Robotic vs. laparoscopic surgery at the operational level: an investigation of surgeons’ perspectives

Introduction: The Robotics Committee of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) conducted a study of surgeons’ perspectives on robotic-assisted surgery (RAS) as compared to laparoscopic surgery (LS) in four domains: performance, requirements, challenges, and surgical care outcomes. Methods: An exploratory sequential mixed-methods study was performed with a thematic analysis of surgeon interviews using the framework method, followed by an online survey of SAGES Robotics Committee members. Descriptive statistics, t-tests, and ANOVA were utilized for analysis. Results: Seven robotic surgeons (3 female, 4 male) were interviewed. The primary themes were that RAS outperformed LS in (1) device performance, (2) intraoperative teaching, and (3) physical fatigue. Three perceived drawbacks of RAS compared to LS were(1) requiring more resources, (2) mechanical malfunction, and (3) care delivery cost. 55 of 92 surgeon committee members (59.8%) completed the survey. 50.9% (28/55) were male, 80% (44/55) practiced in an academic setting, and 70.9% (39/55) learned RAS during residency/fellowship training. Survey results were consistent with interview themes. Participants indicated that RAS improved performance and was associated with improved patient outcomes. They recognized the relative increased cost, the lack of tactile feedback, logistical challenges, and the increased demands of operative staff. 36.4% (20/55) surgeons ranked “AI-assisted navigation/guidance” as the “most wanted” new RAS function. Conclusion: The findings from this study provide useful insights into surgeon perspectives related to RAS as it compares with laparoscopy and desired areas for new RAS developments that may be helpful to surgical organizations and industry partners alike.