robot.

Do Added Costs Justify the Risks?

Robotic surgery is marketed as a way to improve patient outcomes, but these claims are contradicted in a growing number of studies. Last year, a major OB/GYN organization warned that robot-assisted hysterectomies offered no clinical benefits for patients, but were $2,200 more expensive than open surgery. They were also concerned about women being misled by aggressive direct-to-consumer marketing.

As the cost of healthcare surges in the United States, studies like these are sure to raise questions about whether the added cost of robot surgery is justified. Robotic surgery for bladder cancer was about $1,600 more expensive than open surgery, according to study published in 2010 by the Journal of Urology.

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