A three-pronged approach to evaluating robotic surgery

Jeremie Abitbol, Susie Lau, Shannon Salvador, Jeffrey How, Liron Kogan, Roy Kessous, Sonya Brin, Nancy Drummond, Agnihotram V. Ramanakumar, Raphael Gotlieb, Angela Tatar, Arieh Gomolin, Walter H. Gotlieb


Robotic surgery has been rapidly adopted in many specialties, yet barriers remain. The current manuscript outlines a gynecologic oncology division’s experience with robotic surgery and breaks down results from its robotic surgery program into three parts: (I) clinical outcomes, (II) patient-reported outcomes, and (III) hospital outcomes. Published articles, manuscripts in submission, and internal data from various studies within our division were collated. Clinical outcomes were collected from patients’ electronic health records, patient-reported outcome measures [e.g., satisfaction, quality of life (QOL), pain] were summarized from questionnaires, and hospital outcomes (e.g., resource utilization, workflow, costs) were gathered from internal hospital systems. The current review focuses on all surgeries performed for gynecologic cancers (uterine, cervical, and epithelial ovarian cancer) in the Division of Gynecologic Oncology at the Jewish General Hospital, McGill University, Montreal, Canada. In comparison to open surgery, robotic surgery was associated with fewer complications, less blood loss, and less postoperative analgesic use, without compromising recurrence rates or survival. Overall, patients reported being satisfied with the procedure and reported a relatively rapid return to daily activities and to baseline QOL. From the surgeon’s perspective, the robotic system’s user interface enabled performing minimally invasive surgeries in complex surgical cases that were performed by laparotomy prior to the introduction of robotics. From an institutional perspective, the robotic surgery cases were associated with cost savings and entailed operational efficiencies. A division of gynecologic oncology could reap a variety of benefits with the implementation of a robotic surgery program if used carefully and within a setting conducive to such technological change. The overarching implications of a computer-assisted robotic interface in the operating room extend beyond the conventional outcomes measured in healthcare.