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Straight Stick and Robotic Resection for Solid Organ Cancer: A US Hospital-Based National Analysis
Alexander Pohlman1,2,3, Fadi S Dahdaleh4, Amit Merchea5
1Stritch School of Medicine, Loyola University Chicago, Maywood, IL.
Journal of the American College of Surgeons
|May 12, 2026
Summary
Robotic surgery for solid organ cancers shows lower conversion rates than conventional methods. While offering slightly more lymph nodes, other outcomes were similar, suggesting robotic benefits for reducing conversion risk.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Robotic Surgery
Background:
- Comparative effectiveness of robotic vs. conventional minimally invasive surgery for solid organ cancers is unclear.
- Limited evidence hinders evidence-based operative platform selection.
Purpose of the Study:
- To compare robotic-assisted versus conventional minimally invasive approaches for solid organ malignancies.
- To evaluate operative platform selection based on comparative effectiveness.
Main Methods:
- Analysis of 2,258,360 patients undergoing minimally invasive primary tumor resection for 17 solid organ cancers (2010-2022).
- Stratification by robotic-assisted versus conventional ("straight stick") approach.
- Primary endpoint: conversion to open surgery; Secondary endpoints: short-term outcomes, oncologic/technical metrics.
Main Results:
- Robotic surgery (59.3%) had significantly lower adjusted conversion rates (6.1% vs. 13.6%, p<0.001) across all organ sites.
- Robotic approaches yielded ~1 additional lymph node on average.
- Length of stay, 90-day mortality, and negative margin rates were similar, with site-specific variations.
Conclusions:
- Robotic-assisted resection is increasingly used for solid organ malignancies, showing lower conversion rates and higher lymph node yield.
- Robotic platforms may reduce conversion risk.
- Equivalence in other outcomes and potential confounding warrant cautious interpretation.
