Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA.
General Surgery Residency Program, University of Milan, Milan, Italy.
Surg Endosc. 2024 May;38(5):2677-2688. doi: 10.1007/s00464-024-10774-2. Epub 2024 Mar 22.
The introduction of laparoscopy in 1989 revolutionized surgical practices, reducing post-operative complications, and enhancing outcomes. Despite its benefits, limitations in laparoscopic tools have led to continued use of open surgery. Robotic-assisted surgery emerged to address these limitations, but its adoption trends and potential impact on open and laparoscopic surgery require analysis.
A retrospective analysis used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases from 2012 to 2021. The study encompassed various abdominal procedures, employing Vector Autoregressive (VAR) models to analyze the dynamic relationships between surgical techniques. The models predicted future trends in open, laparoscopic, and robotic surgery until Q2 of 2025.
The analysis included 360,171 patients across diverse procedures. In urology, robotic surgery dominated prostatectomies (83.1% in 2021) and nephrectomies (55.1% in 2021), while the open approach remained the predominant surgical technique for cystectomies (72.5% in 2021). In general surgery, robotic colectomies were forecasted to surpass laparoscopy, becoming the primary approach by 2024 (45.7% in 2025). Proctectomies also showed a shift towards robotic surgery, predicted to surpass laparoscopy and open surgery by 2025 (32.3%). Pancreatectomies witnessed a steady growth in robotic surgery, surpassing laparoscopy in 2021, with forecasts indicating further increase. While hepatectomies remained predominantly open (70.0% in 2025), esophagectomies saw a rise in robotic surgery, predicted to become the primary approach by 2025 (52.3%).
The study suggests a transformative shift towards robotic-assisted surgery, poised to dominate various minimally invasive procedures. The forecasts indicate that robotic surgery may surpass laparoscopy and open surgery in colectomies, proctectomies, pancreatectomies, and esophagectomies by 2025. This anticipated change emphasizes the need for proactive adjustments in surgical training programs to align with evolving surgical practices. The findings have substantial implications for future healthcare practices, necessitating a balance between traditional laparoscopy and the burgeoning role of robotic-assisted surgery.
1989 年腹腔镜的引入彻底改变了外科实践，减少了术后并发症，改善了手术效果。尽管腹腔镜技术具有诸多优势，但腹腔镜工具的局限性仍然导致开放手术的持续应用。机器人辅助手术的出现正是为了解决这些局限性，但它的采用趋势及其对开放手术和腹腔镜手术的潜在影响需要进行分析。
本研究采用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，对 2012 年至 2021 年期间的各种腹部手术进行回顾性分析，运用向量自回归（VAR）模型分析手术技术之间的动态关系。这些模型预测了开放手术、腹腔镜手术和机器人手术在 2025 年第二季度之前的未来趋势。
本研究共纳入了 360171 例不同手术患者。在泌尿科，机器人手术在前列腺切除术（2021 年占 83.1%）和肾切除术（2021 年占 55.1%）中占主导地位，而开放手术仍然是膀胱癌切除术（2021 年占 72.5%）的主要手术方式。在普通外科中，预计机器人结直肠切除术将在 2024 年超过腹腔镜手术，成为主要手术方式（2025 年占 45.7%）。直肠切除术也显示出向机器人手术的转变，预计到 2025 年将超过腹腔镜手术和开放手术（2025 年占 32.3%）。胰腺切除术的机器人手术稳步增长，2021 年已超过腹腔镜手术，预计未来还会进一步增加。虽然肝切除术主要采用开放手术（2025 年占 70.0%），但机器人手术在食管切除术中的应用有所增加，预计到 2025 年将成为主要手术方式（2025 年占 52.3%）。
本研究表明，机器人辅助手术将带来一场变革，有望主导各种微创外科手术。研究预测，到 2025 年，机器人手术在结直肠切除术、直肠切除术、胰腺切除术和食管切除术方面可能会超过腹腔镜手术和开放手术。这种预期的变化强调了在外科培训计划中进行积极调整的必要性，以适应不断发展的外科实践。研究结果对未来的医疗保健实践具有重要意义，需要在传统腹腔镜技术和新兴的机器人辅助手术之间取得平衡。
