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Robotic Surgery Oversold on Hospital Websites, Study Contends
Date:5/22/2011

By Steven Reinberg
HealthDay Reporter

FRIDAY, May 20 (HealthDay News) -- Many hospitals tout the benefits of robotic surgery on their websites without solid scientific evidence to back up those claims, Johns Hopkins researchers report.

In fact, four out of 10 hospitals in the study only used manufacturers' claims that robotic surgery is better than conventional surgery, an assertion that the researchers said is unproven and misleading.

The findings are especially troubling since consumers depend on hospital websites for reliable, trustworthy information, the study authors said.

"Hospital websites are a trusted source of medical information for the public," said lead researcher Dr. Marty Makary, an associate professor of surgery at Hopkins.

"This is the first time we've seen industry create content, with disclosures, and put it on the official hospital website to educate patients about treatment options," he said. "To me, that's a very scary trend."

Robotic surgery has grown more than 400 percent over the past four years, Makary pointed out. "It's one of the great modern crazes," he said. "And the public is driven by the idea that more technology means better care."

Proponents say robot-assisted surgeries require smaller incisions, are more precise and result in less pain and shorter hospital stays. The study authors said those claims are unsubstantiated.

The growth of robotic surgery has been driven by hospital marketing, Makary said. "Marketing a robot has become a very successful strategy for hospitals. It implies the hospital has state-of-the-art care," he said. "Patients may perceive the hospital is on the cutting edge because they do robotic surgery."

Makary noted that often hospitals do not mention the material on their website was provided by the manufacturer, and the sites often fail to mention the risks associated with robotic surgery. Risks include being under anesthetic longer and needing to have a second incision to place the robotic arm, he said.

In addition, the researchers looked at the claims made about the benefits of robotic surgery on these sites. "Frankly, the claims are overstated," Makary said. "Improved cancer outcomes -- that's ridiculous."

Thirty-two percent of the sites claimed that robotic surgery improved cancer outcomes, the researchers found. Makary pointed out that in the studies of robotic surgery, patients suffer as many complications as they do with conventional surgery.

Eighty percent of the robotic surgeries done in the United States are urological and gynecological, Makary said. There have been no randomized trials in these areas comparing robotic and conventional surgery, he said.

"To me, this is exactly what is wrong with American health care," Makary said. "We are adopting technology without being up front about the outcomes to consumers. And we adopt technology before we properly evaluate it."

The report is published in the May online edition of the Journal for Healthcare Quality.

For the study, Makary's team looked at the websites of 400 hospitals with 200 beds or more. They looked for whether robotic surgery was available and what information was provided on the hospital's website in June 2010.

They wanted to see how many hospitals used photos and text directly from the manufacturer of the device and what claims were made about the efficacy of robotic surgery.

The researchers found 41 percent of the websites detailed the availability of robotic surgery and how it worked. In addition, 37 percent of these sites had the information on the home page and 66 percent had a link to another page.

The information on 73 percent of these sites came directly from the manufacturer and 33 percent offered a direct link to the manufacturer's site, Makary's group found.

Moreover, 89 percent of these sites said that robotic surgery was better than conventional surgeries. The claims included less pain (85 percent), shorter recovery (86 percent), less scarring (80 percent) and less blood loss (78 percent). No hospital website mentioned risks associated with the surgery.

Chris Simmonds, senior director of marketing services at Intuitive Surgical Inc., the maker of the da Vinci Surgical System, which is the most widely used robotic system, acknowledged that the company does provide ready-made marketing materials for hospital websites.

Simmonds disputed Makary's findings, however.

The evidence of the benefits of robotic surgery is well-documented, Simmonds said. "All the indicators in terms of length of stay, blood loss, complications and cancer control are all better," he said. The company does tell hospitals the system does provide better patient outcomes, he said.

Dr. David B. Samadi, chief of robotics and minimally invasive surgery at Mount Sinai Medical Center in New York City, said that "there is some truth to what Makary says."

"There is a lot of misinformation on some of the websites out there, and patients have to really dig in and make sure the information is correct," he said.

However, the key to successful robotic surgery is the same as any other surgery, namely the skill and experience of the surgeon, Samadi said. "This technology in the hands of an experienced surgeon is a great tool, but if you don't have the adequate training it could be quite dangerous," he said.

The procedure is being oversold, Samadi added, and it is sometimes being done by inexperienced surgeons.

"It's up to patients to get a second opinion," he said. Before undergoing robotic surgery, patients need to understand the risks and benefits and be confident that the surgeon is well-trained and performs many such procedures each year, he said.

More information

For more information on robotic surgery, visit the U.S. National Library of Medicine.

SOURCES: Marty Makary, M.D., M.P.H., associate professor, surgery, Johns Hopkins University School of Medicine, Baltimore; David B. Samadi, M.D., chief, robotics and minimally invasive surgery, Mount Sinai Medical Center, New York City; Chris Simmonds Sr., director, marketing services, Intuitive Surgical Inc., Sunnyvale, Calif.; May 2011 Journal for Healthcare Quality, online


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