A Comparison of Robotic and Laparoscopic Appendicitis Surgeries

Appendicitis is the leading cause of abdominal pain that requires surgery. It is caused by inflammation of the appendix which is located on the right side of the large intestine. An appendectomy is a surgery to remove the inflamed appendix, and it is the best treatment option.

Introduction

Appendectomies are one of the most common surgeries performed. Laparoscopic appendectomies (LA), use small cameras inserted through small cuts in the abdomen to directly visualize and manipulate the appendix during the surgery. Laparoscopy can be performed manually or with the assistance of a surgical robot. Before the widespread use of LA, open appendectomies were the traditional choice for surgery. As medical technology has advanced, less invasive surgeries have become more widespread because they utilize smaller openings that expose fewer internal organs compared to open appendectomy surgeries, and therefore facilitate faster recovery for patients. Robotic appendectomies (RA), use robotic arms controlled by a trained surgeon at a control panel within the surgery room. Both RAs and LAs are widely used today. A recent review paper published in Cureus: Journal of Medical Science aimed to compare RAs and LAs. This article is a summary of that meta-analysis.

Methods

Ten studies that compared RAs to LAs were reviewed. The studies assessed the outcomes for over 86,000 patients suffering from abdominal diseases. At least 325 of these patients received RA. The studies contained details on the length of the surgery, the length of the hospital stay during recovery, the rates of complications, and the cost of performing these two procedures. By comparing these criteria, the paper found a number of pros and cons for each procedure. 

Results and Discussion

Several of the studies found that patients who had an RA recovered slightly faster than those who had an LA, and were able to return to their normal daily activities sooner. Researchers believe this is because RAs allow surgeons to work with improved precision and visualization during the surgery. While recovery may be quicker with RAs, they take longer to perform than LAs because they require extensive preparation of the robot equipment. It is also very costly to purchase and maintain the equipment. Patients should also check with their insurance provider to understand the potential cost of RAs as they can be more expensive. LAs are performed more often because RAs require the surgeons and supporting staff to go through special robotic training, and must be knowledgeable about troubleshooting the system. Overall, RAs and LAs are both safe and effective methods, and the final outcomes for patients were very similar. 

Conclusion

With the research that has been done so far, both RA and LA have their advantages and disadvantages. Studies have shown that RAs offer a faster recovery time especially in complex cases. However, it does unfortunately cost more compared to LA, unless the procedure is covered by insurance. We recommend that you discuss the risks and benefits of both options with your provider, and have a shared decision making conversation on which procedure is best for you. Your doctor will know what skills and supplies are available, as well as what is best for you in the context of your medical and surgical history. 

Written by Addison Hester, Joseph Lee, Laila Kashani, Robert Suttie

Edited by Joyce Lee, MD

References

1. Reddy S, Tote D, Zade A, et al. Comparative Analysis of Robotic-Assisted Versus Laparoscopic Appendectomy: A Review. Cureus. Published online June 29, 2024. doi:https://doi.org/10.7759/cureus.63488

‌