Study casts doubts on benefits of robotic surgery
A report published in the Journal of the American Medical Association raises doubts as to whether robotic surgery provides any greater benefits to patients than conventional laparoscopic surgery. According to the Wall Street Journal, use of robotic surgery for hysterectomies has skyrocketed in recent years, and while the procedures cost up to a third more than regular surgery, the study suggests that the benefits are not commensurate to the increase in cost.
Advocates of robotic surgery say that the machines, called da Vinci Surgical Systems, and manufactured solely by Intuitive Surgical, Inc., provide patient outcomes that include less scarring, less pain and blood loss, fewer complications and shorter hospital stays than traditional surgery, which involves larger incisions and takes longer to heal.
Critics say that the same could be said for all minimally invasive procedures. The crucial variable in the studies cited by robotic surgery proponents, they maintain, is that the surgeries were laparoscopic surgeries, not that they were performed by da Vinci machines, which are now being used in prostate surgery, gallbladder and gynecological surgeries.
In a robotically assisted surgery, the surgeon sits at a console and operates mechanical arms that insert miniaturized tools through small openings in the patient’s body. The physician is guided by a tiny lighted camera that displays the patient’s organs on a 3-D screen.
For the new study, researchers at Columbia University studied the patient records of 264,758 women who had hysterectomies for non-cancerous conditions at 441 U.S. hospitals between 2007 and 2010. During those years, robotic surgeries rose from use in 0.5 percent of cases to almost 10 percent of all hysterectomies, including a rise to 22 percent at the 1,370 hospitals that have purchased da Vinci machines, which cost from $1.5 million to $2.2 million.
The study showed that 25 percent of women who had ordinary laparoscopic hysterectomies stayed in the hospital for two days or more. Of the women who had robotic surgery, 20 percent stayed in the hospital for more than two days, but each group saw complications occurring at the same rate, 5 percent.
However, a robotic hysterectomy costs an average of $8,868, compared with $6,679 for a regular laparoscopic procedure.
The study’s lead author, associate professor of women’s health at Columbia, Jason Wright, told the WSJ, “There are so many options for hysterectomies now that patients should discuss the pros and cons of all of them with their doctors.”
Myriam Curet, an Intuitive Surgical representative said, “We did not develop the robot to compete with laparoscopic surgery. We developed the robot to bring the benefits of minimally invasive surgery to more women.”
The company argued that the da Vinci machines require less training to use than traditional laparoscopic surgery, thereby increasing the availability of the procedures.
A 2009 study published in the Journal of the AMA came to similar conclusions about robotic prostate surgery. While use of da Vinci robots provided some small benefits, a surgeon would need to perform up to 250 procedures with the device to become fully proficient.
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