WSJ

[Anonymous]

How do you respond to this?

 

[Anonymous]

How do you respond to this?

In the latest study to question the value of robotic surgery, researchers from Columbia University found that the technology costs significantly more and has a higher rate of complications than regular minimally invasive surgery for removing ovaries and ovarian cysts.

Last year, the same researchers reported that robotic surgery for hysterectomies was more costly, and brought no better outcomes, than regular laparoscopic surgery. Separately, a small study published in July found that robotic surgery for bladder cancer was no better than laparoscopy at reducing complications.

“There’s a widespread belief that newer is better but our findings question that. People need to stop and critically analyze whether using this expensive technology will really add any benefit for patients,” said Jason D. Wright, chief of gynecologic oncology at Columbia and lead author of the new study, published Tuesday in the journal Obstetrics & Gynecology.

Supporters say that because robotic surgery uses only tiny incisions, it involves less blood loss, pain and postoperative pain medication than traditional open surgery, as well as shorter recovery times and hospital stays. But experts note that regular laparoscopic surgery has the same benefits without the added investment in technology, training and maintenance that robotic surgery requires.

Intuitive Surgical Inc., ISRG -1.06% which makes the da Vinci Surgical System reviewed in the studies, said surgeons and patients choose to use it “because it can lead to fewer complications and shorter hospital stays.” The company also said the technology is often used on patients “with more complex disease and higher risk factors,” which the latest study didn’t take into account.

Sales of the $2 million machines have been hard hit over the past year by concerns over the technology’s safety and cost-effectiveness. The Sunnyvale, Calif., company recently posted its fourth consecutive quarter of net-income declines. For the last quarter, the company reported a profit of $104 million, down from $159.1 million a year earlier. Revenue fell 11% to $512.2 million.

Use of the da Vinci robot—which allows surgeons to sit at a computer console and manipulate robotic arms outfitted with tiny surgical instruments—had been growing steadily since its 2000 debut as hospitals raced to embrace the new technology that was seen as bringing a competitive edge. More than 3,100 of the systems have been installed around the world.

But analysts say hospitals are being more cautious with such purchases as government and commercial payers shift to reimbursements based on value, not volume, of services.

Last year, the American College of Obstetricians and Gynecologists issued a statement telling women that robotic surgery wasn’t the best, or the most cost-efficient, minimally invasive approach for hysterectomy. Barbara S. Levy, ACOG’s vice president for health policy, said the new research showed that, “So far, robotics has not lived up to the hype for benign gynecologic procedures.”

In the latest study, the Columbia researchers analyzed records of more than 87,000 women who had their ovaries or ovarian cysts removed at 502 hospitals between 2009 and 2012. Use of robots increased sharply during that period, from 3.5% to 15% of ovarian surgeries, and from 2.4% to 12.9% for cyst removal, the study reported.

But 7.1% of patients who had ovaries removed with robotic surgery incurred complications—including injuries to the bladder, kidney and ureter during surgery—compared with 6% of those who had regular laparoscopy. And 3.7% of patients who had robotic surgery to remove cysts had complications, compared to 2.7% with laparoscopy.

Given that ovarian and cyst surgery is typically routine and low risk, the authors speculated that the higher rate of complications with robotic surgery could be due to “surgeons gaining experience on a new technology.”

The difference in cost was even more pronounced, according to the Columbia study: robotic surgery cost $2,504 more for removing ovaries and $3,311 more for removing cysts than regular laparoscopy. Both the fixed and variable costs of robotic surgery were higher than laparoscopic surgery, according to the study, which used actual accounting costs reported by hospitals rather than the often inflated “charges.”

“It’s not just the cost of buying this big, expensive machine,“ Dr. Wright said. “Every time they use it, they are incurring extra costs, probably due to longer surgeries and the cost of disposable instruments.”

Robert Edwards, vice chairman of gynecologic services at University of Pittsburgh Medical Center, who supervises more than 80 surgeons, said that robotic surgery has a role in complex, difficult cases that require advanced maneuverability. “But the pendulum has swung a little too far, and now everything is being done robotically. We need to take a hard look at why and how it’s being used,” said Dr. Edwards, who wasn’t involved in the new study.

Vik Srinivasan, a senior analyst at the Advisory Board Co. ABCO +2.42% , who advises hospitals on purchasing robotic systems, said many have been willing to absorb the extra cost in order to gain market share. But that’s become more difficult as more hospitals acquired robots. “Now, hospitals are wondering, do we risk losing patients and surgeons if we don’t have this key technology?” Mr. Srinivasan said. “Those are tough questions that hospitals have to think through.”

Write to Melinda Beck at HealthJournal@wsj.com

 

[Anonymous]

Here is how I respond to this. Columbia owns robots. Its the same story for most hospitals. The jury is still out but hospitals buy robots. The marketing and pressure cooker sales tactics work.


I'm here 5 years in November and my evaluation is this. Some surgeons are outstanding. These are the surgeons that take the technology and utilize it for better patient care. Other surgeons (like 90% of ob/gyn) are not good surgeons, regardless of what technology they utilize.

 

[Anonymous]

Here is how I respond to this. Columbia owns robots. Its the same story for most hospitals. The jury is still out but hospitals buy robots. The marketing and pressure cooker sales tactics work.


I'm here 5 years in November and my evaluation is this. Some surgeons are outstanding. These are the surgeons that take the technology and utilize it for better patient care. Other surgeons (like 90% of ob/gyn) are not good surgeons, regardless of what technology they utilize.

da Vinci doesn't make bad surgeons good, it makes good surgeons great.

 

[Anonymous]

da Vinci doesn't make bad surgeons good, it makes good surgeons great.

DaVinci makes good surgeons great AND it is indispensable on complicated cases that could not have been performed MIS otherwise. Unfortunately, these criteria do not apply to 95% of the cases that are being done with the robot.