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Timothy G. Wilson, M.D. Headshot

Rise of Machines in Surgery Lowers Costs, Improves Patient Outcomes

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In this era of health care reform, policy makers, hospitals, and providers are all evaluating ways to reduce the overall cost burden to society while improving the quality outcomes for patients. Often lost in the debate is the need for investment in technologies that can help mitigate the significant cost drivers of health care.

Robotic-assisted surgery is a game-changing technology in medicine, yet it is deeply misunderstood and often dismissed as just another expensive tool driving up the costs of surgery. This could not be farther from the truth.

Robotic-assisted surgery is a technology that has made it possible for more patients to receive a less invasive surgery. The tool enables surgeons to immerse themselves "virtually" inside a patient, using 3D/HD vision. The da Vinci system, for example, has instruments that maneuver like a human wrist in very small spaces, allowing even greater dexterity in some cases than a surgeon's hands through a large abdominal incision.

According to the CDC, more than 50 million inpatient surgeries are performed in the United States each year. Overall, we're spending an estimated $180 million every year on hospital costs associated with surgical procedures, government data show. In many cases, costs are high because of the complications associated with traditional open surgery, which requires large incisions. This can lead to lengthy hospital stays and prolonged recovery times.

There are a number of patients who still receive large open incisions because they cannot get a minimally invasive surgery through traditional laparoscopy. The investment in robotic technology has enabled many surgeons to offer a minimally invasive procedure to patients -- eliminating both the complications and costs associated with the open procedure.

The evidence supporting the safety and efficacy of robotic surgery is not just anecdotal. Thousands of peer-reviewed clinical studies have evaluated the use of robotic-assisted surgery.

For prostatectomy, two representative larger studies representing thousands of patients demonstrate da Vinci is safer than the prior standard of open surgery. Complications, death, blood loss, and length of hospital stay are all substantially better for da Vinci Prostatectomy by a statistically significant margin.

For hysterectomy, two representative studies show da Vinci is safer than surgery through an open incision and is as safe as laparoscopy, while reducing the length of hospital stays for the subset of patients that can have a hysterectomy performed by either laparoscopy or da Vinci Surgery.

The cost of a technology has to be compared with the alternative cost of treatment. Displacing large abdominal incisions that have complications, high rates of death, blood loss, higher risk of infection and higher length of hospital stay is a good investment and aligns with the goals of health care reform.

Medicine needs innovation, but usually is slow to change. Decades ago, the same criticisms of robotic surgery plagued laparoscopy -- it was expensive, unproven and not safe.

To date, more than 1.5 million da Vinci surgeries have been performed worldwide with an extremely low death rate, a declining rate of adverse events, and a growing body of clinical evidence that demonstrates safety, effectiveness and an ability to reduce both costs and complications of open surgery.

As a surgeon who has performed thousands of procedures -- including open manual laparoscopic and robotic-assisted urologic cancer surgeries -- I believe robotic-assisted surgery is the kind of technological disruption that truly will reform health care.

 
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