Invasion of the robots

In my institution, the surgeons are keen to get some government money to turn us into a robotic surgery centre. I fear they are doing it for the reputation and the referrals, but this would be cynical rather than skeptical (see upcoming blog on the difference). So I will simply say that they are not doing it to benefit the patients. They may think they are, but I am not aware of any evidence that patient-based outcomes are better with robotic surgery. I am however, aware of empirical evidence that robots cost a lot, because I have seen the bill.

It turns out that robotic surgery is yet another example of something that sounds good, with some research showing improvements in some aspects, but with the whole thing falling down when it comes to improving patient health.

Systematic reviews or the clinical research on robotic surgery are plentiful (although not nearly as plentiful as websites promoting robotic surgery) so I have looked at the most recent reviews for the most common applications.

1.     For bariatric surgery (for obesity), a review from this year failed to show any clinical benefit from robotic surgery.

2.     This recent review on urological surgery showed some improvement with certain outcomes (length of stay and blood loss) but not with patient health. And the best thing I can get out of this review of robotic prostatectomy from high volume centres is that it is “safe”.

3.     From 2011, this review on robotics for gynaecology showed no clinical benefit, and the Cochrane review on the same topic didn’t help the cause either.

4.     This paper, this paper and this paper, all from 2012 only showed that robotic surgery was feasible for colorectal surgery, with no clinical benefit.

5.     For cholecystectomy (removing the gall bladder), you only need to read the title of the Cochrane review to realise that having a robot do your operation  “appears safe but does not offer any advantage”. 

It is amazing how awestruck we are when we see high tech wizardry, and how we assume that it must be better than whatever it is that we are doing now. Ask for the evidence before paying thousands of dollars extra for robotic surgery (like many patients around here).

The blog that got me started on this was from Skeptical Scalpel, who picked up on a video clip of a robot folding a paper plane. The blog and the video are good, and they are an example of how we are impressed by the wrong things. Another post on robotics from Skeptical Scalpel (here) is an example of how authors can bias their findings by writing an abstract (summary) that is in contrast to the actual findings of the research paper. Robotic surgery is a pet subject of his, and his posts on subject are all listed here.