Numerous physicians try to push patients towards new hi-tech robotic surgeries. But are these actually any better than normal surgeries? And which procedure is more expensive? Are their differences in fatality rates?
New reports show that contrary to popular belief, robotic surgeries are not better than conventional surgical methods. Apparently they do not cause fewer complications than regular surgeries.
Reuters uses bladder surgery as an example.
“Using robotic techniques to remove a cancerous bladder doesn't reduce the risk of complications compared with conventional ‘open’ surgery, according to a new comparison of 118 patients conducted by surgeons at the Memorial Sloan Kettering Cancer Center in New York,” according to Reuters.
The study was recently published in the New England Journal of Medicine.
It touches on the first ongoing comparison of the risks and advantages of the two different types of surgical techniques. Previous studies found that the robotic technique meant less time in the hospital and fewer complications. However those reviews were done by looking back at the records of patients who had already been treated.
Dr. Laudone who co-authored the study told Reuters, “There's been a lot of hype surrounding robots and it's been hard to gain perspective. The bottom line is: It looks like it was pretty much a wash. if you're going to a surgeon who is experienced in traditional surgery and recommends traditional surgery, that's a reasonable recommendation.”
Around twenty-five percent of bladder removals are done via robotic surgery right now. Almost 70,000 bladder tumors are discovered in the United States every year. And apparently, if surgery is needed, robotic surgery probably is not the better way to go.
How is conventional surgery more beneficial?
Reuters reports, “The study also found that patients who underwent conventional surgery spent about twenty-eight percent less time in the operating room. They experienced more blood loss - about 5 ounces more - but ‘with that amount, we wouldn't expect to see any significant side effect. These results highlight the need for randomized trials to inform the benefits and risks of new surgical technologies before widespread implementation’.”
The new study was conducted using patients who needed both the bladder and nearby lymph nodes extracted from the body. In these cases, the men also lost their prostate and the women lost their ovaries, fallopian tubes, uterus and related organs. Surprisingly, even in surgeries where a $2 million robot was utilized, conventional surgery was also still employed to redirect urine to the intestine.
What were the results? “With robot-assisted surgery, 22 percent of the 60 patients had at least one serious complication within the first 90 days. A complication was regarded as serious if it required further surgery, intubation or major rehabilitation. The rate was essentially the same - 21 percent - with traditional surgery. When the researchers included lesser complications, such as those requiring intravenous medicine or blood transfusion, the risk was 62 percent with robot-assisted surgery versus 66 percent with open surgery.” according to Reuters. This evidence shows that robotic surgery is not superior to conventional methods in many ways.
Researchers also found that the average length of hospital stay was the same for both groups- around eight days. However, not every component of both techniques was the same. The patients in the robot surgery group spent two hours longer in the operating room than the patients who received conventional surgery. The average time was 5 hours and 29 minutes for people who underwent conventional surgery and 7 hours and 36 minutes with robotic assistance surgery.
“Robotic surgery has become a selling point for many medical centers across the country. Last year, robots were used in 422,000 surgeries. That's up 15 percent from the year before,” according to CBS.
The researchers essentially found that there was nothing that made robotic surgery better than conventional surgery in most cases. Yet people are paying higher costs and spending more time in the operating room for robotic surgeries. For example, robotic bladder surgery is around $2000 more in cost to the patient than conventional bladder surgery. Also, hospitals usually spend over a million dollars on each robot machine.
Dr. Bochner from Memorial Sloan Kettering led the study and told CBS,
“The decision on whether or not to use robotic surgery depends on whether it will be better for the patient. What has to be paramount in the decision making is, 'Does this improve patient care?' Because if it doesn't, then it shouldn't be incorporated, and the cost really won't be justified. The rise in robotic surgery has led to a fall in teaching young doctors how to do open surgery. That raises a question for the future: Even if further studies favor the open technique in some cases, will enough doctors still feel comfortable doing it?”
The authors basically came to the conclusion that it is more important and effective to train surgeons well for conventional surgeries rather than focusing on training them to perform robotic surgeries on patients.
One patient from the study who underwent robotic surgery told CBS, “Everybody thinks that modern technology is going to solve most of the problems, but in this case here it wasn't much of a difference.”