# Rapid Adoption of Robotic Surgery: Risks, Benefits, and Unintended Consequences

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $500,984

## Abstract

PROJECT SUMMARY
The United States now performs more robotic surgery than all other countries combined. While the
overall volume of robotic surgery has tripled in the past decade, its use for the most common general
surgery operations (e.g. inguinal hernia repair or gallbladder removal) has increased more than 24-
fold over this same period. Despite this, evidence regarding the use and clinical outcomes of robotic
surgery for these operations is limited – putting patients at risk between enthusiasm for a new surgical
technology and insufficient evidence to justify large changes in clinical practice. Existing observational
studies lack appropriate controls and the small number of randomized trials focus on narrow clinical
domains (e.g. surgery for rectal cancer) with carefully selected patients and the most experienced
surgeons. This proposal uses a combination of Medicare and private payer claims data to
characterize the real-world adoption, outcomes, and health care expenditures of robotic surgery for
common general surgical operations. We focus on inguinal/ventral hernia repair, cholecystectomy,
and surgery for colon and rectal cancer – the clinical domains experiencing the largest growth in
robotic surgery. We leverage natural variation in the regional adoption of robotic surgery as an
instrumental variable to mitigate issues of selection bias that limit prior observational studies
estimating the outcomes of robotic surgery. We use this approach to explore the short-term
comparative safety (e.g. incidence of postoperative complications), spending for the surgical episode
of care, and long-term effectiveness (e.g. hernia recurrence) of robotic surgery relative to the more
established laparoscopic and open approaches for each operation. We assess for heterogeneity in
outcomes across surgeons with varying degrees of experience performing robotic surgeries. The
results from this study will have immediate relevance to patients and providers making treatment
decisions around the safest and most effective approach for surgery. It will also inform the work of
policymakers and professional societies who share a common interest in ensuring the safe diffusion of
new surgical technologies. Finally, these data will provide public and private payers – who are jointly
moving towards greater use of evidence-based coverage design – with data to improve the value of
expensive surgical interventions in the United States.

## Key facts

- **NIH application ID:** 10762441
- **Project number:** 5R01DK131584-03
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Justin Brigham Dimick
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $500,984
- **Award type:** 5
- **Project period:** 2022-01-21 → 2025-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10762441

## Citation

> US National Institutes of Health, RePORTER application 10762441, Rapid Adoption of Robotic Surgery: Risks, Benefits, and Unintended Consequences (5R01DK131584-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10762441. Licensed CC0.

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