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