# Robotic surgery in France: insights from a national administrative database on utilization, access, and efficiency

## TL;DR

Robotic surgery is growing in France, especially in urology, and is linked to better recovery outcomes, but its use varies greatly across regions and specialties.

## Contribution

The study provides the first nationwide analysis of robotic surgery adoption and outcomes in France using administrative data.

## Key findings

- Robotic-assisted procedures increased by 15.6% from 2021 to 2022, with urology being the most common specialty.
- Robotic surgery was associated with shorter hospital stays and fewer ICU admissions compared to laparoscopic and open surgery.
- Regional disparities in robotic surgery adoption were significant, with Île-de-France performing over 27% of procedures.

## Abstract

Robotic-assisted surgery has become an integral component of minimally invasive surgery, yet its nationwide diffusion and real-world impact in France have only recently become measurable following the implementation of mandatory procedural traceability. We conducted a nationwide, retrospective, cross-sectional study. All adult patients undergoing selected urologic, digestive, gynecologic, and thoracic procedures between January 2021 and December 2022 were included. Surgical approaches were classified as robotic-assisted, laparoscopic, or open. Primary outcomes were national volumes, robotic penetration rates, and regional distribution. Secondary outcomes included length of stay, intensive care unit admission, and 30- and 90-day readmission rates. A total of 58 232 robotic-assisted procedures were identified, increasing from 27 011 in 2021 to 31,221 in 2022 (+ 15.6%), and accounting for 15.6% of minimally invasive procedures. Urology predominated (61%), followed by digestive (17%), gynecologic (15%), and thoracic surgery (7%). Robotic penetration reached 54.9% in urology but remained below 15% in other specialties. Marked regional disparities were observed, with Île-de-France accounting for over 27% of all robotic procedures, while several regions reported minimal or no activity. Compared with laparoscopic and open surgery, robotic-assisted procedures were associated with shorter length of stay (4.2 vs. 5.7 and 7.9 days, respectively), lower intensive care unit admission rates (6.3% vs. 9.7% and 14.1%), and reduced 30-day readmissions (4.8% vs. 5.6% and 6.9%). Robotic-assisted surgery in France is expanding and associated with improved early postoperative outcomes, but its adoption remains highly uneven, highlighting the need for coordinated national planning.