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Local news hype of robotic surgery doesn’t match many hysterectomy patients’ experiences

Gary Schwitzer is the founder and publisher of HealthNewsReview.org.  He has written many times about the proliferation of robotic surgery systems.  He tweets as @garyschwitzer.

Click here to read more stories about real people harmed by misleading messages, or share your own story.

Many journalists seem enthralled with robotic surgery systems.  For local journalists — especially local TV journalists — the video of the robotic arms and the surgeon using the hand controls from a distance away from the patient seems all too exciting.

In Secaucus, New Jersey, it’s news when a hospital simply acquires a surgical robot. The announcement promises that the robotic system results “in very small incisions and very little blood loss, enabling patients to go home the same day or the next day.” No data provided to back that up.

In Roanoke, Virginia, it’s newsworthy simply to announce that a local hospital is celebrating the one-year anniversary of having a robotic surgery system. The TV station doesn’t question the surgeon’s claim that fewer painkillers are needed after robotic surgery.  No data provided to back that up.

In Little Rock, Arkansas, a math teacher who had robotic surgery makes the news.  She said in the story, “If you need me to tell anyone what a good experience this was, I will.” The story emphasized pinpoint accuracy and quick recovery. No data provided to back that up.

And in Albuquerque, New Mexico. the titillating angle was that men are now getting robotic surgery inside a local women’s hospital. The TV station admitted that a hospital marketing banner is what caught their eye to do the story. The marketing continued in the so-called “news story.” The surgeon is quoted as saying, “I can actually make one small incision in the belly button, make it cosmetically look very nice. They go home the same day and the benefits are tremendous.”  No data provided to back that up.

Note that in order to watch this news clip from KOB-TV in Albuquerque, you must first watch a brief commercial from local injury lawyers.  Hmmm.  Keep reading below to see the irony in that juxtaposition.

Finally, a Lima, Ohio TV station thought it was newsworthy when a local surgeon performed his 1,000th robotic operation.  (Would they consider it newsworthy when a pediatrician saw her 1,000th patient?)  They apparently did not consider it newsworthy that the surgeon, according to the Dollars for Docs ProPublica project, accepted nearly $20,000 from the maker of the robotic surgery system in 2016.  In the story, the surgeon helped the local hospital’s marketing effort by saying that this demonstrates that even in Lima they can be on the cutting edge of new technologies and it doesn’t occur only in major cities.

All of these stories were reported recently over about two weeks’ time.  All over the United States, these kinds of fawning, drooling stories about robotic surgery appear all the time. And the robotic devices continue to be purchased by more and more hospitals, providing even more marketing magic for patient-needy medical centers.

Quite a different story about robotic surgery – specifically robotic hysterectomy – is being told in a new documentary that debuts July 27 on Netflix.  It’s called “The Bleeding Edge.” (The film also looks at problems from the Essure contraceptive device, with metal-on-metal hip joints, and with vaginal mesh.) Here’s a video clip from the documentary:

Amy Herdy is a journalist who was a producer for this documentary.  “When researching the da Vinci robot,” she told me, “we heard about a case of vaginal cuff dehiscence, which is small bowel evisceration after hysterectomy, and is life-threatening. Research shows it can occur more frequently with robotic hysterectomies. When I heard about that first case and the frightening details, which included the woman’s intestines literally falling out of her vagina, I thought it was one of the most awful things I ever heard, and I’ve been a journalist for more than 20 years. And then, to our horror, we learned of another case….and then another…and then yet another…until we realized we had to do the entire segment on those horrific stories. The public deserves to know about these cases so they can make informed decisions that factor in the very real potential risks, not just the slick marketing that is presented by the manufacturer.”

Radio ad & billboard lured Lori Shanyfelt

“Quicker recovery…smaller incisions…less blood loss…less pain.”

Lori Shanyfelt

Those were the promises that Lori Shanyfelt remembers from the radio ad she heard and the billboard she saw near her Indiana home – ads that changed her life.  She says she never would have pursued robotic surgery for her hysterectomy if she hadn’t seen and heard the ads from a local hospital.  She was told that she needed a hysterectomy but she kept putting it off because she didn’t want to go through what she saw her mother go through with a hysterectomy 30 years ago.  And the robotic surgery seemed to be the answer.

But, she told me, “What I thought would be my answer turned out to be my worst nightmare.”

She had the robotic procedure, but then experienced increasing bleeding, followed by infection, followed by vaginal cuff dehiscence and, in all, had four surgeries in 13 months.  Needless to say, the ad claims were all negated:  Quicker recovery – no; smaller incisions – not after four operations; less blood loss – no; less pain – hardly.  In the end, she thinks she ended up worse off than her mother did 30 years ago.

In the midst of all of this happening, she began to question her doctor about the things she’d been reading questioning the safety of robotic surgery.  He said that was “just a bunch of ambulance-chasing attorneys trying to scare people. ”

Jen Nelson, hysterectomy, Mayo Clinic, 2017

Jen Nelson before and after robotic surgery

Jen Nelson said she wasn’t told anything about complications from robotic surgery when it was recommended to her – as the only option discussed – for her total hysterectomy because of one very large fibroid tumor and several smaller ones in her uterus. She says that when she went home from her pre-op visit, she searched online and found many links to the HysterSisters.com website.  She said that all of the comments about robotic hysterectomy on the site were positive.  “Everything I read on the site was ‘real’ patients raving about the robot.  I thought it must be great.”

It wasn’t great for her.  She wrote to me: “I had three reparative surgeries, a colostomy, treatment for severe sepsis, a drain inserted for the abscesses, and a lot of physical therapy. I have pain always, deal with fecal impact since my colostomy reversal, can only sleep on my back, and live daily with a stomach that resembles what the Bride of Frankenstein’s might look like.”

She went back to the HysterSisters.com website to tell others about her experience. But her posted comment was removed by the website. She later discovered that Inuitive Surgical, manufacturer of the daVinci robotic surgery system, is an advertising sponsor of HysterSisters.com. She says the site lost all credibility with her at that point.

Journalists – and their news organizations, like the ones featured at the top of this post – lose credibility when they present unquestioning, gee-whiz stories about their local hospital’s acquisition of robotic surgery systems or any new medical devices.  Our 10 news story review criteria provide guidance for the kinds of questions that should be asked.

Journalists, patients, health care consumers and news consumers need to critically analyze claims of “very small incisions, very little blood loss, quick recovery, pinpoint accuracy, less pain medication required.” Jen Nelson and Lori Shanyfelt are among the women who did not have those experiences.

Patients can ask about the rates of complications in the hands of the surgeons using the robotic controls.  And when a surgeon recommends robotic surgery for a particular condition, patients can ask how many of those exact same procedures the surgeon has done, and they can then do a little homework online about what the projected learning curve is for surgeons using the robot for that procedure. The manufacturer often shows doctors practicing on a grape. Since your body is not a grape, the true surgical learning curve on people is worth knowing.  Let’s say it takes a surgeon more than 100 procedures to proficient; do you want to be patients 1 through 99?  Some suggested reading resources are listed below.

Other reading

Underreporting of robotic surgery complications – article in Journal for Healthcare Quality (You can also read the Johns Hopkins Medicine news release about this paper)

Unexpected Outcome in Hysterectomy Study – MedPageToday.com.  Excerpt: “Women undergoing radical hysterectomy for early cervical cancer had a significantly higher risk of disease recurrence and worse long-term survival with minimally invasive surgery, including robotic-assisted procedures, two separate studies showed.”

Salesmen in the surgical suite – The New York Times

Expensive robots may not be making surgeons — or patients — much better – The Washington Post

Unplug the robot – a blog capturing many womens’ bad experiences with robotic surgery.

2015 opinion from the American College of Obstetricians and Gynecologists and the Society of Gynecologic Surgeons. Excerpt: “Reporting of adverse events is currently voluntary and unstandardized, and the true rate of complications is not known.”

2013 public caution from the American College of Obstetricians and Gynecologists.  Excerpt: “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.”

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Comments (9)

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Lois Vestal

July 17, 2018 at 4:04 pm

If an individual does their homework and seeks a surgeon that one, has an excellent reputation, two, performs 6-8 total hysterectomies per week, and three, the surgeon uses a renowned hospital, you can be assured robotic surgery will be successful unless, of course, unexpected complications arise as they may with any major surgery.

    Gary Schwitzer

    July 17, 2018 at 4:50 pm

    Lois,

    Thanks for your note. But, to be sure, there are a lot of “ifs” attached to it.

    How does an individual do homework on robotic surgery when complications are under-reported or not reported? When the American College of Obstetricians and Gynecologists states that “the true rate of complications is not known.” How does one effectively investigate a surgeon’s reputation? What is the optimal learning curve for robotic surgery in a given use? These can be overwhelming questions for even a savvy health care consumer to research.

    And then, yes, those “unexpected complications” arise. But is it really “as they may with any major surgery”? MedPageToday.com recently reported, Unexpected Outcome in Hysterectomy Study. Excerpt: “Women undergoing radical hysterectomy for early cervical cancer had a significantly higher risk of disease recurrence and worse long-term survival with minimally invasive surgery, including robotic-assisted procedures, two separate studies showed.”

    Given what is known – and questions about what is not known – I’m not sure about the assurance of success that any one patient faces.

    Gary Schwitzer
    Publisher

Susan Eller

July 21, 2018 at 10:20 am

Being a patient that has suffered complications from hernia mesh, I am hoping that this problem will make it into the light like the vaginal mesh problems. I, too, was convinced that I needed a robot-assisted hysterectomy when my pelvic and groin pain first started. Of course, I trusted my doctor and had the surgery. Turns out I didn’t need a hysterectomy at all. It didn’t relieve my symptoms because my symptoms were caused by a femoral hernia. This is how the nightmare began and after 10 surgeries, I am still recovering from the damage of polypropelene hernia mesh, that it turns out I am allergic to. Having a device implanted that you are allergic to, and having trouble finding a doctor that believes it,, can wreak havoc on your body. Watching the clip for Bleeding Edge has me in tears. It is unbelievable the amount of suffering the medical device industry has caused. My life has been changed in ways I never would have imagined and I am so sorry for all who have been affected and continue to suffer, some in silence with no support. This should never have been allowed to happen!!

Lynn Bakeman

July 24, 2018 at 12:14 am

Gary, thank you for your thoughtful reply to Lois as I wouldn’t have wanted her method for finding a surgeon to remain unchallenged. I’ve seen the inside of too many hospitals and been at the hands of “the best” surgeons at “renowned hospitals” who have been so darn sure of themselves they have rushed through surgeries and missed things. They are human after all but I have a healthy skepticism of an industry whose basic underpinnings are supported by big pharma dollars.

Susan, your story broke my heart. I have had 7 eye surgeries this year for something that should have been easily fixed four years ago. I’m in my 50s and have to learn how to live with permanent damage because someone wasn’t doing their job. There are too many stories like ours.

Deborah Hoyle

July 24, 2018 at 3:14 pm

I had a radical hysterectomy in 2017. All my female organs were removed with a robotic machine. It was the best surgery I ever had and I was up in two days with no pain. I think since it is a new tool, many doctors may need more training to not cause problems later.

Elizebeth Harmon, MD

July 29, 2018 at 11:05 am

This is a sad day. I researched the robotic system stats years ago. They claim fewer complications. Dig deeper and they are comparing the robot stats to abdominal hysterectomy stats. They never compare themselves with vaginal hysterectomy stats. Vaginal hysterectomy is the gold standard for safety, complications and cost. Doctors are not doing their research. If it takes 100 cases to get skills proficient and the average OB/Gyn does 24 cases per year how can that happen? Every case must be done with the robot! True consent does not happen because you need the cases. Now we have a generation of OB/Gyns who don’t learn how to do vaginal hysterectomies so it is expanding the robot business based on hype, data manipulation and less safe options for women. It is a shame in the OB/Gyn world. ACOG has published recommendations and statements advising that the robot is not the best option and it has been ignored. The medical literature is not hard to read or understand and for some reason nobody seems interested in researching for actual facts. The news media is to blame but so is the medical profession. I wrote a term paper about this titled “Just because we can, does not mean we should”. It was a few years ago but it was my personal review of the literature regarding safety and outcomes for routes of hysterectomy. Where are the investigative reporters? Even this story is incomplete. Go do your research and really tell the story. What literature are the robot’s claims based in? What does ACOG have to say? Dig just a little before publishing. This story just scratched the surface and you could do so much more. Show me what real investigative reporting is all about.

    Joy Victory

    July 30, 2018 at 9:13 am

    Thanks for your comments. It is absolutely a topic that needs a deep dive from a savvy investigative journalism team. (Our role is not investigative journalism; we focus solely on surfacing issues at the intersection of health care and the news media–and there are many.) We hope our work inspires journalists to pick up the baton. You also may want to reach out to journalists in your local market and encourage them to investigate.

    Gary Schwitzer

    July 30, 2018 at 11:40 am

    We did link to ACOG warnings at the end of the piece.

    Gary Schwitzer
    Publisher

Elizebeth Harmon, MD

July 29, 2018 at 11:21 am

To Lois: what is an excellent reputation! How do you define this? For robot surgery it is usually based on marketing by the hospital that just spent millions of dollars on their robot and has convinced their surgeons that robot surgery is better. Does an excellent surgeon then abandon a safer, less expensive and less or equally painful procedure that takes 3-4 times longer to perform? I can complete a vaginal hysterectomy in the time it takes to get the patient prepped to start a robot hysterectomy. Patient goes home same day. Minimal pain. Fewer complications. Cost less. Once again I question if an excellent surgeon would do this??? Kind of feels like a contradiction.