title: Robotic Surgery: A Solution in Search of a Problem-A Bayesian Analysis of 343 Robotic Procedures Performed by a Single Surgical Team.
abstract: BACKGROUND
  Despite the obvious technical advantages, the value of robotic surgery is highly debated and its cost-effectiveness has been questioned. The aim of this article is to provide an evaluation of the outcomes of robotic surgery in comparison to conventional laparoscopy.
  
  
  METHODS
  A decision analysis based on the Bayes' theorem and the decision tree was used. The robotic approach was compared with the laparoscopic approach for each of the pathologies discussed in this study. The data on robotic surgeries were obtained from a retrospective study conducted between January 2008, when the da Vinci system became available in our institution, and December 2014. During this period, 343 consecutive robotic operations were performed by a single surgical team.
  
  
  RESULTS
  There were statistically significant differences in the likelihood of an optimal patient outcome when the robotic approach was used for hysterectomies to remove malignant tumors, difficult splenectomies, gastrectomies, and rectal resections. The results did not show important differences between the two techniques for easy splenectomies and hysterectomies for benign cases.
  
  
  CONCLUSIONS
  The results of our study confirm the value of robotic surgery, as an alternative and complex surgical tool, for hysterectomies to remove malignant tumors, difficult splenectomies, gastrectomies, and rectal resections. Laparoscopy was preferred for easy splenectomies and hysterectomies for benign cases, because of the lack of improved outcome with robotic surgery and the high cost of robotic surgery.
authors.affiliation: 1 Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute , Bucharest, Romania .
authors.forename: Simona
authors.initials: S
authors.lastname: Manciu
authors.affiliation: 2 Carol Davila University of Medicine and Pharmacy , Bucharest, Romania .
authors.forename: Mihnea
authors.initials: M
authors.lastname: Dragomir
authors.affiliation: 3 Department of Oncology, Institute of Oncology "Prof. Dr. Al. Trestioreanu," Bucharest, Romania .
authors.forename: Fabiana
authors.initials: F
authors.lastname: Curea
authors.affiliation: 1 Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute , Bucharest, Romania .|2 Carol Davila University of Medicine and Pharmacy , Bucharest, Romania .
authors.forename: Catalin
authors.initials: C
authors.lastname: Vasilescu
mesh_terms: D001499:Bayes Theorem; D003661:Decision Support Techniques; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D008297:Male; D012007:Rectum; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D013156:Splenectomy / Q000379:methods*; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: Bayes' theorem; laparoscopic surgery; optimal outcome; robotic surgery