Robotic Technology Costs More and Has More Complications for Ovary and Cyst Removal

The use of robots in the surgical suite has a checkered history and a fat file of lawsuits by patients who suffered burns, bleeding and other serious harms. Another study has added to the record of woe: robot-assisted surgery to remove ovaries or ovarian cysts had more complications than more traditional and less invasive procedures, such as laparoscopy, and also was more expensive.

For these procedures, laparoscopy involves making a small incision into which surgical tools are inserted; robotic surgery involves the vaginal insertion of instruments controlled by the surgeon using a joystick. Screen-generated images guide both procedures.

As reported by (KHN), research by Dr. Jason Wright, chief of gynecologic oncology at Columbia University, suggests that removing ovaries with the help of a robot cost about $2,500 more than laparoscopic removal, and removing cysts cost $3,300 more.

Even more worrisome for most people than the additional cost, however, is that the women whose surgeries had been performed with the assistance of a robot were slightly more likely to have complications, including bladder injury, bowel obstruction or excessive bleeding.

We’ve called into question the widespread use of robotic surgery many times (here and here). Many people believe that although some disorders are appropriate for robotic technology, it’s overused because surgeons and hospitals make huge investments in the equipment, which encourages their maximum use, even if it isn’t the best option for certain procedures.

The Wright study reviewed the operations of nearly 90,000 women who had ovaries or cysts removed between 2009 and 2012, comparing the cost and safety of robotic surgeries with laparoscopy.

The study “really questions the utility of using robotic-assisted surgery,” Wright told KHN. “More studies need to be done before it’s accepted as the standard of care.”

The data didn’t show why there were complications. But recent reports of software glitches, battery malfunctions and difficulties in seeing through the robotic system’s lens were noted on the FDA’s Manufacturer and User Facility Device Experience database. We’ve blogged about poor surgeon training, as well.

Despite the extra cost and complications, Wright’s team said that the use of robots for these kinds of procedures is on the rise, from about 3.5 in 100 ovary removals in 2009 to 15 in 100 in 2012. Cyst removals showed a similar trend.

For now, according to Wright, “Patients need to understand the risks and benefits of different procedures… The newest, most high-tech thing that’s available isn’t necessarily the best.”

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