Resources: Articles

Rush to robotic surgery outpaces medical evidence, critics say Date: 03/03/16

Richard Mark Kirkner

By Richard Mark Kirkner

I was flipping through AARP The Magazine — yeah, I’m of that age — in January 2014 when I came across a small news item on robotic surgery. I can’t even remember whether it was favorable or negative, but it piqued my curiosity because I had some background with robotic surgery. I had been editor of a trade magazine for general surgeons back in 2003, when the first surgical robots began appearing in hospitals. I had a close-up view of robotic surgery growing from novelty to standard of care.

After I saw the item, I went to PubMed and found a few studies that reported varied results with robotic surgery, particularly with its growing use in gynecology. I also was aware, from my aforementioned days with the surgeon magazine, that robotic operations cost more than conventional surgery and required quite a learning curve for the surgeon and operating room staff.

So I sent a query to John Marcille, then editor-in-chief of Managed Care magazine, for whom I’d written years before but had pulled back from because of a full-time job and a term on my local city council. My term had just ended, and I wanted to get back into meat-and-potatoes, health-care journalism.

Marcille liked my pitch, and I went to work investigating a few different angles: the cost factor, of interest to the magazine’s key audience of executives and managers at health insurance plans; but, more important, the effectiveness of robotics. My article, “Rush to Robotic Surgery Outpaces Medical Evidence, Critics Say,” was published in the May 2014 issue of Managed Care.

It seems that hospitals around the country had been buying the da Vinci surgical robot, manufactured by Intuitive Surgical, for up to $2.1 million a unit (not to mention an annual service contract of up to $150,000 per unit and disposable instruments that add cost to each procedure) because of competitive market pressures not only to attract patients, but also lure new doctors.

Photo: Fort Belvoir Community Hospital via Flickr

The problem is, when a facility gets such an expensive piece of equipment it has to use it. That’s where digging into the medical evidence came in handy. The more studies I looked at, the more I saw that while robotic surgery had become the standard of care for surgical removal of a cancerous prostate, the results for gynecologic surgery didn’t hold up as well. Also, the caseload for gynecologic procedures far surpassed that of prostate surgeries. Hysterectomy has been the largest and fastest growing procedure for robotic surgery on the da Vinci system, having grown 36 percent in two years to 191,000 cases in 2013, while robotic radical prostatectomies declined 20 percent in the same period.

The clincher for me was a study by Marty Makary, M.D., and other researchers in the Journal for Healthcare Quality on the underreporting of complications from robotic surgery. I’d known Makary, a surgeon at Johns Hopkins, from my days with the surgeon’s magazine, and knew he was highly respected among his peers. He and I talked. That helped set the course for my investigative trail, which led to a statement by the American Congress of Obstetricians and Gynecologists that said robotic gynecological surgery was, “not the only or best minimally invasive approach. Nor is it the most cost-efficient.” Finding studies led me to more experts in robotic surgery. In all, I interviewed 10 people over two months.

Whenever new medical technology is put to use, hospitals and specialty clinics like to put the best spin on it. But it can take years for such new medical equipment to prove its mettle compared with existing methods.

A couple of resources were invaluable in shaping my story and tracking down sources. PubMed is a window to the world of medical research. While a reporter has to be careful when reviewing studies of medical procedures and drugs (avoid small studies, take a close look at large clinical trials and meta-analyses, and look for multiple studies that reach a common conclusion), PubMed can be a good resource to at least get a sense of what the medical community is thinking and to find experts. For my article on robotics, my AHCJ membership came in handy for accessing Health Affairs content — another excellent source for studies on clinical effectiveness.

Richard Mark Kirkner (@rmkeditor) is an editorial consultant and independent health care journalist in Phoenixville, Pa. In March 2015, Kirkner’s article on robotic surgery won a third place award in the trade publications category in the 2014 Awards for Excellence in Health Care Journalism.