Users Online : 362 About us |  Subscribe |  e-Alerts  | Feedback | Login   |   
Journal of Minimal Access Surgery Current Issue | Archives | Ahead Of Print Journal of Minimal Access Surgery
           Print this page Email this page   Small font sizeDefault font sizeIncrease font size 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (317 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


 Article Access Statistics
    PDF Downloaded103    
    Comments [Add]    

Recommend this journal


 Table of Contents     
Year : 2019  |  Volume : 15  |  Issue : 2  |  Page : 179

The debate between use and cost of technology is on-going!

Department of Bariatric and Minimal Access of Surgery, Nanavati Super Speciality Hospital, Mumbai, Maharashtra, India

Date of Submission09-Mar-2018
Date of Acceptance17-Mar-2018
Date of Web Publication12-Mar-2019

Correspondence Address:
Dr. Jaydeep H Palep
Department of Bariatric and Minimal Access of Surgery, Nanavati Super Speciality Hospital, Mumbai - 400 056, Maharashtra
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmas.JMAS_59_18

Rights and Permissions

How to cite this article:
Palep JH. The debate between use and cost of technology is on-going!. J Min Access Surg 2019;15:179

How to cite this URL:
Palep JH. The debate between use and cost of technology is on-going!. J Min Access Surg [serial online] 2019 [cited 2022 Aug 17];15:179. Available from:

The series published by the group talks about the use of the now commonly used da Vinci™ surgical robotic system (Intuitive Surgicals, Inc.) for the excision of GIST, which are fairly large in size and/or difficult located tumours. Since the last two decades, globally, robotic-assisted minimally invasive surgery, especially for abdominopelvic surgeries, has taken off.[1] Its use, especially in oncosurgery, to maintain the principles of resection to obtain negative margins for disease has been well established, more so in uro- and gynaec-oncology in recent times with well-documented literature evidence.[2],[3]

However, the question here is, what is the message we are trying to give to the surgeons out there with respect to this particular issue. The case series is only a retrospective one with 12 cases done. On a comparative note, there is no data for the same provided by the team on their results with conventional laparoscopy. Today, we have technologies such as three-dimensional and 4K high-definition laparoscopy at our disposal which provide the same advantages of vision vis-à -vis the da Vinci™ robot. An experienced laparoscopy team will be able to provide the same or better results at a high-volume centre for the same procedures.[4]

In addition, we are dealing with a malignant disease. A short-term follow-up is inadequate to state that the da Vinci™ robot is superior to any other technique because we are more concerned about long-term results in neoplasms rather than short-term recovery.

The crux of the issue is the cost factor for the use of the da Vinci™ robot, which is still prohibitive around the world. If the system is a public health/government-sponsored health scheme, one can use this technology freely. In most countries globally, the system prevailing is self-paying. This makes conventional laparoscopy a more time-tested and economical option than the robot.[5]

A long-term randomised controlled trial comparing advanced laparoscopic techniques with the da Vinci™ robot needs to be designed in organ-specific procedures like these in order to determine the cost-benefit ratio and even long-term survival options for malignancies.

  References Top

Palep JH. Robotic assisted minimally invasive surgery. J Min Access Surg 2009;5:1-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
Gettman M, Rivera M. Innovations in robotic surgery. Curr Opin Urol 2016;26:271-6.  Back to cited text no. 2
Alkatout I, Mettler L, Maass N, Ackermann J. Robotic surgery in gynecology. J Turk Ger Gynecol Assoc 2016;17:224-32.  Back to cited text no. 3
Tokas T, Gözen AS, Avgeris M, Tschada A, Fiedler M, Klein J, et al. Combining of ETHOS operating ergonomic platform, three-dimensional laparoscopic camera, and radius surgical system manipulators improves ergonomy in urologic laparoscopy: Comparison with conventional laparoscopy and da vinci in a pelvi trainer. Eur Urol Focus 2017;3:413-20.  Back to cited text no. 4
El Hachem L, Andikyan V, Mathews S, Friedman K, Poeran J, Shieh K, et al. Robotic single-site and conventional laparoscopic surgery in gynecology: Clinical outcomes and cost analysis of a matched case-control study. J Minim Invasive Gynecol 2016;23:760-8.  Back to cited text no. 5


Print this article  Email this article


2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04