Robots, Weight Loss Surgery, and a Twisted Tale Out of Baltimore

Cheryl Clark, February 21, 2013

Everything you know is wrong.

That phrase comes to mind after a cluster of surprises from news and research papers this week threw conventional practice wisdom onto the bird cage floor like yesterday's news.

First, there was the report showing that a common surgery for benign gynecologic disease such as fibroids produced no better patient quality outcomes when surgeons performed it using the expensive, and heavily marketed, da Vinci robot than when they operated with traditional laparoscopic techniques.

Only the price tag differed, with da Vinci procedures costing on average of $2,189 more. Yet the da Vinci performed 138,000, or 37%, of the total number of 376,000 procedures done by the robot in U.S. hospitals last year, according to the robot's manufacturer, Intuitive Surgical Inc.

The study, published in the Journal of the American Medical Association by Jason Wright, MD, of Columbia University,prompted a comment from Frank Loffer, MD, medical director of the American Association of Gynecologic Laparoscopists, which has recently raised questions about the robot's popularity despite a lack of evidence that it's a better choice for women undergoing a hysterectomy.

"Mainly this is marketing on the part of hospitals and physicians, persuading patients to come in fixed on the idea, saying 'I want the latest; I want a robotic procedure, and if you don't do it I'm going to go to the guy next door.'  Robotics is the latest and robotics is sexy," says Loffer, a gynecologic surgeon at the University of Arizona.

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