Priority of Patient Safety Associated With Robotic Surgical Instruments-Response to Landenberg et al

To the Editor—We read with interest the letter by Landenberg et al.1 We would like to respond to the questions raised by the authors regarding our article.2 The authors expressed concerns about the size or surface area of the instruments.1 They claimed that the assessment should have been confined to the area in direct contact with patients. Decreased incidence of surgical site infection by robotic surgery has been reported, as stated in the articles cited by the authors of the letter.1,7 However, the incidence of infection could be affected by publication bias.8 It is not possible to determine the actual incidence of infection related to accidental events because they tend not to be reported. [...]cases would not be identified when symptoms are not recognized as being associated with infection.8 In fact, there are reports of serious postoperative infections after 3 separate robotic surgical procedures, although the causes were unknown.9 Similar cases may have occurred in other patients who had a longer hospital stays without infection being diagnosed.