Last year, a slew of articles and studies claimed that doctors who play video games become more skilled surgeons. The people who laughed at this idea didn’t realize that the future of surgery involves robots wielding the sharp instruments while humans sit at the controls. Touted as minimally invasive (which supposedly means, among other things, a shorter recovery time), precise, and able to handle complex procedures, robotic surgery systems also don’t get tired, don’t cough or sneeze, and never dip into the pharmaceutical stash. Eliminating human error, which is the major cause of surgeries gone wrong, could only lead to better outcomes for people who go under the knife, right?
Not so fast, recent reports suggest. As marketing strategies convince more patients to undergo robotic surgery instead of conventional surgery, accounts of the damage done by these systems are on the rise.
Porter Adventist Hospital in Denver has been conducting robotic surgeries for a couple years. Warren Kortz, a surgeon there, predicted that robotic surgeries would “eventually replace everything else” when the hospital started using robotic systems for parathyroid surgeries. Last year, Kortz began operating the controls for a new gall bladder removal robotic surgery that involves only a single incision in the belly button.
While Kortz raved about the new techniques, some of his patients (10, between 2008-2011) were suffering from complications or additional surgery-related injuries, such as torn arteries, nerve damage, and something I would have figured only humans would do — objects left behind inside a patient’s body. One of these patients required CPR to survive, and another died. Complaints were made to the Colorado Medical Board, among them 14 unprofessional conduct charges, many of which resulted from patients asserting that Kortz never talked to them about alternatives to the robotic systems, and that he never told them about the risks. Kortz is only one surgeon, and those numbers are just the tip of the iceberg. The FDA had reports of 70 robotic-surgery related deaths since 2009, and reports of injuries are rising too.
Probably the best-known robotic surgery device is Intuitive Surgical’s daVinci System (see the video at the bottom of a da Vinci system peeling a grape). To operate the system, a doctor sits at a console and using a high-definition display to see all kinds of disgusting blood and guts and stuff. The doctor uses hand controls (and even foot pedals) to control the robotic arms that bear surgical tools. Intuitive Surgical gives every hospital that buys its system a marketing kit so it “can attract new patients, new referrals, and new hospital revenue.”
Intuitive’s aggressive marketing has been perhaps too successful. It claims that the da Vinci system “makes difficult operations routine” and that patient benefits include “excellent cancer control, less blood loss and transfusions, shortened hospital stay, less pain, low risk of infection, complications, fast recovery and return to normal activities, and small incisions for less scarring.” Wow — what’s not to love? Heck, that sounds fun!
Robotic surgeries have increased by 60 percent since 2010, and more than 350,000 of these operations were performed in 2012. Among the surgeries performed by robotic systems are heart valve operations, soft tissue operations, prostate cancer treatment, gall bladder removal, and hysterectomies. Intuitive’s website doesn’t guarantee the laundry list of benefits, and it points out that the da Vinci system may not work for every surgical situation or for every patient, which is a start, but if doctors don’t present other options or recognize possible shortcomings, then of course more patients are going to opt for the robot. Just so long as the nurses are human — somehow, I can’t see robots giving sponge baths. But I’m sure someday they will.
Intuitive’s website is just the beginning. The company has advertised da Vinci on YouTube, television, radio, and on billboards, making the same claims they do on their website. The problem is, studies were already reporting contradictory results, shedding doubt on whether robotic surgeries actually result in fewer complications and whether they’re really any better or safer than conventional surgeries. In fact, a 2011 study done at Johns Hopkins School of Medicine concluded that websites such as Intuitive’s “overestimate benefits, largely ignore risks and are strongly influenced by the manufacturer.”
Evaluating the efficacy and safety of the surgeries is only one of the problems — the U.S. Food and Drug Administration’s meager attempts at regulating the industry aren’t helping either. The FDA regulates pacemakers, titanium knees and hips, defibrillators, IV systems, and pretty much every other medical device out there. They’ve got their hands full — apparently so full that they’ve only had two full-time employees monitoring and evaluating the ads companies such as Intuitive are using to promote their systems. By comparison, the FDA has about 60 people evaluating ads for prescription drugs. The FDA did send a warning to Intuitive after finding some cases of the company not reporting adverse effects and device corrections. Intuitive’s stocks have also taken a dive.
Many doctors thought they’d be replaced by robots, or that their patients would leave them if they didn’t adopt these robotic surgical systems. “Learn to do this or you can get left behind” was the going sentiment, says Levine Cancer Institute gynecologic surgeon Wendel Naumann. He gave it a whirl, but didn’t find it to be beneficial, so he no longer uses the system.
Perhaps physicians are the first people who need to do their homework before buying into the hype. After all, their patients are generally going to do whatever they advise, which is how healthcare should work. We shouldn’t have to worry about doctors becoming blinded by the promises of technology, although ironically, one could argue that robots themselves wouldn’t fall for the same dubious assurances.