OBJECTIVES : The use of minimally invasive surgery including laparoscopic and robotic-assisted surgery (RAS) is gaining increasing popularity, however there is lack of latest national data to quantify adoption trends. In this study, we analyzed contemporary trends in the adoption of different surgical approaches across a range of common surgical procedures in the US.

METHODS : This study used data from Premier Healthcare Database® to identify patients who underwent listed common surgical operations (prostatectomy, hysterectomy, colon resection, rectal resection, inguinal and ventral hernia repair, lobectomy, partial and radical nephrectomy) from January 1, 2013 through December 31, 2019. International Classification of Diseases (ICD) 9^th and 10^th revision, Current Procedural Terminology (CPT) codes and hospital billing data were used to define procedure categories and surgical approach.

RESULTS : The study cohort included 2,903,572 patients from 905 hospitals. The use of RAS has steadily increased from 16.3% in 2013 to 30.3% in 2019 (Annual Percentage Change/APC 2.4% per year; 95% CI 2.1%-2.7%). The magnitude of increase was greater in general surgery: the use of RAS increased from 0.8% to 24.2% for inguinal hernia repair and from 0.02% to 17.0% for ventral hernia repair. RAS has also increased in other complex procedures, such as colon resection (from 3.7% to 19.6%), rectal resection (from 11.6% to 35.4%), partial nephrectomy (59.0% to 74.7%), radical nephrectomy (18.2% to 35.1%) and lobectomy (from 13.1% to 40.7%). The increase of RAS was associated with a decrease of open surgery from 50.3% to 37.7% (APC -2.2% [-2.4% to -2%]) while laparoscopic and other minimally invasive surgery remained stable (2013: 33.4%; 2019: 32%, APC -0.1% [-0.2% to 0.1%]).

CONCLUSIONS : The results suggest that RAS has continued to diffuse across multiple specialties in the US. The increasing adoption of RAS was associated with a decrease in open surgery while the adoption of laparoscopic surgery has plateaued since 2013.