The year was 2000. A relatively unknown company called Intuitive Surgical amazed investors with a device that would change medicine forever: a surgical robot. That’s right, a robot that could perform surgical procedures in a less invasive manner, resulting in less blood loss, less pain and a faster recovery for patients.
The robot, called the da Vinci, was hailed as a revolutionary device that would render many complicated surgeries routine. Sales took off and in 2012, Intuitive Surgical saw a 21 percent increase in installations, even though the device is pricey, costing $1.5 million in addition to a $100,000 service agreement for each machine. The company also sells the disposable components that are required for surgical procedures.
During a robotic surgical procedure, a trained surgeon sits at a computer console located near the patient. He looks into a high-definition monitor and uses hand controls and foot pedals to control mechanical arms. These arms are equipped with surgical tools and a 3D camera that allows the surgeon to see the procedure as it is performed on the patient. It's Fantastic Voyage come to life- no shrinkage required.
Procedures Performed by Robots
Robotic procedures have been adapted for many procedures that have been traditionally performed using laparoscopic techniques. Robots have been touted by their manufacturers as offering better outcomes than laparoscopic procedures, and patients too report a quicker recovery time and less pain for specific surgeries such as:
- Bariatric surgeries for weight loss
- Reparation of atrial septal defects (hole in the heart)
- Heart bypasses
- Reparation of congenital heart defects
- Mitral valve repair
- Cystectomies (removal of the bladder)
- Partial nephrectomies (removal of a tumor in the small intestine)
- Removal of blocked ureter
- Hysterectomies (removal of the uterus)
- Myomectomies (removal of fibroid tumors from the uterus)
- Sacrocolpopexies (treatment of a prolapsed uterus)
- Salpingo-oophorectomies (removal of the fallopian tubes and ovaries)
- Prostatectomies (removal of the prostate gland)
However, the Journal of the American Medical Association has not found any evidence that robotic surgery offers better outcomes than other medically approved minimally invasive surgeries.
As robotic surgery has become more popular in the medical sector, however, concerns about its safety have increased. Although Intuitive Surgical denies any safety issues with the da Vinci machines, surgeons, former employees, patients and lawyers have given interviews to the contrary. There are several reasons behind the safety concerns including:
- A significant increase in lawsuits for complications, injuries and deaths following procedures performed by da Vinci robots. Since 2010, there have been 10 lawsuits filed and dozens of other cases went to arbitration.
- Surgeons are authorized to practice robotic surgery after very little training. They are required to take an hour-long online course, watch four hours of video showing two full-length procedures, spend seven hours practicing on a pig and perform just two surgeries under the supervision of a more experienced robot operator.
Some patients have reported complications with their surgical procedures including burns and heat-related damage to their intestines, bowels, ureter and other organs. Surgeons who have used this technology have said burns can occur outside of the robotic surgeon’s view and may not come to light until several days post-operative. In addition, the incidents of burns may be underreported because patients do not always link the use of a robot with their injuries.
Since 2000, there have been 85 deaths and 245 injuries reportedly linked to robotic surgery using a da Vinci machine. 4,600 total “adverse events” have also been reported to the Federal Drug Administration (FDA). Over that time, approximately 1.5 million procedures were performed using robotic surgical technology. While this may suggest that the reported events are not statistically significant, experts say the complications are grossly underreported.
As more and more surgeons are discovering these complications, they are choosing to perform traditional laparoscopic procedures rather than use the da Vinci or other robots. One of the problems is that surgeons are not able to directly feel the patient they are working on. This lack of “tactile feedback” increases the risk of rupturing a blood vessel, resulting in a dangerous situation. In addition, robots have been known to arc during surgery, causing burns that are out of the surgeon’s control.
The Future of Robotic Surgery and Obamacare
Clearly, there are some questions surrounding the effectiveness and safety of robotic surgery. That being said, most health insurance companies already pay for a surgical procedure performed by a surgeon-assisted robot and patients assume no additional out-of-pocket costs for this kind of procedure. Unfortunately, however, robotic surgery is currently more expensive than other methods, including the laparoscopic procedures that have been the gold standard until now. In addition, there is no conclusive evidence that robotic surgery improves patient outcomes except for reducing blood loss during the procedure.
One main focus of Obamacare is reducing medical costs. While having a robot perform your surgery, with the assistance of a surgeon is pretty cool, it isn’t very cost effective, particularly if there is no improvement in outcome. A 2010 study completed by the New England Journal of Medicine found that robotic surgery is about $3,200 more than a conventional procedure that produces the same result. This data could lead to an examination of the costs related to robotic surgery and to health insurance companies deciding to limit the use of robots for specific procedures.
Moreover, Obamacare increases the taxes on technology, which means that hospitals that want to add robots to their operating rooms will be required to pay even more for the da Vinci or any other model. These costs will undoubtedly be passed along to insurance companies and then to consumers. This is another reason the Affordable Care Act may cause insurance companies to exclude robotic surgery from coverage. There really is no reason to pay more for a surgery that can be performed at a lower cost and lead to the same results.
In the end, it seems like science fiction when you think about a robot performing surgery on humans. However, just because it’s possible, doesn’t mean it’s the best course of action. As health insurance trends move toward cutting waste and implementing cost-saving measures, the surgical robot might soon be out of a job.