In an interview on a website called MassDevice, Gary Guthart, CEO of Intuitive Surgical, maker of the Da Vinci surgical robot, offers many seemingly persuasive arguments regarding why the robot is revolutionizing modern surgery.
Here is an example of an interesting answer he gave to a question about a paper from the Journal of Clinical Oncology that said robotic hysterectomy was much more expensive than standard laparoscopic hysterectomy without demonstrable improvement in outcomes. Guthart said, “It turns out that the paper actually entirely misses the point, in that it compares laporoscopic [sic] to robotics, but the reality is that what's happening in the market is robotics are converting open procedures to robotic procedures.”
The paper didn't miss the point at all. It made the point that standard laparoscopic surgery is equal to robotic hysterectomy except for its cost.
He went on to cite a paper in European Urology [full text here] that he said: “covers 20,000 minimally invasive prostatectomy surgeries – almost all of which are robotic – and it covers 60,000 open patients. What it shows is that a length of stay for the minimally invasive arm is reduced by 2 days and that complications – basically every complication they measure – are less with robotic than open and mortality is significantly less with robotics than open.”
The paper was a study of a Medicare administrative database and compared 19,594 minimally invasive radical prostatectomies [MIRP] to 58,638 open radical retropubic prostatectomies.
The word “robot” is mentioned only six times in the paper, mostly in the context of this sentence from the “Methods” section: “A unique designation for robotic assistance did not exist during the study period; therefore, we were unable to distinguish pure laparoscopic from robot-assisted surgery, and both were categorized as MIRP.”
It’s true that minimally invasive surgery resulted in shorter lengths of hospital stay and fewer complications in this paper but the patients in the minimally invasive group were both significantly younger and had significantly fewer co-morbidities, p for both < 0.001.
The skeptic community still awaits a scientifically valid study that proves robotic surgery is better than standard laparoscopic surgery for any disease.
Thanks to Nathan @NJHM for alerting me to the interview.