Health News Review

The surgeon who blogs and tweets as The Skeptical Scalpel (@Skepticscalpel) started my day with a Tweet that read:

Houston Chronicle’s hard-hitting exposé on robotic surgery. http://is.gd/lT5ed4

You have to know his work and his style to know that he was being sarcastic about “hard hitting exposé.”

The headline of the piece is:

Advances in surgeries with robots reduce risks and trim recovery times

The lead paragraph is:

What if you could have a major surgery with only a short hospital stay, very little pain, low risk of infection, little blood loss, minimal scarring, and a fast recovery and return to normal daily activities?

Unfortunately, readers are never given any evidence about reduced risk, trimmed recovery times, shorter hospital stay, very little pain or any of the other claims in the headline and lead.

The entire piece – as so many stories about robotic surgery tend to do – focuses on what it means to the surgeon:

  • “improving the surgeon’s visibility and dexterity”
  • “surgeons don’t have to remove their eyes from the scene of surgery”
  • ” and they have more range of motion through the wrists of the device than through scopes.”
  • “Straight-stick surgery is hard on the (surgeon’s) body – my elbows are up in the air, my shoulders are hunched; it’s very fatiguing”

While we all want surgeons who are comfortable with what they do (if we choose surgery), these testimonials do not necessarily equate to improved patient outcomes.

And while the story discusses using the robot in some new applications, patients/readers should be told something about the learning curve.  How long does it take a surgeon, using a new device in a new way for a different condition on a different part of the body, to become proficient?  If the answer is 500 cases, would you want to be numbers 1 – 499?

That’s what was missing in the “hard hitting exposé.”

Journalists can do better in reporting on new technologies, and on the proliferation of new technologies into new fields. And if they don’t, they’ll have to live with comments, like some of these, left in response to the Houston Chronicle story:

  • “The biggest drawback is the cost. Much more expensive than laproscopic surgery and no significant benefit noted (studies have shown this). I have said for years that the robotic surgery devices are looking for an indication and the manufacturers have been very aggressive marketing these to community hospitals as a marketing ploy.”
  • “I’m surprised this story appears at all because it isn’t news. Maybe one of the institutions mentioned in the story wanted some publicity, so they took a reporter to lunch and fed the reporter more than food (if you grasp my meaning).”

See past blog posts about robotic surgery marketing vs. data/evidence.

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Comments

Skeptical Scalpel posted on March 12, 2013 at 11:24 am

Isn’t it interesting that the comments were so much more insightful than the story?

Quinn Eastman posted on March 13, 2013 at 10:03 am

I thought journalists would be less enthusiastic about this type of story since robotic surgery has become more common. Simply put, it’s not news anymore.
Also – cardiac surgeons at the university hospital where I work told me, “We have used the robot for a certain procedure several times, but we found losing the tactile feedback has drawbacks.”

Daniel Pendick posted on March 18, 2013 at 10:08 am

Some prospective residents and fellows won’t even consider accepting a position at a major hospital if they don’t have a robot to play with. It’s another example of a factor driving the proliferation of expensive medical technology that may have little to do with patient outcomes–in this case, the point is that surgeons in training perceive robotic surgery as good for their careers. That said, I am sure they also believe robots are good for patients.

Addi Faerber posted on March 18, 2013 at 1:03 pm

I think for new surgical technology we need to measure a “Number to Competency” which summarizes how many surgeries the average surgeon will have to perform using the new technology in order to have measured outcomes _equivalent to_ the standard surgery. From what I’ve ready the NTC for robotic prostatectomy is close to 40 – If you’re case 1 to 39, you should know that you’re practice fodder for the surgeon who is expected to perform the surgery worse than if you’d gotten the basic procedure.

    Gary Schwitzer posted on March 18, 2013 at 1:21 pm

    Addi,

    Thanks for your note.

    I’ve seen (and written briefly about) learning curve estimates ranging from 150 – 1,600 surgeries. However, I acknowledge that I have little confidence in such estimates.

      Walter Lipman posted on March 18, 2013 at 6:31 pm

      Ought not the fee charged to a patient in the “learning group” for a given procedure be reflective of this fact? Alternatively, perhaps “learning group” procedures should be performed on those cases and in a clinic setting keeping with patients from whom the hospital has little or no hope of recouping their customary fees for service? So much of robotic surgery and its applicable learning curve defies what ought to be the true economics of the situation, given our present system of medical care and billing.