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Is Robotic Surgery Right for You?

Hospitals tout the benefits, but doctors are concerned about the number of casualties

A horizontal action shot of an operating room featuring the da Vinci Si Surgical System (©2013 Intuitive Surgical, Inc.)

Surgeons demonstrate the da Vinci Si robot. — 2013 Intuitive Surgical, Inc

En español l In 2010, Paul Elliott, then 55, a high school teacher at a public school in Gonzales, California, checked into a hospital to have his prostate removed.

When he awoke, he had no feeling in his shoulders and arms. During the eight-hour operation, his body had been suspended in a steep head-down position to accommodate the positioning of the robot used to assist the surgeon. Elliott suffered nerve damage and never regained full use of his left hand.

Elliott is one of more than a million people in the U.S. who have undergone robotic surgery since it was introduced in the 1990s. He is also one of a growing number of casualties.

While robotic surgery dates to 1992, when a 64-year-old man had his hip successfully replaced with the assistance of a machine called Robodoc, it wasn't until the U.S. Food and Drug Administration (FDA) cleared the da Vinci robotic system in 2000 for a large swath of minimally invasive procedures that the concept took off.

Calling Dr. Robot

Over the past decade, some 2,000 surgical robots have been sold in the U.S., and the number of robotic procedures, for everything from delicate head and neck surgery to routine hysterectomies, has soared by 30 percent each year. Experts attribute the surge to aggressive marketing that plays up the robot's wow factor.

"Billboards and TV commercials can make hospitals that have the robot seem more high tech and cutting edge," says Karen Schoelles, M.D., medical director of the ECRI Institute, a nonprofit research organization that assesses safety and cost-effectiveness in patient care.

But robots in the OR may not be living up to their promise. "Years of data tell us that for many procedures, there's no benefit to the patient over standard minimally invasive surgeries," says Marty Makary, M.D., a surgeon at Johns Hopkins Hospital in Baltimore and author of several studies on robotic surgery. "While the robot provides a benefit in some operations, most uses are for procedures where there are no advantages and there may be potential risks."

Hysterectomy, the second-most-common surgery for American women, is a good example. According to a recent Journal of the American Medical Association study of more than 250,000 procedures, hysterectomies performed with the da Vinci robot had no better outcomes than those done through laparoscopic surgeries.

"All of the studies so far show it's no better or worse, but it takes longer and is more expensive," says James T. Breeden, M.D., immediate past president of the American Congress of Obstetricians and Gynecologists.

Reviews of studies on other operations, including gallbladder removal, colorectal surgery and procedures to reverse reflux, have reached similar conclusions.

The FDA originally cleared the use of surgical robots for general laparoscopic surgery — minimally invasive procedures done through small incisions — which reduces the risk of infection and speeds recovery. Other uses have been added since.

Next page: Risks versus rewards. »

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