OB/GYN group: Robotic surgery not the best choice for routine hysterectomies

Hospitals still bullish on technology to boost market share and attract surgeons
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Robotic surgery for hysterectomies shouldn't be the first--or even second--choice for women undergoing routine procedures, the American Congress of Obstetricians and Gynecologists said in a statement.

"Expertise with robotic hysterectomy is limited and varies widely among both hospitals and surgeons. While there may be some advantages to the use of robotics in complex hysterectomies, especially for cancer operations … studies have shown that adding this expensive technology for routine surgical care does not improve patient outcomes. Consequently, there is no good data proving that robotic hysterectomy is even as good as--let alone better than--existing, and far less costly, minimally invasive alternatives," wrote ACOG President James T. Breeden, M.D.

There's a learning curve with the system, and patients of surgeons learning it may have more complications, the group added. 

The Food and Drug Administration is surveying hospitals on complications, outcomes and dangers with Intuitive's da Vinci robot. The FDA says it's conducting the probe in response to an uptick in adverse event reports, including organ damage and device failure, and the agency wants to figure out if they result from user error or design problems with da Vinci, FierceMedicalDevices reported earlier this month. 

A spokesperson for Intuitive Surgical, which makes the da Vinci robotic system, told Bloomberg News that "evidence supports that robotic surgery has dramatically decreased the number of open hysterectomies in the U.S." and that the company's website "is fully sourced with clinical outcomes data."

Meanwhile, hospitals have embraced the system for its ability to attract top surgeons and market the technology aggressively. Twenty-five bed Pullman Regional Hospital in Washington, for example, spent $2 million on the system in 2011. The hospital's CEO told The Seattle Times that was the price to lure a new urologist to practice at the tiny facility.

And Lois Hole Hospital for Women in Edmondton recently launched a campaign to raise $3 million in hopes of becoming the first hospital in Canada that uses the technology exclusively for women's health, according to CTV News.

In the Bloomberg article, Mario Leitao, a robotic gynecology surgeon at Memorial Sloan-Kettering Cancer Center in New York, called the ACOG statement "misguided," one that "reflects a lack of desire to move the surgical field forward."

He expressed similar views in an editorial accompanying a study in the Journal of Clinical Oncology that found  no significant differences in the rate of complication rates for robotic hysterectomies versus laparoscopic hysterectomies.  Rather, the big difference was in price: nearly $1,300 more for the robotic surgery. 

Meanwhile, the mainstream media has also come under fire for gushing about the technology, as outlined in a blog post at healthnewsreview.

A study published last summer at American Journal of Obstetrics and Gynecology found that hospitals' online marketing relied heavily on materials from the manufacturer while only 3.7 percent of websites mentioned cost and only 1.6 percent mentioned possible complications.

To learn more:
- here's the statement
- check out the Bloomberg article
- find the Seattle Times story
- read the CTV News report
- here's the blog post

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