Lack of Access to Robotics Is Associated with Higher Open Surgery Rates

Fong ZV, Anderson CK, Wall-Wieler E, et al. Association Between Surgical Robotic Availability and Open Operation Rate: A Geographic Analysis. J Am Coll Surg. February 2025.

This geographic analysis linked all payer claims data with hospital-level robotic availability (AHA survey) to evaluate whether living in a ZIP Code Tabulation Area without a robotic system is associated with more open surgery. 

Five procedures were studied: pulmonary lobectomy, hysterectomy, colorectal procedures, partial nephrectomy, and prostatectomy. Of eligible regions, 57% had at least one robotic system. Areas without robotic access had substantially higher open surgery rates (42.9 vs 19.4 per 100 procedures; relative rate 2.21), and the association persisted after matching (relative rate 1.66; p <0.01), including across social vulnerability strata and for three of the five procedures.

For surgeons and service-line leaders, approach selection at the population level is influenced by local technology availability, not just patient factors or surgeon preference. Even if many cases can be performed laparoscopically without a robot, the data suggest that lack of robotic access correlates with a higher likelihood of open surgery in certain operations. 

Practically, this argues for a deliberate strategy around equitable access to minimally invasive capability, including workforce training, case allocation, and regional referral pathways, rather than assuming open rates reflect only case complexity.