While the use of robotic surgery has increased significantly here, especially in the fields of gynecology, ear-nose-and throat, general surgery and urology, there is no conclusive evidence that the technique has advantages over the laparoscopic (keyhole) approach.Instead, argue Rambam Medical Center researchers, it appears that market power and the desire to be at the forefront of technology drive many hospitals to purchase the robot and train doctors in its use.So say Drs. Emad Matanes, Sari Boulus and Lior Lowenstein of the obstetrics and gynecology department at the Haifa medical center, writing in the latest issue of the Israel Medical Association Journal (IMAJ).Robot surgery was first carried out 30 years ago, and it has evolved gradually and significantly over the last decade, they write.The idea was taken from the US National Aeronautics and Space Administration’s use of robotics to enable the treatment of soldiers on the battlefield without endangering medical staffers. The US Food and Drug Administration approved the first surgical robot in 1993. Since 2011, hundreds of articles have been published on the “theoretical and practical aspects” of surgical robotics.The Rambam doctors noted that the cost of surgical robots is very high, the amount of space they take up in the operating theater is very large, much disposable equipment has to be purchased and the cost of maintenance is significant.Between 2008 and 2013, six robots were bought – by the Hadassah Medical Organization, Rambam, Assaf Harofeh Medical Center and Assuta Medical Centers.By 2013, there were 150 surgeons in Israel who had trained to use the da Vinci surgical system. Of those, 104 were listed in a database as robotic surgeons.That same year, 975 robotic surgeries were performed, about half by urologists to remove diseased prostate glands and the rest to remove uteruses, reconstruct pelvic floors, take out benign smooth-muscle growths and perform other operations.Meta-analyses on the subject, however, showed “a lack of hard evidence for greater efficiency compared to laparoscopy,” the authors said.They “presume that the robot will undergo many improvements to increase cost-efficiency...but the advantages of robotic over laparoscopic surgery have yet to be demonstrated in every field, and the issue of cost must be examined thoroughly... The forces of the market seem to exceed those of evidence-based medicine,” they concluded.