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A surgeon’s hands or a robot’s?

Rating

2 Star

A surgeon’s hands or a robot’s?

Our Review Summary

Yes, the story included mini-caveats, such as: 

  • "does not necessarily mean outcomes are better"
  • "hospitals market aggressively"
  • "hefty price tag"
  • "some equipment malfunctions have been reported"

But, no, the story did not quantify any of these major points.  It did not give details or data on meaningful outcomes.  It did not give estimates of how much hospitals spend marketing the technology.  It did not explain what the cost to patients would be.  It did not quantify harms.  And it did not seek truly independent sources’ perspectives.  
 
While there are no carefully controlled studies comparing outcomes between robotic surgery and more traditional approaches, there are analyses examining outcomes in peer-reviewed publications that refute some of the assertions made in this article – assertions that – in the end- threw the story out of balance.

The story was misleading and is likely to feed into unrealistic patient expectations which might contribute to the disappointment in the outcomes reported by patients.   

 

Why This Matters

Patients apparently have unrealistic expectations for robotic procedures and one study concluded: "Patients who underwent (robotic prostatectomy) were more likely to be regretful and dissatisfied, possibly because of higher expectation of an “innovative” procedure. We suggest that urologists carefully portray the risks and benefits of new technologies during preoperative counseling to minimize regret and maximize satisfaction."  We pass along similar advice to journalists: carefully portray the risks and benefits. 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

 The story included a cost estimate for the equipment along with a quote from a spokesperson for a professional society for those using this sort of instrumentation indicating that there was no cost difference to the patient or insurance company.   This seems like an incomplete and possibly biased report about the costs to consumers for making use of this technology.  The costs per procedure are considerably higher with robots and the amount passed on to patients is unclear.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story reported, using prostatectomy for treatment of prostate cancer as an example, that patients having a robotic procedure were less likely to need blood clots,  and needed less pain medication.  However – there was no quantitative data presented or even a discussion about the source of the information used for the comparison.

The patient who went back to work after taking off the weekend following robotic surgery is atypical.  While recovery time is faster with robots, patients still usually require a few weeks.

Rather than focusing on the short term, the major benefits to consider are cancer control, survival, and long-term quality of life after treatment.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story indicated that the instrumentation for robotic surgery can be ‘really dangerous in the wrong hands’.  However it provided no estimates on the frequency for this sort of problem.

The story included some questions to use when considering robotic surgery.  One of these was to learn about the conversion rate (i.e. what are the chances that an open procedure will be needed to complete the procedure?  However the story itself gave no information about how commonly this occurs. 

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story does not mention specific studies comparing the outcomes obtained with robotic, laparoscopic, and open procedures.  The writer paints with a broad brush without being clear about the source of the data or even providing qualitative information on outcomes.  Instead of quantitative information with a source, it uses lines like "…surgeons say that…."  That’s not an evidence-based approach to health journalism.

Does the story commit disease-mongering?

Satisfactory

 The story does not engage in overt disease mongering.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

 It appears that all the doctors quoted in the story were either affiliated with the Pennsylvania hospital group described or the instrumentation.  While those quoted were adequately identified, there were no seemingly independent sources interviewed for this story.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

 The story provided readers with a positive impression about robotic surgery but could have done a better job about distinguishing how it compares and contrasts with open surgery and with laparoscopic surgery.

Particularly troubling was the human interest story at the beginning about the patient who chose to have robotic surgery as opposed to an open radical prostatectomy to treat his prostate cancer during tax season so that he could get back to work quickly.  There was no mention of the fact that most often early stage prostate cancer is slow growing and that a patient can take weeks or even months to decide on treatment.  So from the little information in the story, it appears that if he wished, he could have put off treatment altogether until after the tax season crunch. However – this was not mentioned as one of his treatment options.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

 The story included a list of hospitals that had the equipment for robotic surgery so that at least locally, readers can tell which hospitals do and don’t have the equipment. 

Does the story establish the true novelty of the approach?

Satisfactory

The story was clear that the devices used for robotic surgery are available at certain locations and this instrumentation has been in use for several years.

Does the story appear to rely solely or largely on a news release?

Satisfactory

 Does not appear to rely solely on a press release.  

Total Score: 4 of 10 Satisfactory

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