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Robot surgery finding new uses
April 07, 2009
Another story about the growing uses for robotic surgery. But the story gave no data or evidence, framed it like playing video games, and failed to put into context of other available procedures.
Our Review Summary
This was another story about the growing uses for robotic surgery. And it was another story that read like an ad for the DaVinci robotic system. This one focused on bladder surgery. Good points: the story discussed patient cost and insurance coverage and mentioned the expense of the equipment and the physician training required.
But the story was troubling for a number of reasons:
- No discussion of data or evidence.
- Framing the procedure like playing video games - "It's like shooting at space ships." Even though the surgeon interviewed said this, it would have been interesting to get a primary care doc's reaction to this comment. In fact, any independent source would have been appreciated.
- The informed consent process was only described by the patient as "The doctor mentioned that he would be doing it robotically. I was more interested in what they were doing than how they were doing it." A choice is made by journalists about whom to include in stories. Perhaps it would be more helpful for readers if the story included someone who was more of an active participant in the decision-making process. But this patient was probably provided by the surgeon or the medical center as a model, successful patient.
- The robotic assisted laparoscopic procedure described should have been put into context with the open surgical procedure and a simpler laparoscopic procedure. All have both positive and negative aspects. The less invasive approaches overall result in shorter hospital and recovery times as compared to open traditional procedures. However, the long term outcomes (tumor recurrence and bladder function) with these limited approaches are unclear. The story fails to note this important aspect of new technology adoption.
Even with prostate cancer, for which robotic systems have been used most often, the US Agency for Healthcare Research and Quality says there isn’t enough research yet to tell us how well robotic surgery works compared with other treatments.
That should have been part of this story. Somewhere between "video games" and "shooting at space ships."
Click on Criteria for definitions.
The story states that the robotic surgical systems have popped up at 1,000 hospitals worldwide in the past 5 years. However, this implies that the procedure (robot assisted laparoscopic cystectomy) is similarly available. This is not likely to be the case. A recent review of the literature suggests that approximately 350 cases have been reported to date. The story appropriately notes that the University of Miami is one of the few centers using the DaVinci for this purpose.
The story states: "private insurance pays for the $50,000 operation."
There really isn't any substantive discussion about the condition(s) for which the robotic system is used.
A major shortcoming of the story: no evidence was discussed - only one surgeon's experience. But no discussion of evidence or data.
In fact, the absolute value of robot assisted laparoscopic surgery compared to laparoscopic surgery and open procedures is unclear at the present time. While there may be short term advantages to laparoscopic surgery (robot assisted and non-robot assisted) over open procedures, the long term functional outcomes are unknown for bladder removal due to cancer. In addition, the ability to remove all cancer present using laparoscopic procedures is also an open question when compared to the open and traditional approach. The story provides a single and presumably somewhat biased informant (the surgeon doing the surgery) to validate the technique.
No discussion of evidence on harms. But in a story that frames this - through the surgeon's words - as like "video games....like shooting at space ships" - perhaps this is understandable.
That surgeon says the system is "more precise...there's less pian. less blood and a shorter recovery time." But no evidence is provided to support that. The possible short term gains of less pain, less blood and shorter recovery time need to be balanced against the possible harms of an incomplete cancer removal and a possible recurrence of the cancer.
The story gives some background on the history of, and other uses for, robotic surgery and states "robotic surgery isn't new."
Again, no data nor evidence for efficacy were presented.
Does not appear to rely on a news release.
Besides the Miami surgeon profiled, a Mayo surgeon was interviewed. But both are robotic system users. No truly independent source was interviewed.
No meaningful substantive comparison with other approaches was included.
Total Score: 4 of 9 Satisfactory
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