OBJECTIVES

Robotic-assisted surgery (RAS), as a new technology of minimally invasive surgery (MIS), has been diffused into practice in Korea. In order to provide data to the public for clinical or policy decision making, the study aims to assess the trend of surgical approaches (open, laparoscopic, and robotic-assisted) in surgical procedures having adopted RAS.

METHODS

We used a national claim database from the Korea Health Insurance Review & Assessment Service (HIRA) to acquire the volumes of open and laparoscopic procedures. Volumes of robotic-assisted procedures were obtained from Intuitive Surgical’s reporting system (manufacturer of the da Vinci® surgical system, Sunnyvale, CA, USA). A total of six procedures were included: prostatectomy, partial nephrectomy, hysterectomy, gastrectomy, esophagostomy and rectal resection.

RESULTS

The proportion of RAS has increased in all six procedures from 2011-2016. In terms of RAS adoption rate, the most substantial growths were from partial nephrectomy (from 14% in 2011 to 36% in 2016) and prostatectomy (from 45% to 66%). The disproportional increase of partial nephrectomy indicates that RAS may enable a procedural shift from radical to partial nephrectomy. Laparoscopic approach showed growing trend particularly in rectal resection (from 59% to 71%) and gastrectomy (39%to 60%) but decreased in partial nephrectomy and prostatectomy. Open approach decreased in all procedures but it was still the main stream in esophagectomy (71% in 2016, 95% in 2011). Up to 2016, the proportion of RAS was the highest in prostatectomy (66%) followed by partial nephrectomy (36%), esophagectomy (22%), malignant hysterectomy (12%), rectal resection (6%) and gastrectomy (3%).

CONCLUSIONS

There is an increase trend towards MIS (either laparoscopic or robotic-assisted) and a decrease of open surgery regarding surgical approaches from 2011-2016. RAS has an overall increase trend yet the adoption varies by surgical procedures.