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Cutting Edge: Robots and Surgery

Rating

2 Star

Cutting Edge: Robots and Surgery

Our Review Summary

The article discusses surgical robotic technology and provides a little drama by telling stories through the eyes of patients. A key weakness of the story is that the evidence used to support claims of benefit is not the best evidence or perhaps not even the right evidence. A stronger study (meta-analysis) concluded that it’s uncertain whether outcomes are improved with the new technology compared to standard techniques. Given that much of the story is devoted to surgical removal of prostate cancer, there should have been some mention of the controversy over treatment of early stage prostate cancer. Touting another way to do surgery on the prostate when we don’t know if any surgery or any treatment does more harm than good is not good journalism. Because the article does not provide accurate or objective information, the article is not balanced and leaves readers misinformed. The real issue of whether the marginal benefits are worth the marginal costs of a very expensive technology is yet to be determined and is not developed in the story.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

While costs of the machine are mentioned, costs per procedure and how that compares to standard

procedures (either open or laparoscopic) are not mentioned. Additionally, costs to the patient are not mentioned, since

patients may have out-of-pocket expenses associated with the new technology, even if they do have insurance coverage.

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

Not Satisfactory

While some benefits, like blood loss and days in hospital, are provided, they

are in relative terms–like 5 times the blood loss, 4 times as fast. More importantly, the evidence chosen isn’t the best

evidence– the numbers suggested are supported by stronger research.

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

Not Satisfactory

No mention of harms to the patient are reported. There are harms and

side effects with any procedure.

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

Not Satisfactory

Again, purported benefits are mentioned based on some early research and what appear to be

surgeon anecdotes, but later meta-analysis (2004) of the evidence does not support improved outcomes. The evidence quoted is

not the “right” evidence. Importantly, the article lacks any comment on the lack of evidence that treating early prostate

cancer does more harm than good.

Does the story commit disease-mongering?

Not Satisfactory

Descriptions of robotic techniques revolutionizing surgery are a bit premature given the lack of evidence that the

technology improves outcomes. Given that much of the story is devoted to surgical removal of the prostate for cancer, there

ought to be at least some mention of the controversy over treatment of early stage prostate cancer in general. Touting

another way to do surgery on the prostate when we don’t even know that surgery, or any active treatment, does more harm than

good is journalistic sensationalism.

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

Satisfactory

Independent

input about the purported benefits of the technology was obtained (Finlayson, Dartmouth). This expert points out the real

issue: whether marginal benefit is worth the marginal cost. Unfortunately, that issue is not developed in the story and a

counterpoint is immediately presented after Finlayson’s comments.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story mentions the alternatives of open and laparoscopic surgery for prostate removal.

Advantages (the story claims less blood loss, shorter hospital stays, etc.) and disadvantages (cost and surgeon training

time) of using robotic technology compared to open or laparoscopic technology are compared. But the purported advantages of

robotic technology aren’t supported by stronger, meta-analytic evidence, which concluded that it’s uncertain whether

outcomes are improved or not (Humphreys, Gettman, et al., 2004). Additionally, the article doesn’t even mention the very

important fact that experts don’t know whether any active treatment of early prostate cancer does more good than harm.

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

Not Satisfactory

Story states Da Vinci robotic system has had FDA approval

since 2000. While it also provides number of machines that have been purchased and provides number of estimated procedures

performed, it is up to the reader to “connect the dots” and put together that these figures mean that finding the technology

and/or a skilled surgeon to use the technology may have many obstacles. Also limiting availability is whether a man’s

insurance would cover such a procedure. Because these very real issues of availability are not developed, the story gets an

unsatisfactory grade on this criterion.

Does the story establish the true novelty of the approach?

Satisfactory

The story talks about robotic

technology as a new (since FDA approval in 2000) technique.

Total Score: 3 of 10 Satisfactory

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