The following column was published on June 5th, 2012 in USA Today.
I recently had the opportunity to try out a surgical robot, a medical device that has excited doctors, patients and hospital marketing departments. During the demonstration, I was able to precisely manipulate the robotic arms using joysticks. The experience felt right out of a Hollywood movie, as I was able to view the operating field with impeccable clarity using a sophisticated 3-D camera. As a primary care doctor who rarely uses medical devices, I was certainly impressed.
But the implications of robotic surgery go far beyond any video game or science fiction movie. We have yet to see any real data that suggest robotic surgery helps patients more than traditional surgery. What’s more certain is that expensive new high-tech robotic devices will contribute to the nation’s soaring health costs.
Robotic surgery is mostly used now for prostate surgery in men and hysterectomies in women, though it can be employed in other operations, including heart procedures or surgery in sensitive head and neck areas.
Growing use
The number of robot-assisted devices has exploded. Last year, 360,000 procedures were robot-assisted around the globe, up 29% from 2010, according to Intuitive Surgical, the sole manufacturer of surgical robots. As of early this year, more than 1,500 robots were installed in the U.S.
Whether the influx of robots in our operating rooms benefits patients remains uncertain. Of the few studies that have compared robotic surgery head-to-head with a traditional, minimally invasive approach, there was no clear benefit from using the robot.
Unfortunately, this hasn’t stopped hospitals from aggressively marketing robots. A 2011 study of 400 random hospital websites found that 37% featured a surgical robot on their homepage. It’s no wonder hospitals are showcasing the robots. They are very expensive. At up to $2.3 million each, plus an average of $135,000 in annual service fees, they are costly hospital outlays.
Expensive devices
In a study presented last month at the American Urological Association’s annual meeting, robot-assisted prostate surgery added $6,000 to each procedure, a cost primarily absorbed by the hospital. But hospitals argue that the machines are necessary to stay competitive, especially because patients are asking for the robots.
Jeffrey Cadeddu, a urologist at the University of Texas Southwestern Medical Center, told the New York Times that patients are asking doctors: “Do you use the robot?” If the answer is no, they leave, he said. It feeds into the narrative that expensive technology must mean better health care. That mindset must stop.
In fact, hospitals have to make up the robot’s costs by performing more operations. Otherwise, hospitals might have to reduce services, or worse, the costs could be passed on to patients through higher insurance premiums.
Better studies are needed to determine whether robots really benefit patients. More important, we need to change the way hospitals are paid. Assuming the U.S. Supreme Court doesn’t strike down the Affordable Care Act, health reform will fund such comparative effectiveness research and change the financial incentives that motivate hospitals to perform costly procedures that don’t help patients.
The surgical robot is a marvel of technology. And its potential to definitively help patients, perhaps by remotely performing procedures in underserved areas, for instance, cannot be denied. No doubt, robots will play an important health care role in the future, but that time isn’t now.
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