On September 18, 2024, the interim report meeting for SMART parallel studieswas held at Room 403, Building A, Peking University Science Park. Experts engaged in in-depth discussions on the application of surgical robot technology in the medical field, cost-effectiveness analysis, and related research progress. The meeting focused on the current application, health economics evaluation, technical advancements, and future prospects of surgical robots, providing theoretical and practical support for the development of intelligent healthcare.

At the beginning of the meeting, Professor Gordon G. Liu, Dean of the Peking University Institute for Global Health and Development, emphasized that the development of Robot-Assisted Surgery (RAS) has expanded the capabilities of surgeons and represents a milestone in clinical medicine. He also highlighted the SMART Surgery Quarterly journal, which is established by the institute, and provided an overview of the progress of the SMART project. Following this, eight principal investigators reported on the progress of their respective research teams.

1. Analysis of the current application and its influencing factors of surgical robots

Professor PAN Jie’s team from the West China School of Public Health (West China Fourth Hospital) at Sichuan University shared their latest findings on “ Analysis of the current application and its influencing factors of surgical robots”. This study employed a structured approach of “status description - distribution differences - difference analysis” to reveal the current application of surgical robot technology, its characteristics across different techniques, populations, and institutions, and to analyze the factors influencing these differences, providing an evidence base for subsequent Health Technology Assessment (HTA) analysis.

The research indicated that the global surgical robot market is steadily growing, but its economic benefits remain unclear. By analyzing the distribution and disparities of surgical robots among medical institutions, physicians, and patients, the team delved into the development of the surgical robot market. The findings revealed significant regional differences in the introduction of surgical robots: Beijing and coastal areas were the earliest adopters of this technology, while central and western regions lagged. Additionally, the study uncovered decision-making mechanisms for technology adoption, highlighting that hospitals’ social benefits and physicians’ career development plans are key factors driving the development of surgical robots.

2. Economic evaluation of medical robotics and laparoscopy for hepatocellular carcinoma resection

Associate Chief Surgeon LIANG Xiao’s team from the General Surgery Department at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, focused on the health economic comparison of robotic and laparoscopic surgery for hepatocellular carcinoma (HCC) resection. Using real-world data, the study conducted a retrospective cohort analysis to evaluate the efficacy, safety, and cost-effectiveness of medical robots and laparoscopic surgery for HCC resection.

The report highlighted that HCC has high incidence and mortality rates, and robotic liver resection is increasingly demonstrating advantages in complex surgeries due to its flexibility and precision. Although robotic surgeries involve higher initial costs, the technology is expected to reduce overall surgical costs in the future by minimizing postoperative complications and shortening recovery time. Additionally, the study noted that as surgical complexity increases, the cost-effectiveness gap of robotic surgeries gradually narrows.

3. Clinical efficacy and health economics evaluation of robot-assisted hip and knee replacement based on real-world data

Assistant Professor LYU Beini’s team from the Peking University Institute for Global Health and Development conducted a study using a patient cohort from Beijing Jishuitan Hospital who underwent knee replacement surgeries. The research compared robot-assisted surgeries to traditional surgeries in terms of clinical outcomes, health benefits, and costs to clarify the economic value of robotic technology.

The study found that robot-assisted surgeries have displayed advantages in improving surgical precision. Further analysis revealed that robotic surgeries significantly reduced intraoperative blood loss and shortened postoperative hospital stays. However, the surgical costs of robotic procedures remained substantially higher than those of traditional surgeries. Moving forward, the team plans to continue follow-up studies to further determine the cost-effectiveness of this technology.

4. Does robotic surgery reduce the economic burden of liver, gallbladder, and pancreatic malignant tumors? A micro-level cost-of-illness study.

Postdoctoral Fellow WU Ziting’s team from the Peking University Institute for Global Health and Development conducted a retrospective study on common surgical approaches for hepatobiliary and pancreatic malignancies, such as hemi-hepatectomy and pancreaticoduodenectomy. The research examined the direct and indirect costs associated with robotic, laparoscopic, and open surgeries for these malignancies, evaluating whether robotic surgery could help reduce the economic burden of diseases.

Through a review of the literature and real-world data analysis, the study found that robotic surgery provided oncological and surgical safety benefits, particularly in the treatment of pancreatic head cancer, where robotic surgery demonstrated superior safety and better long-term cost-effectiveness. However, the study also highlighted that the high cost of robotic surgery remains a significant challenge for patients and healthcare institutions.

5. Assessment of the impact of surgical robots on surgical risk and uncertainty

Postdoctoral Fellow CHEN Ermo’s team from the Peking University Institute for Global Health and Development conducted a retrospective analysis covering most regions of mainland China. The study evaluated the impact of introducing robotic-assisted surgery on surgical risks and other uncertainties by examining changes in the volatility of factors including surgical failure rates and major expenses at healthcare institutions.

The research introduced an innovative approach by assessing the impact of surgical robots on surgical risks from both “average” and “uncertainty” perspectives. The results showed that surgical robots not only reduced the risk of surgical mortality but also significantly improved surgical safety and reliability. Moreover, the technology reduced uncertainties in surgical costs. Causal analysis further validated the positive role of surgical robots in enhancing surgical performance.

6. Cost-effectiveness analysis of robot-assisted surgery (RAS): a department-level evaluation

Assistant Professor PAN Yuhang’s team from the Peking University Institute for Global Health and Development employed microeconometric methods to quantitatively assess the consequences and cost-effectiveness of introducing medical robots at the departmental level. The study aimed to comprehensively understand the impacts of robotic technology on the efficiency within the healthcare system.

The team further analyzed the economic effects of introducing surgical robots in specific departments. The findings revealed that the overall departmental expenses were minimally affected, while individual patient costs increased following the adoption of robotic technology. On the other hand, robotic surgery significantly reduced hospital stays, highlighting its potential to enhance medical efficiency.

7. The role of artificial intelligence in facilitating women's breakthrough of career barriers: an empirical analysis based on surgical robots

Boya Distinguished Professor YI Junjian’s team from Peking University conducted an empirical analysis using data from multiple hospitals following the introduction of surgical robots. The study found that the adoption of surgical robots significantly increased the participation rate of female surgeons, particularly in urology.

Preliminary results indicated that robotic surgeries might reduce the physical demands associated with traditional surgeries, thereby providing more opportunities for female surgeons. The report further explored the impact of gender on career development in the medical field, highlighting the positive effects of robotic surgeries on the professional advancement of female doctors.

8. Clinical evaluation of robotic-assisted laparoscopic radical prostatectomy for prostate cancer based on real-world data

Professor CHEN Lei, Vice President and Party Committee Member of West China Hospital, Sichuan University, led a team conducting a Health Technology Assessment (HTA) of robot-assisted radical prostatectomy (RALP) at West China Hospital. The study aimed to evaluate the efficacy, safety, and cost-effectiveness of RALP to inform decision-making for prostate cancer treatment and optimize treatment pathways.

The findings showed that robotic surgery performed exceptionally well in perioperative indicators such as reduced intraoperative blood loss, earlier mobilization, and shorter drainage tube retention time. However, no significant differences were observed in long-term postoperative safety. The study recommended expanding the sample size and extending follow-ups in future clinical applications to clarify the long-term benefits of robotic surgeries.

Following the cohort study reports, Professor Gordon G. Liu, Dean of the Peking University Institute for Global Health and Development, provided evaluations and guidance for each study. He acknowledged the progress made so far, expressed expectations for the research outputs, and shared insights into future cohort studies. The meeting highlighted the extensive application of robotic surgery in various medical fields, particularly in terms of surgical precision, safety, and economic efficiency. Despite the high costs of robotic surgeries, their significant advantages in improving surgical success rates, reducing hospital stays, and lowering postoperative complications were evident. Participating experts agreed that as technology continues to develop and expand, robotic surgery will play an increasingly important role in future medical applications.

This meeting provided valuable experiences and data to support research on the application of robotic surgery technologies, paving the way for new directions in the field of intelligent healthcare.

（LIU Meng, HU Xuefeng/Text and Photos）