If my Google search can be trusted at this moment, very few mainstream news organizations have reported on new robotic prostate surgery data presented at a cancer meeting in Florida this week.
MedPageToday had the best story I’ve seen, “Long Learning Curve for Robotic Prostate Removal.” Excerpts:
“Three experienced surgeons needed more than 1,600 cases to achieve acceptable outcomes with robotic-assisted laparoscopic prostatectomy (RALP), data from a retrospective chart review showed.
The results suggest that proficiency in RALP involves a much longer learning curve than previously recognized.
“Robotic prostatectomy is gaining in popularity and being done by a large number of surgeons who thus do a relatively few number of cases…We thus recommend that this operation should not be done by all urologists in small community hospitals,” Prasanna Sooriakumaran, MD, of Weill Cornell Medical College in New York said.
“It should be concentrated into those high-volume centers of excellence, where the operation can be done by surgeons who do a large number of cases very frequently, in order that they can achieve the best possible cancer-control results for their patients,” he said.
Of the estimated 90,000 radical prostatectomies performed in the U.S. each year, robotics is used in more than 70,000 cases. More than 70% of RALP procedures are performed by surgeons who do fewer than 100 cases a year, according to Sooriakumaran.
Studies suggest urologic surgeons require only 25 to 40 cases to master the safety of RALP, he continued. However, the learning curve to achieve expert-level results has not been established.
“I think this data will make everyone pause and say, ‘maybe it’s time to go a little bit farther before we rush into this surgery,’” said Nicholas Vogelzang, MD, of Comprehensive Cancers Centers of Nevada in Las Vegas.
The take-home message from the study, according to Sooriakumaran is that RALP is “indeed a simple procedure, in terms of the safety aspect. In terms of achieving the best possible results, it is not a simple procedure, and it takes a lot of skill and experience.”
Because I was curious, I found an Oncology Times article from more than 5 years ago that raised questions about the “learning curve remains steep” from this procedure, and quoted one expert questioning “whether the procedure’s benefits outweighed the human costs of the learning curve.”
Of course, questions about a learning curve 5 years later – today – are much more concerning.
A cancer specialist wrote to me this week after checking the fourth quarter results for the companhy that makes the robotic surgery system. He wrote:
“For the year their revenue was 1.4 billion dollars. That is 1.4 billion dollars drained from the health care system with little proof that it saves lives, while it is now being marketed to everyone under the sun.
What could we do with $1.4 billion–and climbing?????
While we try to move the system to a more rational process, others are trumpeting irrationality. And they have more money and more influence than we will ever have.”
Meantime, medical centers promote their robots like crazy. One staffer from a robot-using medical center even urged me to promote the out-takes of a TV commercial they produced about their robot. And he posted the comment in response to an article I wrote about robot hype! See the comments section. (I can still remember my instructor from my single PR class in college saying, “It doesn’t matter what you say about me as long as you spell my name correctly.”)
Isn’t it nice that medical centers have budgets to not only produce commercials about their robots, but budgets to pay people to put out-takes on YouTube?
Let me be clear: this technology will undoubtedly offer some benefit to some patients with some conditions. I’m not a doctor. I am choosing to reflect on the public messages and news coverage about new technologies. I’ve witnessed an imbalance in the public discussion and in the news coverage of robotic prostate surgery. (I did a search on this blog just to get some indication of how often I’ve written about such imbalanced news coverage in the past. See the search results.) I wish that every news organization that has hyped robots had given equal weight this week to the study about longer than expected learning curves.
What are the human costs of this finding?