Adoption of robot-assisted minimally invasive surgery across surgical specialties in France: a nationwide population-based study

Robotic minimally invasive surgery has been used in France for nearly two decades, with monitoring enabled by the National Health Data System (SNDS) since March 2020. No French study has comprehensively described robotic procedures, including ENT, at a fine geographical scale. We aimed to assess the use of robotic and non-robotic minimally invasive surgery over time and across French departments (administrative subdivisions), describe patient and healthcare facility characteristics and investigate determinants of robotic surgery use. We identified adults undergoing robotic or non-robotic minimally invasive procedures in urology, gynaecology, digestive, thoracic, and ENT specialties between January 2017 and June 2023. From July 2020, robotic surgery use was described by specialty, quarter and department, and temporal trends were assessed using SARIMA models. Determinants of robotic surgery use were identified by specialty using multivariable logistic regression models. Between January 2017 and June 2023, 914,350 minimally invasive surgeries were performed, including 432,505 from July 2020 onwards, of which 19.2% were robotic. This proportion varied by specialty (urology: 63.6%, thoracic surgery: 18.5%, ENT: 16.8%, gynaecology: 9.7%, digestive surgery: 6.5%). Across all specialties, the proportion of robotic surgeries increased by 0.66% points per quarter. Minimally invasive surgery volume and robotic surgery use varied substantially across departments. Robotic surgery use was associated with patient sociodemographic characteristics and facility characteristics (facility type, number of beds and surgical volume). Robotic surgery use is increasing in France, with substantial variation across specialties, departments, patient and healthcare facility characteristics. Further studies on safety and effectiveness are needed to complement real-world monitoring.