Now the province of only big, upper-tier hospitals and health systems, expensive and complex robotic surgery systems could begin making their way into medium-sized hospitals in the coming years.
Whether that’s a good or a bad thing for the U.S. health system — and its soaring costs to American patients — remains to be seen.
A recent report from patient safety group the ECRI Institute asked whether “costly robot wars” could be coming to America’s operating rooms, with the expected market entry of a competitor to the best-known surgical robot system, the multi-armed da vinci from Intuitive Surgical. The da vinci typically costs between $1.75 million and $2.25 million, and is most often used for prostatectomy and hysterectomy procedures, according to the report.
Another company, Titan Medical, is expected within the next few years to release a four-armed surgical robot called the Amadeus, which could be a lower-cost (but still expensive) alternative to the da vinci.
“With more than 5,500 hospitals in the United States, there seems to be room for more market penetration, and the features of the Amadeus system may be attractive to many facilities that have not yet adopted robotic surgery for general and oncologic surgical procedures,” the ECRI Institute’s report states.
But patients shouldn’t necessarily view the increased access to these high-tech surgical devices as a universally positive thing. The use of surgical robots in the U.S. is proliferating, even though there’s no conclusive scientific evidence that robots lead to better patient outcomes in many of the procedures for which they’re used.
That raises questions about whether the da vinci and similar technologies are merely contributing to the medical arms race — a rush by hospitals to keep up with the competition by adding more and more expensive new technologies that may or may not actually improve patient care.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
“Despite a lack of definitive evidence for the superiority of robot-assisted surgery compared to traditional laparoscopic surgery for many applications, steady growth in both the types and numbers of robotic procedures continues,” the report states.
Dr. Jeffrey Hazey, a gastrointestinal surgeon at Ohio State University Medical Center, shares that concern. He’s been using the da vinci for more than a decade and performs one or two procedures a month with the robotic system.
However, Hazey’s department uses the da vinci for just one type of procedure, called the Heller myotomy. It’s a complex procedure in which the muscles surrounding the lower esophagus are visualized and cut to treat an esophageal condition called achalasia.
Hazey calls the da vinci a “very expensive tool with not a whole lot of benefit.”
“It doesn’t make the operation any faster,” Hazey said. “It doesn’t change anything for the patient other than making it more expensive for us.”
It’s unlikely that robotic surgery devices will ever make it to small hospitals because the technology is so expensive and requires skilled surgeons, Hazey said. But if the technology does get a little cheaper — which is the expectation once Titan’s Amadeus hits the market — robotic surgery-assistance devices could begin infiltrating medium-sized hospitals, he said.
Just don’t expect that to be much of a benefit to patients. At this point, robotic surgery technology appears to be a classic example of commerce trumping medicine.
“It is very much a market-driven technology because there is no evidence that it’s superior as far as patient outcomes,” Hazey said.
