November 20, 2019

Dr. Andrea Pakula Featured in General Surgery News Article On the Spot: The Surgical Robot

Colleen Hutchinson’s expert forum article asks an important question: What has the surgical robot done for us lately? The answer: quite a lot. Interviewing some of the most talented minimally invasive surgeons today, including Andrea Pakula, MD, MPH, Hutchinson investigates thoughts on the robot versus laparoscopy, cost, new robots, and the continuous conflicts of this controversial topic.

The robot enables surgeons to perform minimally invasive surgery in cases where they otherwise couldn’t.

Most of the experts agreed that robotic surgery allows surgeons to find success in cases that they otherwise might not have been able to. The adoption of robotic surgery has advanced many minimally invasive surgeries (MIS), making possible procedures previously unaddressed through a laparoscopic approach.

Words of disagreement emphasized that well-trained surgeons, able to perform laparoscopic surgery regardless of robotic usage, are needed for any MIS. The introduction of robotics has advanced surgery, making some techniques easier, and perhaps easier to master than traditional surgery techniques. However, this advancement, discussed Dr. Prabhu, may have taken the place of further advancement in laparoscopic surgeries. Perhaps laparoscopic surgery, given the same support and attention, may have been better adapted for certain procedures.

The robot has proven to have more advantages over traditional laparoscopy in some types of procedures.

Clear, scientific data is still needed to support this broad statement, and most of the experts agreed. Personal experience, however, especially in their fields of expertise, has led many of the doctors to acknowledge multiple advantages to robotic over traditional laparoscopy. For example, technological enhancements such as visualization and articulated instruments have improved doctors’ ability to help their patients.

There is a demonstrated cost advantage in using the robot over laparoscopy.

While overall hospital costs may be less due to factors like a decreased stay, the costs of the robotic platform is significant. Startup costs and maintenance fees vary from institution to institution and cost advantages can be found with select procedures. Capturing consistent, relevant data evaluating the cost analysis is complicated due to nonstandardized billing practices and complex variables. To support this statement, most of the experts agreed that more time and the collection of unbiased data is required.

The new robotic platforms entering the market will result in economic and other improvements to robotic surgery.

New robotic platforms may deliver an increase in quality, innovation and enhanced robotic surgery. Yet it seems competition will be the most likely cause of possible economic improvement. The Intuitive and the da Vinci platforms seem to be the favorites of this panel of experts. It will take some convincing for them to agree on a better robotic platform in performance and/or lower costs.

As demonstrated in the recent American Journal of Surgery article, there is legitimate concern regarding the body of literature published on robotics to-date and conflicts of interest.

Even though the doctor’s opinions were divided, they all seemed to agree that conflicts of interest are not unique to robotics or unexpected in publications. Evaluation of the literature and consideration of possible conflicts should be the standard in any field. As it is still very early in regards to robotic surgery, there is limited data currently available. Better conclusions about robotics in surgery can be made without the concern of conflicts of interest as more studies are conducted and more surgeons with robotics expertise publish their data.

The contributing medical experts for this article included Igor Belyansky, MD, Erik K Johnson, MD, Filip Muysoms, MD, Andrea Pakula, MD, MPH, Ajita Prabhu, MD, Raul Rosenthal, MD, Steven D. Wexner, MD, PhD(Hon), Noel Williams, MD and Sabino Zani Jr., MD.

Part 2 of this article, scheduled to be published later this year, will cover the robot’s role in driving innovation in reconstructive techniques: What’s Really in the Ergonomic Benefit?

To read the article in its entirety, visit

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