Robotic surgery systems are spreading so quickly across the U.S. and across the globe that trying to keep up with the news could become a fulltime beat. Here are just a few nuggets in an attempt to catch up on things you may have missed.
The Pennsylvania Reading Eagle reports, Fans test surgical robot at baseball game: “Fans at FirstEnergy Stadium got the chance to try Reading Hospital’s da Vinci surgical robot before the Fightin Phils game Thursday night…The hospital has three da Vinci robots, which are used for minimally invasive surgeries, including heart, thoracic, bariatric, urologic, gynecologic, cancer and other procedures.”
The Fightin Phils are a minor league affiliate of the Philadelphia Phillies major league baseball team. A news release from Reading Health System touting the event stated: “Benefits for patients include: significantly less pain after surgery; less blood loss; less scarring; shorter recovery time; faster return to normal daily activities; and, in most cases, better clinical outcomes. Approximately 3,000 peer-reviewed studies have been published demonstrating the clnical (sic) effectiveness of da Vinci procedures.”
The official scoresheet shows the news release to be a major league strikeout in that it didn’t provide site-specific data from Reading Hospital and it didn’t mention any of the growing number of peer-reviewed studies that have raised questions about robotic surgery system proliferation, cost effectiveness, efficacy and safety concerns.
One reader saw through the hype, leaving an online comment on the Reading Eagle newspaper website: “Ha Ha Ha they are getting really desperate for people to experiment on with this thing. Three robots purchased? Ouch! No hospital coming back from 7.5 mil wasted. What other surgical instrument is brought to malls and baseball games to fool the public? No scientific evidence of meaningful improved results, but some poorly run hospitals keep buying these things for the pathetic misleading sales slogans, testimonials, and misrepresentation of the future.”
We’d seen robotic surgery promotions in shopping malls before, but the ballpark setting was a new one to us. Maybe Reading readers should also read or watch stories like the next three we profile.
- HealthDay last month reported, New, pricey prostate cancer treatments may be overused: study:
“The use of intensity-modulated radiotherapy (IMRT) and robotic prostatectomy to treat prostate cancer patients at low risk of dying from the disease increased from 32 percent in 2004 to 44 percent in 2009, researchers found in reviewing Medicare patient data…
“The implementation of these technologies occurred in populations at a time when there was an increase in awareness that some prostate cancers might not warrant treatment,” said study co-author Dr. Brent Hollenbeck, an associate professor of urology and director of the Herbert H. and Grace A. Dow Division of Health Services Research at the University of Michigan…
"What’s more, new technologies like IMRT, robotic prostatectomy and proton beam therapy have not been shown to be any more effective in treating prostate cancer or avoiding side effects than established procedures like traditional external beam radiation treatment (EBRT) and open radical prostatectomy…
"Aggressive direct-to-consumer marketing and incentives associated with fee-for-service payment may promote the use of these advanced treatment technologies,” the study authors wrote.
- Last month, NBC News reported – including in an 11-minute Rock Center segment – Robotic surgery is high tech ‘tour de force’ – but is it safe. In it, Dr. Marty Makary, a Johns Hopkins surgeon, said, “The story of the robot is really the story of American medicine: expensive technology, poor evaluation, and little communication with patients about the research and the data about robotic surgery.”
On CNBC, Herb Greenberg has devoted much attention to “The da Vinci Debate.”
And now a brief glimpse of some recent journal articles:
- A Viewpoint article in JAMA Surgery, Robotic Thyroidectomy: Do It Well or Don’t Do It. Excerpt:
“Overall, robotic thyroid surgery is unlikely to show improved outcomes with typical metrics. It is unlikely to be cost-effective because it involves more equipment and, even in the best of hands, more operating room time. Length of stay is unlikely to be effected because most thyroid surgery patients are in the hospital for less than 24 hours. Robotic thyroid surgery is not minimally invasive; therefore, is there really any expectation of a decreased level of pain during the postoperative period?
The implementation of the routine use of robotic technology will depend ultimately on what it means for the patient—the real stakeholder. Comparative efficacy studies have partially addressed the end points of robotic thyroid surgery by focusing only on the risk of complication or oncologic value when compared with conventional or endoscopic surgery, but what about other patient-centered end points? Are the patients happy and satisfied, and are they more satisfied than someone who underwent conventional thyroid surgery? At the end of the day, it will come down to how a third-party payer or health care provider system weighs patient-centered outcomes and whether such surgery would be covered and provided, or whether it would be considered purely cosmetic in nature.
In summation, once you strip away all the blinking blue and green lights, the hundreds of moving parts, and the beeps and occasional error messages, robotic thyroid surgery can be just as elegant, effective, and safe as conventional surgery. It can be efficient. However, to get to this point, the surgeon needs to be committed to this type of surgery and not merely regard it as a hobby or a sideline. It needs to be the focus of a truly dedicated thyroid surgeon who has excellent outcomes with both the standard and robotic approach. Emil Theodor Kocher was not the first surgeon to win the Nobel Prize for nothing. After a century of experience, the new high-profile version of his thyroidectomy may be good, but it is not better than the tried and true.”
- A journal article, Robotic surgery in the Netherlands: lack of high-quality proof of efficacy:
“Given the high costs and small scientific evidence, the introduction of robotic surgery has been irresponsibly quick. Better scientific research of robotic surgery is needed before this technology can be broadly applied in clinical practice.”
“Surgeons must try to avoid marketing operations behind some of the indications of companies producing robotic instrumentation. Otherwise, the first robotic surgery centers will be seen as 'a real taste of Hollywood'…Robotic surgical procedures’ economic aspect should be analyzed and we have to reconsider whether our countries (Poland, the Czech Republic, Slovakia) are at such an economic level that they are able to compete with more economically developed countries such as Germany. I believe that they are not . Certainly, only a few robotic surgical centers need to be built in each of our countries. They should carry out scientific research, should be supported by other than state funds, and should cooperate with each other so that the whole system does not become just 'a taste of Hollywood' for a particular surgeon or center.”
In summary, when thinking about robotic surgery, you could sing “Take Me Out to the BallGame,” but remember the closing lyrics:
Let me root, root, root for the home team,
If they don’t win it’s a shame.
For it’s one, two, three strikes, you’re out,
At the old ball game.
Addendum on July 19: See Gary's next-day post, FDA warns robotic surgery maker, which complains of ‘negative press’.