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:
Legitimate questions can and should be raised about any new medical technology. This story raised few, but let true-believer-surgeons promote their pet technology. One said he "loves his robot."
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."
The story states: "private insurance pays for the $50,000 operation."
Again, no data nor evidence for efficacy were presented.
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.
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.
There really isn’t any substantive discussion about the condition(s) for which the robotic system is used.
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.
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 gives some background on the history of, and other uses for, robotic surgery and states "robotic surgery isn’t new."
Does not appear to rely on a news release.