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Robots Are Becoming An Integral Part Of Surgery, But Are They Worth The Cost?

Karen Finney / Courtesy
 

Karen Finney / Courtesy

The Da Vinci robot is sleek and white. Its mechanical arms are outfitted with high-resolution cameras and a gamut of surgical tools.

The UC Davis Medical Center acquired the latest model this month, adding to a fleet of robots that help out in the operating room. A surgeon makes the first incisions themselves and then controls its arms from a consul a few feet away.

Dr. Bahareh Nejad, an OBGYN and director of the center’s robotic surgery program, says the machines have a few advantages.

“Because they have a 360-degree range of motion, it’s actually better than the human wrist at times,” Nejad said. “We’re able to angulate around these really large and difficult organs with the robotic system with the small incisions, and then simply take out what we’re removing through a small hole.”

She says smaller and fewer cuts help patients recover faster and reduce the risk of infection. The new model can perform some surgeries through just one incision, or through a natural opening.

Despite those advantages, some experts are questioning whether the benefits of this technology outweigh the costs.

The robots are expensive — roughly $2 million each — and the existing body of research shows the high-tech surgery offers limited advantages. And there are some health risks. Patients sometimes stay under anaesthesia longer because of the time it takes to set up the robot, and the U.S. Food and Drug Administration has documented concerning technical glitches during surgery.

“It’s high-tech, it’s got software, it’s got a lot of moving parts,” said Diane Robertson, director of health technology assessment for the ECRI Institute, a nonprofit that tracks the safety and efficacy of medical innovations. “So there are a lot of things that potentially could go wrong or malfunction. And that happens.”

Most major hospitals have robots, including Sutter Health, Kaiser Permanente and Dignity Health in the Sacramento region.

Robots are involved in less than 5% of surgeries. Market analysts predict that will grow to one in three U.S. surgeries by 2021.They’re commonly used for hysterectomies and prostate removal, though they can also perform gastrointestinal, cardiac, or head and neck surgeries.

But Robertson says patients should ask questions when their doctors try to push robotic-assisted surgery.

“For most procedures that the Da Vinci is used for, although there are a lot of potential benefits and claims made about those potential benefits, there is not evidence that clearly shows that those benefits are achieved,” she said.

Nejad disagrees. She says the benefits of surgical robots are clear, and the risks are minimal. At UC Davis, surgeons complete a thorough training process before getting clearance to use the Da Vinci system. Equipment specialists are on standby, and surgeons are always prepared to switch to traditional methods if necessary.

She says this technology has the potential to change the surgical landscape in even bigger ways.

“The horizon is artificial intelligence, where the robots and the systems themselves will help us navigate the operation, instead of just being the equipment,” she said. “I hope that we can operate completely remotely. I hope that we as surgeons could help people on military fields, for example, without being there.”

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