Monday, April 2, 2012

CEO of Surgical Robot Maker “Spins” References to Favor His Product

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.


mdaware said...

I'm an ED resident, not a surgeon, but I reviewed some of the literature 2 years ago while interning with a news organization, and it seemed that all the literature in favor of robotic surgery showed an improvement in OR time. However, this was all measured in skin-to-skin time, i.e. did not include time taken to prep the gear before and after the case. Not surprisingly, all those studies were industry sponsored. Any thoughts?

Skeptical Scalpel said...

You are correct about skin-to-skin time. I am told that setting up the robot prior to making the incision takes upwards of one hour. This time is often disregarded by proponents of the device.

I'd like to see a reference. I am not aware of any good studies comparing OR times for the different methods.

T. said...

Have you looked at the references they cite in the latest (2011Q4) investor report?


Skeptical Scalpel said...

T, Thanks. I hadn't seen that. Very impressive. Maybe I should stop trashing the robot and invest in it. :-)

T. said...

You are very welcome. I have long wanted to start a series of interviews on my blog with all kinds of people around dealing with surgical robotics. If we find the time, would you be the first subject?


Skeptical Scalpel said...

I would be glad to help.

Anonymous said...

Has anyone thought what would happen if the "robot" had a malfunction and shutdown during the procedure and had to be rebooted?

Skeptical Scalpel said...

Yes, and what about doing a case remotely and a complication occurs which requires open surgery. What if the surgeon running the robot is miles away? Or there's a power failure?

Anonymous said...

Anybody surprised over this?;JCO.2013.53.5096v1

Well not me:
There aren´t any proven benefits, with reference to complications, when comparing robotic surgery to open surgery.

Skeptical Scalpel said...

Anon, of course I am not surprised. That paper has not changed the mind of even one robotic prostatectomist. That is no surprise either.

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