CEM16: Robot-assisted laparoscopy to outpace robotic technology

Contrary to current views that robotic technology such as daVinci marks the end-phase of cutting-edge surgical technologies, the future may yet favor robot-assisted laparoscopy, which is far more feasible and beneficial than current robot techniques, according to a prominent robotic and laparascopic expert surgeon who spoke at the 16th Central European Meeting (CEM16) held today in Vienna, Austria.

“The future is robot-assisted laparoscopy…and I think and hope that it will not be technologies such as daVinci,” said Prof. Gunter Janetschek in an overview lecture which compared standard laparoscopy, robotic technology with that of open surgical procedures.

Presenting results from studies and research articles in recent years and recalling his own experience, Janetschek made the provocative statement even as he carefully outlined the conclusions by other researchers that in head-to-head comparisons, robotic technology and standard laparoscopic both offer comparable results.

“Oncologic and functional results are comparable between standard laparoscopy and daVinci. Between daVinci radical prostatectomy (RP) and open RP the continence rates are comparable, while oncologic results are as good in both,” said Janetschek. " He added: "The difference between surgeons is greater than the difference in the methods.

He also expects the costs of daVinci to decline in the future as the technology faces competition and its accessibility expands. With competition and wider access, daVinci faces a natural devolution in adaption, similar to what occurred in ESWL for stone treatment.

Using the data from a study by N. Fossati which recently appeared in European Urology, Janetschek noted that surgical experience is crucial in robotic technology.

“Robotic technology compensates for lack of experience, but morbidity is not evaluated,” he said. Saying that it is misleading to think that robotics is the end-phase of an evolution, Janetschek said that in his view the evolution has just begun.

“We are at the beginning of this evolution not at the end,” said Janetschek as he cited recent developments in the field such those happening in Ireland and South Korea, with the former reporting about the MIRO Surge-robot, and the latter showing the potential in a porcine model of the REVO-I robotic surgical system (robot-assisted fallopian tube transection and anastomosis).

“We must also look for better alternatives to daVinci with systems that provide features such as motorized three-arm device, autostereoscopic monitor and active force feedback,” he added.

He said he will bet on the side of robot-assisted laparoscopy as this technology offers or has the potential to offer the benefits of other techniques while reducing problems in learning curves, morbidities and oncological margins, amongst other issues.