Top Line: Anyone with friends in anesthesia have heard the woes of a once commonplace 45-minute procedure extending to 4 hours in the arms of a robot.
The Study: But the robot is so popular with the marketing team! This pooled analysis of two large prospective cohorts (n=2738) confirmed that postoperative pulmonary complications were roughly twice as common after robot-assisted versus conventional laparoscopy (19% vs 9.5%). And multivariable modeling pointed towards a clear culprit: duration of mechanical ventilation, full stop. Neither ventilation intensity nor robotic approach appeared to independently influence pulmonary risk. Patients undergoing robotic cases were exposed to more intense ventilatory mechanics and had over double the ventilation time (median 219 vs 95 minutes), with ventilation time consistently mediating pulmonary risk across sensitivity and matched-cohort analyses. And not to ruffle too many feathers, but ventilation duration here includes all time before, during and after surgery with some cases clocking hefty “non-surgical” ventilation times, where the authors kindly suggest that risk may be reduced simply with “interventions aimed at improving operating room logistics and minimizing nonessential surgical and ventilation time.”
TBL: Common sense prevails: increased anesthesia and nonsurgical ventilation time may work against other risk-reducing goals of robotic surgical procedures. | Serafini, JAMA Surg 2025
The Study: But the robot is so popular with the marketing team! This pooled analysis of two large prospective cohorts (n=2738) confirmed that postoperative pulmonary complications were roughly twice as common after robot-assisted versus conventional laparoscopy (19% vs 9.5%). And multivariable modeling pointed towards a clear culprit: duration of mechanical ventilation, full stop. Neither ventilation intensity nor robotic approach appeared to independently influence pulmonary risk. Patients undergoing robotic cases were exposed to more intense ventilatory mechanics and had over double the ventilation time (median 219 vs 95 minutes), with ventilation time consistently mediating pulmonary risk across sensitivity and matched-cohort analyses. And not to ruffle too many feathers, but ventilation duration here includes all time before, during and after surgery with some cases clocking hefty “non-surgical” ventilation times, where the authors kindly suggest that risk may be reduced simply with “interventions aimed at improving operating room logistics and minimizing nonessential surgical and ventilation time.”
TBL: Common sense prevails: increased anesthesia and nonsurgical ventilation time may work against other risk-reducing goals of robotic surgical procedures. | Serafini, JAMA Surg 2025