Friday, June 20, 2014

Peel me a grape!

Whenever I promise myself not to write another post about robotic surgery, I see an ad or an interview doubling as an ad so full of misrepresentations that I have to reach out for an antiemetic.

Here's the latest, a June 18 piece on Bloomberg TV.  It is shocking because Bloomberg is so careful about accuracy in its news reports.  Of course, the video starts with a short ad, which is clearly labeled as such.  But they really should have kept that label in place for the duration of the video.

Did Intuitive Surgical pay for this piece or just provide the visuals?  For surely they did provide the visuals, as is clearly disclosed.

It appears that they also provided some answers.  When the interviewer asks at, 3:56, "What about the costs?" Dr. Michael Stifelman from NYU's  Langone Robotic Surgery Center responds, "There is a perception that robotics is going to be more costly. What we're finding is that, when put into experienced hands . . . those increased cost are somewhat nominal if anything.  The benefit for the patient is they're going to get out of the hospital earlier . . . less risk of blood loss, less pain, and most importantly . . . the costs to society.  Each patient will be able to get back to work more quickly than they would using a more traditional technique for these procedures."

Sorry, Dr. Stifelman, but all of those assertions are not supported by objective, peer-reviewed studies.  Your point about cost also ignores the purchase cost, disposables, and maintenance contracts associated with this equipment. You also appear to be subtly offering a comparison of robotic surgery with open surgery, as opposed to manual laparoscopic surgery.  Here's a more objective recent portrayal of the issue in a recent New Yorker article.  An excerpt:

Many hospitals, faced with the pressure to compete with high-tech programs, are advertising robots aggressively—on billboards, on YouTube, even at baseball games. Some may be overselling the benefits of the technology. Researchers at Johns Hopkins University analyzed the Web sites of four hundred U.S. hospitals and, in a study published in the Journal for Healthcare Quality, reported that the majority of sites claimed that robotic surgery offered an “overall better outcome,” and a third of the sites touted “improved cancer control.” (None of the Web sites mentioned risks.) A study by researchers at Columbia University investigated the marketing of robotic gynecological procedures and found that many hospital Web sites described robotic surgery as the “most effective treatment.”
Jason Wright, who worked on the Columbia University study and is the chief of gynecologic oncology at the university, told me that many claims made about robotic surgery aren’t based on clinical evidence. “When you see an ad for a drug on television, the claims that are made have to be backed up by scientific data,” he said. “There’s not the same level of scrutiny for devices.”

Intuitive Surgical loves Dr. Stifelman:

Dr. Michael Stifelman, Associate Professor of Urology and Director of Robotic Surgery at NYU Langone Medical Center, has been named the 2011 recipient of the Crystal Award, given by Intuitive Surgical, Inc., to surgeons who have contributed significantly to the advancement of clinical knowledge in the field of robot-assisted surgery. The company, which manufactures the da Vinci Si robotic surgical system, gave the award to Dr. Stifelman in a ceremony at its annual meeting in Boca Raton, Florida.

And the company also promoted his interview with Diane Sawyer as well as numerous entries on its DaVinci Surgery Community site.

But here's the great part.  While Dr. Stifelman talks, the video meticulously presents the visual story of a grape being peeled.  I wondered if a surgeon might tell us how relevant that is to prostatectomies, hysterectomies, and the like, so I did a Google search on the question, "Is surgery like peeling a grape?"

I was overwhelmed by the response.  What good fortune.  Here's a portion of that page from my browser, with videos going all the way back to 2010.  Surgery is like peeling a grape, and how lucky we are to be able to do that robotically.


Bart Windrum said...

Are our internal organs and other parts that are subject to cutting more, the same, or less squishy than the example grapes?

Charlotte said...

Maybe the Senate committee should be looking at Dr. Stifelman instead of/in addition to Dr. Oz.

Anonymous said...

This is again a pathetic initiative by Intuitive to create a WOW factor in the minds of poor patients. Peeling a grape doesn't mean that outcome are better. Surgery is more than peeling a grape. Surgery is an art and the surgeon is the artist, regardless of the means. A 1.7 M tool cannot make a stupid surgeon better. A fool with a tool is still a fool. And most of those who do this for a living do not use the robot. Paul has already spoke at length and discovered ethical issues in Illinois and everywhere else, so you draw your own conclusions. Please read the entire New Yorker piece. Dr Garcia-Aguilar (a real expert from Memorial Sloan Kattering said HE HIMSELF prefers to have an open operation than having cancer the next year).
Peeling a grape is a diminuitive, very reductive, and offendlingly simplistic way to disregard the art of mastering preoperative, postoperative management, and the technical mastery of the art of surgery. This is value based patient centric care. Not vile attempts to brainwashing potential patients' mind and subliminally bias their choices.
That is shameful, as shameful is the behavior of those who purchase the robot and those who use it.
I am a surgeon, I tried it, I don't use it as I don't see the utility. I am faster, I have better results than my colleagues who use this. WE should continue talking about this. One day YOU may get that call and go to a consultation with someone who is going to offer YOU this treatment. How would you respond? How well educated will you be? Life is yours, don't delegate decisions to others.

Anonymous said...

Well, after reading all this, I basically will have my fingers crossed for a good robotic outcome in August. It seems there is no correct choice. Like so much in life, it is a crap shoot.

Anonymous said...

There is indirect evidence that the quality of a surgeon is inversely correlated to the use of the robot. You don't see experts vouching for it. You see anonymous individuals using it. This is why intuitive is struggling. The company could not recruit known individuals so now it is gasping as the grape has gone the wrong way

Matthew Leo said...

From Facebook:

I'd like to see the robot suture the skin back on. Then I'd be impressed.

Patricia L. Hale said...

From Facebook:

There is a place for all technological advances in my opinion but marketing and greed are the real problem here rather than the field of robotics itself.

Norma Sandrock said...

Fromm Facebook:

Even the headline itself is so misleading, demonstrating that Bloomberg's doesn't even know what they're writing about. (For those of you who don't live in the OR---the robot doesn't replace the surgeon, the robot is a tool the surgeon uses.) (a gigantic, hugely expensive tool, helpful in some specific situations but not all)

Anonymous said...

Robitics in cardiac surgery has failed miserably. Boston Medical Center's cardiac surgery division is basically dead because the previous chief, a robotic 'expert' drove it to the ground. He was then fired from Rush in Chicago and Arizona for poor robotic outcomes. Intuitive is now looking for the next generation of leaders. In the process, the poor patients are the ones hurting.

Paul Levy said...

Sorry, unknown, but I do not allow naming of specific doctors in this space.

Unknown said...

I am one of a "staggering number" of permanently harmed patients who underwent da Vinci surgery at the "renowned" "world class care" Cleveland Clinic. Marketing hype at the Cleveland Clinic is mirrored by da Vinci marketing. Avoid the da Vinic robot, Cleveland Clinic, and any hospital pushing the da Vinci. Read Patient Safety Issues/da Vinci here: