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Critics question value of da Vinci robots
10/27/2011
 
The da Vinci® Surgical System, which combines computer and robotic technologies to create a new category of surgical treatment, is used by nearly 1,100 hospitals in the U.S. Critics say that’s too many given the scanty evidence that the da Vinci system produces better results.

"There's strong incentive for hospitals to use the robot once it's acquired because it's very expensive to try to recoup their investment," Dr. Danil Makarov, an assistant professor of urology and health policy at the New York University School of Medicine, told the Associated Press.

"Are we treating a lot of patients who don't need surgery in the first place? We don't know," he says.

Intuitive Surgical, which designs and builds the da Vinci system, says the system makes it possible to treat a broader range of conditions using a minimally invasive approach. “This means that with da Vinci, you can have major surgery with only a few tiny incisions. In addition, your surgeon can operate with better visualization, precision, dexterity and control than possible using traditional surgical approaches,” it says on a website devoted to the surgical system.

“To date, da Vinci has been used in everything from minimally invasive heart surgery to minimally invasive cancer surgery, to treat conditions as diverse as prostate cancer, endometrial cancer, morbid obesity and mitral valve regurgitation. In short, the da Vinci Surgical System combines robotics and surgical technology as never before, enabling your surgeon to provide the most effective and least invasive treatment option available for a wide range of complex conditions,” Intuitive Surgical says.

Dr. Thomas Shultz, an obstetrician affiliated with CoxHealth who has performed more than 320 hysterectomies with robotic surgery, told the AP “it brings tools to the surgeons' hands that we've never had access to before. That brings me a degree of safety I could never have before."

Despite glowing testimonials by some surgeons, “there's never been a study showing clinical superiority," Dr. Marty Makary, a surgeon at the Johns Hopkins University School of Medicine in Baltimore, told the Los Angeles Times. "For the patient, there's clearly no difference," he says.

In a paper published in May by the Journal for Healthcare Quality, Dr. Makary made the case that the robot is more of a marketing tool to attract patients than a medical one to improve their care.

The Los Angeles Times also quoted Dr. Hyung Kim, a urologist who uses a Da Vinci system at Cedars-Sinai Medical Center in Los Angeles, as saying he is not sure that the robot makes a difference for patients. "The jury is completely out," Kim says. "There is no consensus."

The newspaper cited The Institute for Clinical and Economic Review, an independent healthcare evaluator at Massachusetts General Hospital in Boston, which examined da Vinci surgery as part of a 2009 report on prostate cancer treatment. There was no evidence of major benefit from the robot compared with open surgery, says Dan Ollendorf, the institute's chief review officer.