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Monday, May 20th 2013

Your Robotic Surgery Costs More, Doesn’t Get You More

Robotic surgery has been a marketing point for plenty of hospitals across the country. Topping the list is the da Vinci surgical system used primarily in urologic and gynecologic surgeries and some cardiac surgeries. But these systems are expensive, costing nearly 2 million dollars. And the benefits of such, as compared to traditional minimally invasive surgery, such as with laprascopy, is highly questionable.

The surgery is “minimally invasive,” and there is some small evidence, although hardly uniform, that they may be an easier thing to learn than laproscopy. For some procedures, notably prostatectomy, the robot offers the only “minimally invasive” option. But the growth in robotic surgery, and where manufacturer’s are marketing are in procedures with other, cheaper, minimally invasive alternatives.

There is hardly an obstetrician/gynecologist or urologist or general surgeon graduating training in the western world today without extensive laprascopy experience. Heck, after a single year of general surgery, which I’m now well removed from, I almost feel comfortable taking out a gallbladder with a scope. Not that that’s comparative in difficulty to a hysterectomy with a scope (which may be why there hasn’t been a splurge for using the robots from cholecystectomies…yet) but you get the idea. I’m not sure the increased costs associated with robotic surgery can be excused as allowing a subset of older surgeons to easily expand their limited minimally invasive repertoire.

The benefits of robotic surgery have simply not been born out in the literature. See here and here and here.

Robotically assisted and laparoscopic hysterectomy had similar morbidity profiles, but the use of robotic technology resulted in substantially more costs.

The growth in these procedures is being driven largely by marketing. Marketing to providers and directly to consumers. The technology is presented as ideal for “unique” cases. But such obviously is silly. As a patient, my future or your current “unique” case, has been well represented in the studies.

Given my particular health history and current diagnosis, and based on the reading I have done and my consultation with my oncologist, I believe that da Vinci is likely to bring some genuine benefits to my situation. Not only will the surgical incisions be small (minimally invasive), easing my recovery significantly, during the procedure, as this ABC News video shows, the robot’s dexterous mobility and 3D visualization will offer heightened precision. Dr. Irvin has called da Vinci “a quantum leap” forward in treating gynecological malignancies, and that sounds good to me.

Such does little more that contribute to America’s ridiculous health care spending.

I do see a final benefit to this wide adoption. There’s a very legitimate chance that this technology will evolve and improve into systems that truly have benefits. The da vinci may be a precursor to automation or something. Adoption and support obviously make further research and investment possible. But I’m not sure even that’s an adequate excuse for the wide adoption. Maybe skip picking whose going to do your mitral valve replacement based on a billboard for now.

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