Surgical robot news release puffery – here a 1st, there a 1st, everywhere a first 1st

Trudy Lieberman recently wrote a guest blog post on this site headlined, “Dissecting press release puffery.” What follows is what you might call a sequel by Trudy. 


This time it’s the long arm of a surgical robot that a healthcare seller hoped would make news. “Midtown Surgery Center Announces First-Ever Use of Robotics During a Total Extra-Peritoneal Hernia Procedure,” the news release said informing us that its “Groundbreaking Use of Robotics Could Change the Face of Inguinal Hernia Repair.” It was that old press release trick I wrote about a couple weeks ago—shout to the world you’re the first, and patients will flock to the door.

The da Vinci surgical robots made by Intuitive Surgical, a Silicon Valley innovator, have been around for several years and are often used for prostate and gynecological procedures, and in some kinds of hernia repairs using laparoscopes. However, according to the Midtown Surgery Center news release, roughly 70 percent of all hernia repairs are still done the old-fashioned way by making large incisions in the groin instead of using laparoscopy, which involves much smaller incisions and shortens recovery time. So it’s not surprising the news release appears to be another way to drum up business and help expand the market for Intuitive’s technology. It’s a classic strategy for finding new uses for drugs and medical devices already being sold.  And like most others, this release served up glowing testimonials about the product’s wonders such as this from Dr. Mark Reiner, whose medical group appears to be one of the physician-owners: “There is no doubt that the robot dramatically simplifies the laparoscopic procedure. It is because of this that I now believe robotics will be the future of hernia surgery.”

I turned to Paul Levy, the former head of Beth Israel Deaconess Medical Center in Boston who now writes a blog called “Not Running a Hospital,” where he has discussed the marketing efforts of Intuitive Surgical. What’s going on here, he told me, is that the company, which has saturated the market for robotic prostate surgery, needs a new use for robots, and hernias are good candidates. In this case the news release also aims to bring more patients to Midtown Surgery Center in New York City, a physician-owned practice that’s been in business for four and a half years. The Center, it seems, knows a thing or two about news releases. Exactly three years ago this week, it sent out a news release promoting another robotic technology, the MAKOplasty, made by MAKO Surgical Corp. The release called MAKOplasty “a state-of-the art robotic arm-guided procedure” that offered patients quicker and cheaper alternatives to traditional knee surgery techniques and instruments. The Center also noted it was New York state’s “first ambulatory surgical facility to fully support” the new technology. (Note:  Levy has written about MAKOplasty, as well – “More robots, more questions.”)

Fast forward to mid-March of this year. Was Midtown Surgery Center in New York City really the first using robots for this particular procedure?  A spokesman for Dr. Reiner said the Center had done an exhaustive search of published materials and found none about this particular procedure performed with a robot. They say they also checked in with other experts in the field and other hernia specialists. (A simple web search turned up all sorts of results about robotic total extra peritoneal inguinal hernia repair. See screenshot of search results below.  We’ll let the claimants argue with each other about who was first with which procedure.)


Regardless, should a claim like that be sufficient assurance of the procedure’s safety and efficacy to send hernia patients scurrying to the eastside of Manhattan to be one of the first patients to undergo this particular kind of hernia repair?  As I noted in my first “puffery post,” sometimes you want a well-documented track record before embracing something so new. Levy put me in touch with Dr. Bruce Ramshaw, a Florida hernia surgeon who is the immediate past president of Americas Hernia Society.

On the NY center’s “first” claim, Ramshaw said:

“I honestly don’t know what they meant by ‘first ever.’ The total extra peritoneal hernia repair is a specific laparoscopic approach for inguinal hernia repair. It is always difficult to determine who was the first to do what in surgery.  Also they could have meant the first in the U.S. or state or city. I was one of the first to do a large volume of this specific lap inguinal hernia repair and have well over 1,000 so the robot would not add much value for me if any for this particular technique.”

Ramshaw said that doing laparoscopic repairs was tricky business and that’s why so many doctors don’t use them. He said he did not use robots in his practice, but the device “potentially has value to enable more surgeons to do laparoscopic repair.”

But is it better for patients?  That’s the big question news releases don’t answer. But Ramshaw says the real questions are what’s the value to the patient, and where does the robot have value in the context of each patient care process and for each local environment. “The robot is great technology. It’s cool,” he says. But he notes that like all drugs, devices, and screening tests, robotic surgery systems have value in some situations, cause harms in others, and may be wasteful in still others. “Unless we measure the value to patients, we won’t know the actual value of the tool,” he concludes. The country is a long way from measuring the value of such medical interventions. Instead news releases and seller marketing prowess substitute for real information about whether a patient should undergo this procedure or others that have limited or no objective evidence about whether they add value and for whom.

You have to hand it to the technology companies. Getting doctors and surgery centers on board is smart marketing. A few years ago the CEO of a regional medical center in Nebraska told me of his misgivings about buying a robot for urological surgery. It was an added expense of more than $1 million, and he said he was not convinced from the evidence it was worth it. Urologists in the area thought otherwise and continued to push the hospital to buy it and threatened to send their patients to facilities in nearby cities where they could get robotic surgery. Eventually he bought the device. Paul Levy had a similar experience. Other hospitals in the Boston area had bought the da Vinci Robot Surgical System, and finally he did too. Prospective medical residents felt that the absence of a robotic surgical system was a deficit in the hospital’s training program and physicians were taking patients elsewhere. “The device cost $l.5 million, and the money came from earnings capital that would have gone to some more useful piece of equipment,” Levy told me.

These kinds of press releases are another form of direct-to-consumer advertising, which does stimulate demand—demand for often unproven technology that threatens to overwhelm the U.S. health system. Such technology may one day be useful and cost effective, but for now it adds mightily to the country’s healthcare tab. Those little one-sided news releases pack a big wallop.

Reminder from Publisher Gary Schwitzer:  We plan to introduce our first systematic criteria-driven reviews of health care news releases as early as next week – releases from medical journals, hospitals, academic medical centers, drug companies, device manufacturers and others.  Look for an updated announcement early next week. 

Also see my related post, “Step Right Up And Be The First In Your Region To Get Robotic Surgery for ___?___,” with a visual gallery of marketing promotions for robotic surgery “firsts” from across the U.S.


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Comments (2)

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FV Sutton

April 8, 2015 at 1:24 pm

I wish for you (not on you) an experience that will rescue you from your ignorance. Not a personal attack, just your reality – and that’s okay. That’s why we have marketing and that’s why we let people know when something is being done differently. It is a common error to focus on upfront costs for minimally invasive surgery. Initially, it’s the lower costs and benefits of laproscopic surgery: shorter lengths of stay, lower infection rates for example. But then one realizes that the vast majority of procedures in the abdomen are still being done OPEN! Why? Because proficient lap skills are very difficult to attain. What the da Vinci robot has done is to restore OPEN intuitive principles to minimally invasive surgery, namely Wristed, articulating instruments and 3D Vision. That’s why women today have only a 1/3 of the open hysterectomies they used to have, even decades after the lap HYST was introduced. Because the robot has been able to do what lap surgeons could and can not do: dramatically reduce the incidence of the incredibly invasive OPEN hysterectomy. So I applaud other pioneering surgeons and specialties who are now venturing into a more minimally invasive approach, ie General and Colorectal Surgery. Keep letting us know where you are!

    Gary Schwitzer

    April 8, 2015 at 3:59 pm

    FV Sutton:

    Let me remind you (I’ll give you the benefit of the doubt that you have forgotten, rather than calling you ignorant as you have called us):

    The robotic hysterectomy you so praise is the procedure that led the president of the American College of Obstetricians and Gynecologists to write:

    “Many women today are hearing about the claimed advantages of robotic surgery for hysterectomy, thanks to widespread marketing and advertising. Robotic surgery is not the only or the best minimally invasive approach for hysterectomy. Nor is it the most cost-efficient. It is important to separate the marketing hype from the reality when considering the best surgical approach for hysterectomies.”

    And if you leave a comment like that on this website again, with language you claim is not a personal attack, but is there for all to see it as it is, it will not be posted.

    The full comments policy on our site includes this quote from another website I admire:

    “Shed light, not just heat. Facts, challenges, disagreements, corrections — those are all fine. Attacking the person, instead of the idea or the interpretation, is neither acceptable nor helpful.”

    I hope you learn from our light; keep your heat to yourself.