Surgical robot use criticized in new report

Using surgical robots for procedures on the ovaries, fallopian tubes or ovarian cysts does not produce better outcomes and also has higher costs, a study published this month argues.

Robotically assisted adnexal surgery—any surgery involving ovaries, fallopian tubes or ovarian cysts—had a small but statistically significantly increase in complication rates compared to laparoscopy, the common alternative to robotic surgery, according to the study, published in the October issue of the journal Obstetrics & Gynecology.

In each of the procedures that the authors studied, the medial total cost for a robotically assisted procedure was higher when compared to laparoscopic surgery for the same treatment. For example, the total median cost for a robotically assisted oophorectomy—a surgical procedure where a patient has one or both ovaries removed—was $7,426, while a laparoscopic oophorectomy was roughly $4,922.

The authors also raised concerns about whether the use of bundled payments for adnexal surgery would mean lower reimbursement for physicians who choose to use a surgical robot and the patients who would have higher out-of-pocket costs.

“In summary, these findings highlight the need for more prudent policies to guide the development, testing and use of surgical innovations,” the authors concluded. “Before widespread acceptance, additional rigorous data supporting the safety and comparative effectiveness of robotically assisted adnexal surgery should be collected.”

An increasing number of experts have questioned the clinical evidence and higher costs associated with surgical robots, which can cost a healthcare provider between $1.5 million and $2 million to purchase. Intuitive Surgical, the only company with a robotic system approved by the Food and Drug Administration, has reported that about 1,500 hospitals in the U.S. have installed the da Vinci Surgical System in the nearly 15 years it's been on the market.

But using robotic surgery instead of laparoscopic surgery for procedures such as hysterectomies is on the decline. The American College of Obstetricians and Gynecologists, in particular, has been critical of the marketing of the da Vinci system. “There (are) no good data proving that robotic hysterectomy is even as good as—let alone better—than existing, and far less costly, minimally invasive alternatives,” ACOG President Dr. James Breeden said in an often-cited statement from 2013.

Intuitive Surgical is expected to release its third-quarter earnings Oct. 21. The company in July reported that sales of new systems fell 34% in the second quarter of 2014, compared to the same quarter a year ago.

Follow Jaimy Lee on Twitter: @MHjlee