OBJECTIVES:

The study objective was to investigate the utilization of robotic-assisted surgery in Germany.

METHODS:

We conducted a retrospective data analysis using German § 21 KHEntgG hospital data of the Federal Statistical Office of Germany and the InEK (Institut für das Entgeltsystem im Krankenhaus/ Institute for the Hospital Remuneration System). Robotic-assisted surgery was identified by OPS codes 5-987.0, 5-987.1, 5-987.x from 2005 to 2020. Age and sex specific trends in the utilization of robotic-assisted surgery were investigate and compound annual growth rates (CAGR) calculated. Predominant indications and medical specialties associated with robotic-assisted surgery were identified by DRG and ICD-10-GM codes.

RESULTS:

1079 robotic-assisted surgeries were performed in 2005 in German hospitals. By 2020, the number had increased to 37,876, resulting in a CAGR of 26.8% (29.6% male, 22.2% female). With a sex ratio of 1.1:1, robotic-assisted surgery was performed with similar frequency in males and females in 2005. Differences steeply increased until 2009 (sex ratio: 6.4:1), before steadily declining to a sex ratio of 2.6:1 by 2020.

In 2020, the medical specialty in which robotic-assisted surgery was used most often was urology (66.7%), with the most common indication being malignant prostate neoplasms (41.8%). Other relevant specialties are gastroenterology (10.1%), orthopedics (9.2%), and gynecology (6.0%). 74.6% of robot-assisted surgeries were performed in connection with tumor indications (malignant neoplasms: 69.7%, benignant neoplasms: 4.9%).

69.4% of patients receiving robotic-assisted surgery in 2020 were 60+. Mainly complex robotic systems were used (5-987.0: 87.3%), as compared to robotic arms (5-987.1: 10.0%), or other systems (5-987.x: 2.8%).

CONCLUSIONS:

Use of robotic systems has proliferated over the past 15 years and is integrated in several medical specialties. It is most relevant in urology and malignant prostate neoplasms. We expect further growth in the use of robotic systems in the future, as well as continued diversification in application areas.