Do Robots Drive Up Prostate Surgeries?

After Wisconsin hospitals acquired robotic surgery technology, the number of prostate removals they performed doubled within three months, a new study shows.

By contrast, the number of prostate surgeries stayed the same at hospitals that didn't purchase the new $2-million technology.

The increase in such surgeries raises questions about whether more doctors at hospitals with robots are recommending surgery for men with prostate cancer, say the authors, instead of alternative treatments like radiation or "watchful waiting."

"Trying to be ahead of the curve is a human instinct," said lead author Dr. Joan Neuner of the Medical College of Wisconsin, who noted that new medical technologies are often adopted quickly by hospitals, and demanded by patients.

The robot costs nearly $2 million, plus more than $100,000 per year for maintenance. Hospitals who get the robot may feel pressure to cover the additional costs by performing more surgeries, said Dr. Jim Hu, director of urologic robotic surgery at Brigham and Women's Hospital in Boston, who was not involved in the new study.

The new finding comes just months after a report from Johns Hopkins showed hospital websites often hype robotic surgery, ignoring the risks and playing up the benefits.
Neuner and colleagues found that between 2002 and 2008, Wisconsin hospitals performed more than 10,000 prostate removal surgeries. Nearly one in four hospitals purchased surgical robots in that period.

There were 1,760 prostates removed in 2007, compared to 1,400 in 2002. This increase was somewhat surprising to the authors, because fewer men had prostate cancer in 2007.

There are significant concerns about the million-dollar technology. It is now used in nearly three-quarters of all prostate removals nationwide, according to Dr. Yair Lotan, associate professor of urology at University of Texas Southwestern Medical Center at Dallas. The weight of evidence, however, does not show it to be more effective in saving lives from cancer than traditional surgery, said Lotan, who was not involved in the study.

Some advertisements have claimed that robot-assisted surgery decreases the chance of impotence and incontinence, according to the earlier Hopkins report, but neither of these benefits has been scientifically proven either.

The robotic system gives surgeons "enhanced dexterity, precision and control," according to the website of robotic surgery system manufacturer Intuitive Surgical. The surgeon controls the robot from a console, and the robot never acts independently.

While shorter recovery times, less blood loss, and smaller scars are benefits of using the robotic system, there may be additional risks.

Since there is a learning curve associated with mastering a new procedure, inexperienced surgeons may make more mistakes, leading to complications, Dr. William See of the Medical College of Wisconsin, a co-author of the study, told Reuters Health. Additionally, robotic surgery keeps patients under anesthesia longer, which can expose them to potential harm.

Neuner and colleagues attribute their findings in part to patient demand, driven by aggressive marketing of the robot by both manufacturers and hospitals. In fact, patients often specifically request robotic surgery without knowing the risks and benefits, said Lotan.

Hu argued that marketing has perhaps placed too much emphasis on the robot, which is just a tool in the hands of the surgeon. The outcome has more to do with the skill of the surgeon rather than the tool used, he said.

"It is not the robot that provides the benefits, it's the surgeon."