Friday, February 3, 2012

Why robotic cholecystectomy may not become the standard way to remove a gallbladder

I have written in the past about robotic surgery pointing out that there is no proof that it is better than regular laparoscopic surgery.[Here and here]

Some think I am a Luddite. Other asked if I remembered all the naysayers 20 years ago who said that laparoscopic surgery was unnecessary. The answer is “Yes, but this is different.”

Here is why robotic cholecystectomy may not be the standard of care in the future.

Yesterday, a former resident of mine asked me if I thought he would be excluded from performing gallbladder surgery if he did not take a course in robotic surgery. I said I didn’t think so but since this thing is being marketed so heavily, it may become consumer-driven. He then told me that the hospital where he works has only one robot.

The lights came on.

There are about 700,000 cholecystectomies done in the US every year. How many robots would have to be purchased at $1.5M apiece to accommodate the volume? General surgeons would also be competing for use of the robot with gynecologists, urologists and colorectal surgeons, to name a few.

Will it be practical for busy hospitals to buy three or four robots? Are there more important things to spend health care dollars on? I think so.


T. said...

I do not believe that volumen would be a hard limit here. Currently there are over 1550 da Vincis in the US. There are 5500 hospitals. Intuitive and Titan assumes there is a placement opportunity for around 5-8000 robots, depending on their capabilities. even at the current occcurance, that means only 10 R-chole/robot/week. That is not that farfetched number! Although the current average usage rate for the robot falls behind this number.
I think it's more about the fact that lapchole is still a valid, competitive alternative, and a lot cheaper.

Skeptical Scalpel said...

Dear T.

I appreciate the comment but I hope you are wrong. At $1.5M per robot placing 5000 more would cost $7.5 billion for an unproven technology.

Tony said...

Well, just for the record let me say I just had a robot assisted ventral hernia repair. While many of the posters here have an opinion they are just that. There are some good advantages to robotic assisted surgery. Recovery time being one item among many. The key here is that a good surgeon will most likely always be good, but poor one will always be poor! The problem with reimbursement is laid at the insurance companies door steps. Many of the companies hire very under educated people to process claims turning many down because they are encouraged to do so. This hurts the bottom line for other physicians as well as hospitals. As a physician YOU pick up a phone once in a while and talk to a claims person. Then you might begin to understand some of the real issues.

My insurance company, for this surgery, recommended a certain surgeon that didn't even practice in the city they cited. I laughed at their choice.
So please gather all the facts first. Well this is 2015 now. So maybe your article is really out of it. Oh yes please post said video of surgeon operating with knife and fork. Bullocks.

Skeptical Scalpel said...

Tony, did you read the post? It's about cholecystectomies, not hernias. Despite your anecdotal experience, there is not a shred of proof by any study that repairing a hernia with robot assist results in any better outcomes for the patient than a standard laparoscopic hernia repair.

For the record, you don't need to tell us physicians about arbitrary decisions by morons at insurance companies. We've all talked to many clerks.

Your comment about a knife and fork lost me. I don't know what you are referring to.

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