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Robotic-assisted surgery offers consumers advantages, but is it really better?

This article first appeared in the St. Louis Beacon, Aug. 24, 2012 - If it weren’t a robot, somebody might have named it Dr. da Vinci.

The machine is skillful enough to use minimally invasive techniques to perform complex surgery. Patients generally are said to experience less pain, less bleeding and shorter hospital stays after going under da Vinci’s knife.

Robotic-assisted surgery is taking hold at a few area hospitals. SSM DePaul Health Center seems to be among the leaders. In an announcement this summer, it said the latest da Vinci Surgical System was providing the “most advanced robotic surgical technology” in the area at its SSM Robotic Surgery Institute.

Regular laparoscopic procedures also use cameras and tiny instruments for performing surgery, but the robotic approach is more sophisticated, says Dr. John “Jay” Moore, chief medical officer at DePaul.

Situated a few feet from the patient in the operating room is the actual surgeon, who sits before a monitor that offers a 3-D view inside the patient’s body. Moore says the robot’s surgical instruments are small, finely tuned and easy to use after practice. The surgeons rely on their hands and feet to manipulate the robot to reach places inside the body they otherwise couldn’t reach when using tiny incisions. “The doctor does the surgery on camera and is able to take out your appendix or gallbladder without completely opening your stomach,” Moore said. 

He adds that robotic surgery is useful in treating numerous illnesses, such as heart problems, various forms of cancer and kidney and gynecological conditions.

While pointing out the value of this surgery, Moore acknowledges that some of the claims about robotic technology are based on a manufacturer’s hype rather than fact. A study in the American Journal of Obstetrics & Gynecology found that many of the selling points about robotic surgery have been based on marketing material supplied by manufacturers rather than on research. The study also concluded that while patients undergoing robotic surgery bled less and recovered quicker, the outcomes for some procedures weren’t necessarily any better than those from regular surgery.

And da Vinci isn’t cheap.

“You’d think that with fewer side effects, shorter (hospital) stays and other issues, it might be cheaper for the hospital to do this,” Moore says. “But the equipment is so expensive and the amount of time the (surgical) procedure takes is longer. So it ties up our operating room for a longer period.”

One report in FierceGovernment, a weekly internet newsletter, says surgical robots cost between $1 million and $2.5 million each. The manufacturer, Intuitive Surgical Inc., of Sunnyvale, Calif., is said to have sold about 2,200 robots worldwide.

The price tag is probably one reason few area hospitals own a da Vinci. But that could change over the years. Medical technology, no matter how expensive, eventually finds its way into nearly every hospital. Time was when only a few area hospitals had a sophisticated medical imaging machine, such as a CT scan or a MRI. Now they have multiple imaging technologies. Some critics argue that an oversupply of high tech equipment drives up the cost of health care.

Aside from the high price tag, hospitals have another disincentive to invest in a da Vinci. Medicare and private insurers don’t pay higher reimbursement rates for performing operations with state-of-the-art robotic technology.

While this robot doesn’t increase a patient’s cost directly, it does boost “macro level cost,” Moore says. “As you’re forced to invest in more expensive technology, you’ll see fees for everything go up by a few pennies here, a few pennies there. You spend more for the same service, and you make less.”

But Moore notes that cost isn’t the only factor that hospitals take into account when buying goods and services.

“The interesting question for me and for the hospital is the clinical effectiveness,” Moore says. “The data we looked at before has told us that patients who get this procedure robotically will have fewer side effects, less pain and so on.”

He acknowledges that new medical literature comparing some procedures now suggests that “there might not be a clinical difference between robot surgery versus non-robotic surgery.”

But there’s a preference among some patients for high tech medicine and the least invasive surgery possible. That’s one reason Moore believes investing in da Vinci has been a good decision from the point of view of marketing and prestige. “Some patients are attracted to places that have technologically superior” medical  equipment. “They look at a place like DePaul and say they have a robot there, so they must really be advanced. And surgeons say you have to have this in your toolbox.”

Moore adds that, “We want our name to be associated with the hospitals that have this higher prestige. So from a marketing point of view, it makes sense to get one.”

At the same time, he stresses that DePaul isn’t interested in buying every piece of high tech equipment that’s hyped by manufacturers.

“Just because something is technologically advanced, it doesn’t mean it’s better.”

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.