Authors' objectives:

The da Vinci surgical robotic system is a master-slave telerobotic system in which the surgeon remotely controls robotic arms from a video console using handles which transmit the surgeon's movements to the robot.

This report aims to provide information regarding the use of the da Vinci surgical robotic system for all types of surgery, and addresses cost and resource use issues, legal, regulatory and company issues, surgical training and other policy issues.

Authors' results and conclusions: At present there is insufficient evidence to determine the safety or efficacy of robotic surgery compared with conventional open or laparoscopic surgery for any surgical application. Small sample sizes and short durations of follow-up characterise the majority of studies. However, in trend terms: operative times were generally longer using the robotic system, reflecting increased set-up times and learning curve issues; length of hospital stay may be shorter, but is influenced by hospital protocols; and rates of complications appeared to be similar. The case series and case reports established the feasibility of robotic surgery in a wide range of surgical procedures, and detailed procedural and technical complications associated with the use of the robotic system. Most authors were positive about their experiences, however, they also reported problems adjusting to the robotic system and set-up and a range of technical difficulties. A learning curve (or a volume effect) was evident in many of the included studies. As experience with the robotic system increased, operative times, complications and conversions all tended to decrease.

Authors' recommendations: Robotic surgery offers some benefits over conventional laparoscopic or open surgery, however, there is a significant learning curve and substantial costs involved both in the initial purchase and ongoing servicing and maintenance of the system. Frequent hardware and software updates can be expected, as with any computer-based equipment. Given the paucity of studies comparing robotic surgery with conventional surgery high quality randomised trials and thorough economic evaluations are required. Those contemplating the purchase of a da Vinci surgical robotic system should consider whether sufficient procedures can be done to overcome the learning/volume effect and offset the start-up and fixed costs associated with the system.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.surgeons.org/asernip-s/publications_robotics.htm

Year Published: 2004

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