Surgical Injustice – Robotic Surgery Revisited

Not usually being one to say, “I told you so”, when it comes to the role of robotic surgery in modern medicine and more specifically gynecologic surgery, it must be stated, “I told you so.” Three years ago I wrote an article regarding my concerns over the use and misuse of robotic surgery and how I was concerned that a marketing force was driving patients to a surgical approach which was not the BEST approach for them or, even worse, not indicated, at all.

In the article, I listed examples of how this technology was being advertised and employed improperly. I discussed concerns over longer operative times, greater complication rates, increased anesthesia exposure, steep surgeon learning curves, enormous expense and use of the more invasive technology not because of indication but for physician enjoyment or to log training cases.

Again, my expertise lies in gynecologic surgery, and it is in this area that I can say the robot is being inappropriately advertised and utilized. The least invasive approach to the majority of these procedures is through the vagina. To suggest otherwise, demonstrates either a lack of knowledge of the subject matter or worse, a deliberate attempt to deceive patients.

Finally, our own regulatory body has spoken out on this issue, when, in March, the president of the American College of Obstetrics and Gynecology, James T. Breeden, M.D. stated, among other things that, “…there is no good data proving that robotic hysterectomy is even AS GOOD as-let alone better-than existing, and far less costly, minimally invasive alternatives.” My only question is, “What took so long?”

I encourage you to read Dr. Breeden’s, “Statement on Robotic Surgery.” It is informative, to the point and echoes many of the same concerns I voiced three years ago in the article.

Recently, I was asked to assist another surgeon in what was posted as a Laparoscopically-assisted vaginal hysterectomy. When I arrived at the operative suite and learned that the case was actually a robotic hysterectomy, I informed the surgeon I would be unable to assist. I could not and cannot, in good conscience, participate in this practice in gynecologic surgery. In what other specialties might similar concerns exist? It saddens me to see this practice in medicine today.