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Is robotic surgery better?

The first robotic surgery was performed in the mid-1980s. Now thousands of operations are being done with the assistance of robots. A better term might be robotic instrumentation because, ultimately, there’s always a human surgeon with his or her hands on the controls.

Even without robots, a lot of surgery is less hands-on than it used to be. For decades, surgeons have been doing many common abdominal operations with laparoscopes — tube-like instruments with video cameras on the ends — and long-handled surgical instruments. Surgeons watch magnified images on video monitors to see what they are doing so they can guide the surgical instruments.

There was a learning curve, but laparoscopic surgery is actually easier to perform in some ways than surgery done with direct visualization through large incisions and with instruments that bring the surgeon’s hands in closer contact with the tissue. And the smaller incisions have made a big difference for patients: there’s less pain and scarring, and people usually recover much faster, so hospital stays are shorter.

During robotic surgery, surgeons usually don’t stand at the operating table, but instead sit and watch a video console that displays three-dimensional images. They use computer controllers to guide the robotic arms that maneuver the surgical instruments inside the body. The machines are expensive to buy and also to operate, since disposable instruments are used for each operation.

It’s impressive technology, but what are the benefits? Unfortunately, up to this point, there’s little, if any, evidence that robotic surgery helps the patient or the surgeon. Yet more hospitals are buying these machines, not out of any real medical need or advantage, but because of marketing by the companies that make them. Once a hospital has robotic surgery equipment, it needs to justify the cost by marketing it to the public.

Surgeons are now using the machines to perform cardiac, rectal, thyroid, and other operations. There may turn out to be some benefit. But so far, much of robotic surgery has been a costly experiment in marketing that has mainly benefited the companies that make the machines. In health care, we have to resist falling into the trap that newer is always better.

June 2011 update

 

Harvard Health Letter

It's important to keep up with the medical news that affects your health and well-being. It's even better when the facts come directly from the more than 8,000 doctors and researchers at Harvard Medical School. There is no more trustworthy source of medical research articles and advice than the Harvard Health Letter. Learn more »