Is Robotic Surgery Better?

Harvard Health Letters

Q. A hospital in the area is advertising robotic surgery. Is it really any better than having a surgeon do the operation?

A. The first robotic surgery was performed over 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, like gallbladder removals, with laparoscopes -- tubelike instruments with video cameras on the ends -- and long-handled surgical instruments, all of which are inserted through small incisions. 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 that's being operated on. And the smaller incisions of laparoscopic surgery have made a big difference for patients: there's less pain and scarring, and people usually recover much faster, so hospital stays are shorter.

Robotic surgery is being touted by some as the next generation of laparoscopic surgery. In the most common setup, surgeons 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 large robotic arms that maneuver the surgical instruments inside the body. The machines are expensive to buy (the price tag is well over $1 million) and operate (disposable instruments are used for each operation).

It's impressive technology, but what are the benefits? Unfortunately, up to this point, there's remarkably little, if any, evidence that robotic surgery helps the patient or the surgeon. For example, studies comparing robotic with standard laparoscopic approaches for prostate surgery haven't shown any real improvements in recovery times or key functional outcomes (impotence, urinary problems). Yet more hospitals are buying these machines, not out of any real medical need or demonstrated advantage, but because of smart, skillful 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. That's why you are seeing ads from the hospital in your area.

Surgeons are now using the machines to perform cardiac, rectal, thyroid, and other operations. Surgeons at the hospital where I work, Massachusetts General Hospital, are doing robotic surgery. I'll keep an open mind. There may be some benefit. But so far, I think 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. -- Richard A. Hodin, M.D., Massachusetts General Hospital, Harvard Health Letter Editorial Board

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