A Retrospective Study on the Use of Robotic Surgery in Rural Areas Compared to Urban Centers

Abstract

Background

Robotic surgery may lend several advantages to the rural surgeon such as improved visualization, ergonomics, mobility, and decreased conversions to open. This study evaluated the growth of robotic surgery across the state of Kansas in regard to urban vs rural use.

Methods

A retrospective review of surgical cases performed on da Vinci robotic systems from 2018 to 2022 throughout the state of Kansas. The information is grouped together based on the Rural Urban Commuting Codes (RUCA) for the location of procedure. The cases were divided by type (general surgery, cardiothoracic, urology, and gynecology).

Results

General surgery was the fastest growing procedure type over the 5-year span increasing in proportion from 45.7% to 64.2%. This was followed by gynecology initially at 36.4% to 24.5%. Urology ranged from 16.6% to 9.5% and thoracic remained at 1% for the 5-year span. RUCA 1 facilities maintained a steady growth of cases per robot over the 5-year span initially at 225 cases per robot and increasing to 375 cases per robot. RUCA 4 centers illustrated a slower growth initially down trending the first 2 years then showing steady growth ending around 250 cases per robot. RUCA 7 centers had the fastest growth curve starting at 175 cases per robot and increasing to 360 cases per robot finishing just behind RUCA 1 centers.

Discussion

The robot may be an effective tool in a rural facility to generate caseload, revenue, recruit physicians, and provide health equity.