I Robot

It seems as if you cannot open a magazine, listen to the radio or watch a tv program without catching an ad for robotic surgery. The surgical robot is indeed a remarkable instrument with the potential to take minimally invasive surgery to a whole other level. However, the proliferation of surgical robots also has a downside. Witness today's NY Times:

... The new study follows a series of reports critical of robotically assisted surgery. Documents surfacing in the course of legal action against Intuitive have outlined the aggressive tactics used to market the equipment and raised questions about the quality of training provided to surgeons, as well as the pressure on doctors and hospitals to use it — even in cases where it is not the physician’s first choice and she has little hands-on experience.

Nevertheless, robotic surgery has grown dramatically, increasing more than 400 percent in the United States between 2007 and 2011. About 1,400 da Vinci systems, which cost $1.5 million to $2.5 million, have been purchased by hospitals, according to Intuitive’s investor reports.

The expansion has occurred without proper evaluation and monitoring of the benefits, said Dr. Martin A. Makary, an associate professor of surgery at Johns Hopkins and the senior author of the paper.

“This whole issue is symbolic of a larger problem in American health care, which is the lack of proper evaluation of what we do,” Dr. Makary said. “We adopt expensive new technologies, but we don’t even know what we’re getting for our money — if it’s of good value or harmful.”

As of yet, it's been difficult to demonstrate that the expensive robots result in outcomes that are worth the investment. ACOG released a statement on robotic surgery concluding:

... Aggressive direct-to-consumer marketing of the latest medical technologies may mislead the public into believing that they are the best choice. Our patients deserve and need factual information about all of their treatment options, including costs, so that they can make truly informed health care decisions. Patients should be advised that robotic hysterectomy is best used for unusual and complex clinical conditions in which improved outcomes over standard minimally invasive approaches have been demonstrated.

While it's a poor carpenter who criticizes his tools, periodically we need to know that a particular tool is, as R Crumb's Mr. Natural put it, "the right tool for the right job."

Also, if you are considering robotic surgery, be sure to ask the surgeon some very specific questions about experience, volume, and outcomes. 

Of course that's just my opinion. I could be wrong.