Thursday, 21 February 2013

Should we All have a Robot?

JAMA Network | JAMA | Comparative Effectiveness Research on Robotic SurgeryComparative Effectiveness and Robotic Surgery
An interesting leader in JAMA this week about the true usefulness and cost effectiveness of robotic surgery.

As someone who does not routinely practice either 'standard' laparoscopic/thoracoscopic surgery or robotic surgery, I think I am a good person to adjudicate on this. The usual gripe from traditional laparoscopic surgeons (such as Skeptical Scalpel) and others is that the use of a robot in laparoscopic/thoracoscopic procedures results in outcomes that are no better than those outcomes after similar procedures performed without the robot. This edition of JAMA has yet more evidence of this - in patients undergoing hysterectomy. Dissemination of the practice has resulted solely from aggressive monopolistic marketing from Intuitive Surgical, the company that makes and sells the DaVinci Robot. It is curious that all the ire comes from the USA where the free market has always reigned (so far at least) in healthcare rather than the UK where everything is tightly regulated from the centre. I suppose the number of Robots in circulation in the UK is still very small. Anyway I digress - I agree with these arguments against robotic surgery.  However, it is clear to me, as a beginner in the art of ...scopic surgery, that the freedom of movements provided by the robotic hands, makes this type of surgery easier to learn, more accurate and safer. Compared to open surgery, standard laparoscopy/thoracoscopy is akin to operating with bilateral frozen shoulders and elbows. If therefore the aim of surgery in general is to extend the scope of keyhole surgery (all patients want this) then robots are here to stay. The obvious problem is the fact that there is only one maker and supplier of surgical robots. As any student of economics will tell you, a free market with a monopoly will result in the worst of all worlds. The world needs multiple manufacturers and suppliers of many different types of cheaper surgical robots. Funnily enough she thinks so!