Robotic Surgery and the Low End of the Learning Curve

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Austin Frakt points us today to a new study that compares the effectiveness of robotically assisted hysterectomies vs. laparoscopic surgery. “Both approaches provide benefits compared with open surgery,” says an editorial in JAMA, “including smaller incisions, shorter hospital stays, less postoperative pain, and possibly quicker return to function.” But the robotically-assisted surgery costs more without providing any improvement in outcomes. “On these results alone,” says Austin, “the call is a simple one. At current prices and on the basis of health outcomes, robotic hysterectomies are not worth the cost.”

Normally, I’d be jumping up and down to agree. But this time, I think there’s reason to pause. Why? Because of this from the JAMA editorial:

Robotic surgery may have a shorter learning curve than laparoscopic surgery, making it an enabling technology that allows surgeons otherwise unable to perform minimally invasive surgery to offer this benefit to their patients.

This is the future of surgery, and I suspect there may be a real benefit to rolling it out widely, getting lots of surgeons trained to use it, and producing commercial pressure to constantly improve the technology. I’m not trying to make excuses for rosy advertising promises or hospitals that hype their results to push patients into a more expensive procedure, but at the same time, this strikes me as qualitatively different from, say, billion-dollar proton beam facilities to treat cancer. In the long run, robotic surgery is likely to make medicine cheaper, safer, and more widely available worldwide, and the sooner we get to this future, the better off we are. A bit of a gold-rush mentality while we’re still at the low end of the learning curve might be the price we pay for this.

I have a feeling my point is going to be misunderstood here. I also have a feeling it’s hopeless to add a whole string of caveats. Just try to take this in the spirit in which it’s offered, OK?

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