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Robotics vs. laparoscopy: Investment priorities may be changing

March 11, 2013    | Comments (5)

Becka DeSmidt

With such a hefty price tag attached to the da Vinci robot, many hospitals we work with wonder: How many of the 450,000 robotics procedures performed in 2012 alone were worth the additional cost?

High cost, little gain in robotic hysterectomy case

When compared to open surgery, minimally invasive techniques require smaller incisions and lead to shorter hospital stays, less postoperative pain, and faster recovery for patients.

Recent research published in the Daily Briefing uses the example of benign hysterectomies to assess the impact of the robot on patient outcomes compared to laparoscopy—both minimally invasive techniques, but one vastly more expensive than the other.

Unfortunately, the study found that despite higher costs, the robot did not confer significant clinical advantages in the cases considered.

Study conclusions

The study’s conclusions look bad for the robot. However, there are exceptions to this discouraging outlook for robotic hysterectomies. Some procedures do improve patient outcomes when switching from open surgery to the robot, and certain patients with comorbidities or especially challenging anatomies may benefit more from robotic procedures.

Why continue to invest?

Despite the negative press on the effectiveness of using the robot, we see hospitals continuing to market this technology for three reasons:

  • Physicians are coming out of residency trained in robotics and many require it as a condition for practicing at a hospital.
  • Hospitals feel that if they do not have the robot, they will be left behind.
  • For procedures that are currently done openly, it can make a big difference. Providers should prioritize these procedures over procedures already done laparoscopically.

Impetus for investing may soon change

As hospitals become more focused on finding cost-effective patient care alternatives, the robot may become a less attractive investment. Intuitive Surgical is still pushing the robot into new areas, such as general surgery, but these efforts may be met with scrutiny.

Many general surgeons already perform procedures laparoscopically and are less interested in switching over if there is not a clear benefit to their patients.

Many members have recently expressed skepticism toward investing, and administrators are not as willing to bend to physician demands as they have been in the past. However, da Vinci sales are growing, albeit at a slower rate, indicating that hospitals haven’t yet made the shift away from robotics.

Where Does Your Facility Stand on Robotics?

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Posted in: Service Lines, Clinical Research, Clinical Technology

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What Your Peers Are Saying

Rating: | Jacques de Toeuf | June 25, 2013

High costs for minor or no patient benefit.
But marketing reasons prevailed on EBM data.

Rating: | Phyllis Youngblood | May 28, 2013

My current facility owns 7 DI Vince Robots. Physicians who have been well-trained ( fellowship programs) or have performed large numbers of procedures with the robot, have excellent clinical outcomes. The same is true with expert clinicians who use an open approach. The outcomes of the surgery are more dependent upon the skill of the surgeon rather than the surgical modality.
At an ACCC fall conference in 2010, one urologist, Dr. Raj Langani, presented data that showed the cost of a robotic prostatectomy in his community hospital was actually more cost effective than the open procedures, when surgery volumes are high. The clinical outcomes were superior to the national norms for both open and robotic cases.

Rating: | Rod Hayhurst | April 08, 2013

We currently utilize an S platform robot - almost exclusively for Gyn and Urology cases, some General - and are actively evaluating for replacement/upgrade to the single port Si platform. Big price tag - with little trade-in value for the perfectly working old. Subject to same sales dynamics as mentioned above & in comments.

Rating: | Ann Gantzer | March 13, 2013

We are actively involved in trying to determine the feasibility.

Rating: | Kenneth Natzke | March 12, 2013

This subject really speaks to the worst of the U.S. healthcare system. Too many hospitals have been pulled into providing this service by the likes of Intuitive Surgical because Intuitive wants to sell product and once the competition starts facilities are afraid to be "left out". Surgeons are subject to the same forces. This is so unfortunate because robotic surgery is more expensive, more time consuming, and frankly leaves more scars than good laparoscopic surgery. Robotic surgery has its place;however, the sales machine has pushed the envelope so far patients are not being well served.

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