Robotic Surgery: An Example of When Newer Is Not Always Better but Clearly More Expensive.

Abstract

When the US Food and Drug Administration (FDA) first approved the da Vinci surgical robot for clinical use in 2000, many people assumed that robotic surgery would have as much effect on improving patient outcomes as had minimally invasive,orlaparoscopic,surgery.Adecadeafteritsintroduction,laparoscopic surgery and the smaller incisions it uses produced clear evidence that patients generally did better—faster recoveries, shorter hospital stays, less bleeding, and so forth—than with more “traditional” or open surgery. That said, in some instances surgeons believe they will have better outcomes if they have both the sight and the feel of the whole area allowed by traditional incisions. The evidence associated with robotic surgery, however, has been considerably less compelling. The lead researcher on robotics at ECRI (formerly known as the Emergency Care Research Institute), a nonprofit organization that brings applied scientific research to assess the effect of medical procedures, devices, drugs, and processes on patient outcomes, recently commented that with publications on robotic surgery with varying study designs and variable conclusions appearing monthly, it becomes challenging to draw definitive conclusions comparing robotic surgery with traditional laparoscopic surgery. It also depends on which type of surgery is being compared. 1 The incremental costs associated with the da Vinci procedure are less debated, with costs ranging from $3,000 to $6,000 more than traditional laparoscopic surgery. As more procedures are performed and more evidence is accumulated, some types of procedures have been found more likely to benefit from robotic surgery, while other types have not. Not surprisingly, the difference tends to be associated with those areas in the body that are difficult