Authors' recommendations: Despite the shortcomings of the available published evidence, robotic-assisted surgery is emerging as an alternative to conventional open or laparoscopic approaches for a range of urological, cardiac and gynaecological procedures. After reviewing the relevant comparative evidence published in the last five years, it seems that robotic-assisted surgery is at least as efficacious as conventional open or laparoscopic surgery, and appears to offer the advantages of decreased blood loss and transfusions with resultant decreases in length of hospital stay without increasingthe rate of severe complications. To date, operative times for robotic-assisted approaches have generally been equal to or longer than conventional approaches, although it is likely they have been influenced by the experience of the surgical team and are amenable to improvement with increased experience. These findings from the published literature seem to echo the experiences of the Australian surgeons using this technology who were interviewed for this report. Currently, it is difficult to compare robotic-assisted and conventional approaches with regard to cancer control due to a lack of sufficient follow-up, although positive surgical margin rates appear to be similar. Patient-related outcomes, such as urinary continence, erectile function, quality of life measures and pain appear to be similar but were also difficult to assess as they were generally poorly reported. Many of the limitations of the published evidence used in this review would beovercome by the availability of concurrently-controlled trial evidence. Ideally, studies should randomly allocate patients to treatments and follow them up over a sufficient length of time to ensure that useful survival data can be obtained. A sufficient number of patients should be recruited so that planned subgroup analyses of factors thought to influence outcomes, such as prostate size in the case of radical prostatectomy, can be undertaken without compromising statistical validity. Wellvalidated functional outcome measures that measure outcomes of importance to patients should be used. It is likely that many of these issues are addressed in current ongoing trials of robotic-assisted surgery, the results of which should assist in more clearly defining its safety and efficacy compared to conventional approaches.Searches of the Clinical Trials Database, NHS CRD, NHS HTA, Current Controlled Trials and the Australian New Zealand Clinical Trials Registry identified 15 ongoing trials. While the majority of these trials are being conducted in the United States, trials are now also underway in Canada, the United Kingdom, Sweden, Germany and Switzerland. In addition, one trial is being conducted in Australia at the Queensland Centre for Gynaecological Cancer, in collaboration with a US centre. While the undertaking of multicentre RCTs of robotic-assisted surgery is desirable, the problems inherent in attempting to randomise patients who are actively seeking treatment with this technology, which at present is primarily available in private hospitals in Australia, may mean that it is difficult.

Project Status: Completed

URL for project: http://www.surgeons.org/media/17419/RPT_2009-12-09_Robotic-assisted_Surgery.pdf

Year Published: 2009

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical

Contact Address: ASERNIP-S 24 King William Street, Kent Town SA 5067 Australia Tel: +61 8 8219 0900

Contact Name: racs.asernip@surgeons.org

Contact Email: racs.asernip@surgeons.org

Copyright: Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S)