Robotic Assisted Cancer Surgery: Robotic Surgery vs. Laparoscopic Surgery

As noted previously, robotic assisted surgery was developed to improve laparoscopic surgery. Laparoscopic surgery is a common surgical technique to treat several types of cancers including prostate, colon, kidney and ovarian cancers as well as cancer of the throat and esophagus. Given the ergonomic advantages of a laparoscopic surgery using the da Vinci surgical system, which technique – traditional or robotic – provides the most successful surgeries when treating cancer?

In general, robot-assisted surgery has been associated with reduced blood loss, reduced transfusion exposure, fewer complications, reduced post-operative pain, shorter hospital stays, and reduced recovery times as compared to typical laparoscopic and open surgical techniques . But, given the relatively recent introduction of robotic assisted surgery, there is a lack of substantial medical proof to substantiate these clinical benefits.

For example, according to the Canadian Agency for Drugs and Technologies in Health (CADTH), conclusions regarding the benefits of the da Vinci must be drawn carefully due to the lack of clinical research. CADTH’s literature analysis of current research measuring performance of the da Vinci surgical system for laparoscopic prostatectomy, hysterectomy and nephrectomy (common surgeries to treat prostate, cervical and kidney cancers), which is limited, showed statistically significant benefits. This included less blood loss during the procedure and shorter hospital stays after the procedure when compared to a typical laparoscopic and open prostatectomy, hysterectomy and nephrectomy. But, according to CADTH’s report, research in this area is limited making it difficult to come to any substantial conclusions . With that being said, the research that does exist suggests that some laparoscopic procedures that use the da Vinci may be less invasive and provide several short term benefits.

But what about long term benefits? According to CADTH, there are currently no long term clinical benefits to using the da Vinci. This seems to be one of da Vinci’s largest criticisms because robotic assisted surgery is costly compared to open and laparoscopic surgeries. The da Vinci costs roughly C$2.7 million with annual maintenance costs of about C$186,000. In addition, the average instrument cost per procedure is approximately C$2,600 (many of these instruments are not reusable) . The use of the da Vinci may also require additional operating room time and there is a learning curve associated with effective use the of the da Vinci surgical system – surgeons must perform 150 to 200 procedures to really become adept with the technology . Therefore, when push comes to shove, one has to wonder if it is cost effective to use the da Vinci over traditional surgical procedures. Do the benefits outweigh the costs?

Take prostate cancer as an example. A popular treatment for prostate cancer is a laparoscopic prostatectomy. A da Vinci laparoscopic prostatectomy costs (net cost) roughly six per cent more, or $1,600, not including the robot itself, than alternative procedures . Even though it is more expensive, the da Vinci laparoscopic prostatectomy may offer a less invasive surgical option. This may benefit prostate cancer patients because often times patients choose non-surgical interventions such as “watchful waiting” to avoid the consequences of surgery. But the potential for a surgical procedure that offers a faster recovery time as well as fewer complications during the procedure may encourage patients to opt for a surgical intervention using the da Vinci. The extra cost may be offset by reductions in post-operative hospital costs as patients recover more rapidly from this procedure. But this is all speculation. Time will tell if this is truly the case.

So is laparoscopic surgery using the da Vinci superior to traditional laparoscopic surgery? Preliminary research suggests it may be. But the question remains: is it worth the economic price we pay for the technology?

i Canadian Agency for Drugs and Technologies in Health. (September 28, 2010). Draft report - Robot-assisted surgery versus open surgery and laparoscopic surgery: Clinical and cost- effectiveness analyses. Accessed at  http://www.cadth.ca/index.php/en/publication/2682


ii Ibid


iii Ibid


iv Vancouver Sun. (October 2, 2010). Meet Jack the surgical robot: He’s on the cutting edge of cancer treatment. Accessed at http://bit.ly/9f9gE0


v Ibid


vi “Watchful waiting” is a non-surgical intervention for prostate cancer. It involves a regular examination of the prostate and its PSA level. Immediate treatment (surgery or other) is only recommended if signs of cancer appear or change. Prostate cancer is not known to be an aggressive cancer. Some prostate cancers are very slow growing and can be present for years without affecting one’s health.