Robotic Surgery Complication Rates: How Safe Is It?

People who train in robotic surgery are mostly already laparoscopic surgeons who've done many laparoscopic surgeries — very few robotic surgeons are 'de novo,' never having done laparoscopic surgery. If you've driven a manual car and now you're going to an automatic, proficiency comes sooner — you just need to learn to drive the robot. On conversion: I had one case in the last three to four years where I had to open a patient up, purely because during robotic surgery the patient's head is at a 30-degree angle, quite low down, and there was a lung compromise issue — the patient wasn't able to maintain oxygen saturation. We tried undocking the robot and raising her head, waited ten minutes and restarted, but her saturation kept dropping, so we had to open her up. That's the only case I can recall in three years, out of several hundred surgeries — patient selection is the most important thing.

With God's grace, none of my patients have ended up in the ICU or anything like that — they've all recovered beautifully. I've done more than 400 to 500 robotic surgeries so far, and I cannot recall any complications in terms of injury to the bladder, bowel, or ureter — essentially a 100% success rate at the post-operative stage.

It depends what's meant by 'failure rate' — conversion to open surgery, complications, or the surgery not being viable at all. On not being viable: if you're an expert in robotic surgery, you should be able to make that decision pre-operatively through proper planning — getting an MRI or CT done if the ultrasound report isn't satisfactory. On complications: the risk of injury is less than 1% with robotic surgery — for bowel and vessel injury specifically the risk is less than 0.5%, and bladder injury is similarly low, compared with 1 to 2% with laparoscopic surgery.

Artemis has been very proactive with all sorts of expansion, and is very much into the international world — we're there to support it. With the new digital world, things like today's Zoom session can happen, and I'll be very happy to be part of any travel needed, taking time out every couple of months to be with the doctors and patients there. I'm a very proactive person when it comes to teaching and training, because the skills we've acquired are good to spread around so more people can gain the expertise.

Robotic surgery is a little more expensive than laparoscopic surgery — depending on the type of surgery, somewhere around $1,000 to $1,200 extra than any conventional laparoscopic surgery.

The main organs at risk are the bladder, bowel, ureter and blood vessels. With robotic surgery, bowel and vessel injury occurs in less than 0.5 percent of cases, and bladder injury rates are similarly very low, compared with a bladder injury rate of around 1 to 2 percent typically quoted for laparoscopic surgery.

Careful, evidence-based pre-operative planning is essential, including getting an MRI or CT scan done if an ultrasound is not conclusive, which allows a surgeon to decide before the operation whether robotic surgery is a viable option for that patient.

In the one conversion case recorded over three to four years and several hundred robotic surgeries, the cause was a patient's oxygen saturation dropping due to a lung issue related to the head-down positioning required for robotic surgery, not a surgical complication.

Careful patient selection ahead of robotic surgery is credited with an outcome of more than 400 to 500 robotic surgeries performed with no recorded complications involving injury to the bladder, bowel, ureter or major blood vessels.