Because robotic is rapidly emerging around the world (more than 80% of the prostatectomies in the US are performed with the daVinci robot), many health care providers are undergoing assessment of this new technology (HTA - Health Care Assessment).
They all have failed so far to show any benefit for the patient but are worried about the costs increase of the surgical procedures and the monopolistic position of Intuitive Surgical. Some interesting studies are given bellow. As a general conclusion, there is insufficient evidence to determine the efficacy or potential harmful effects of robotic surgery compared with conventional open or laparoscopic procedures but overall costs are much higher than any other surgical approach.
Please feel free to add any other relevant study and/or comment.
1) HTA report of the Belgian Health Care Authorities (Belgian Health Care Knowledge Centre) www.kce.fgov.be/Download.aspx?ID=1462, the recommendations of this report are summarised as follows:
There is no clear evidence to prove or refute the superiority of robot- assisted surgery. Therefore, surgeons should refrain from presenting the use of robot-assistance as inherently better as this might induce unreasonable expectations in patients.
Robot-assisted surgery has been shown to be reasonably safe and efficacious only when applied by surgical teams with adequate skills and experience with this technique. -There is also evidence that performance and patient outcomes improve with increasing experience. Therefore, it is recommended that robot-assisted surgery should only be performed by surgical teams specialised in performing the specific interventions using robot-assistance. Because of the limited absolute number of potential interventions in Belgium for each of the different disciplines, the number of these specialised teams should be limited, to enable those teams to build-up the required expertise.
2) A comprehensive report on Robotic Surgery issued by the Canadian Coordinating Office for Health Technology Assessment (CCOHTA) has similar conclusions:
-Limited studies indicate the promise of these systems, which appear to be safe, but their efficacy is not fully established. In some procedures, the advantages they offer may also be achieved by newer non-computer assisted techniques.
-Capital costs are high and cost-effectiveness has not been demonstrated.
-Diffusion of these systems can be expected to continue, but their place in surgical practice is not yet clear. They are most likely to be of value for centres undertaking specialized surgical services.
3) In a canadian assessment in the field Gynecology performed by the University Hospital of Montreal, the authors have serious concerns about efficacy, patient outcome and and high costs: http://www.chumtl.qc.ca/userfiles/File/100531-robot-gynecologie.pdf
"Worldwide studies suggest that surgery performed with the Da Vinci robotic system have a comparable efficacy when compared to laparoscopy.
However, economic studies indicate that the robotic assisted surgery is much more expensive than other available treatments. This is certainly due in part to the fact that only one supplier of this device (Da Vinci Robot) is operating in the market.
Clear scientific evidence regarding the effectiveness and efficiency of the Da Vinci robotic system is not yet available (due to the absence of randomized clinical trials and economic evaluations) and it would be premature to undertake a wide dissemination of this technology. The superiority of robotic interventions remains to be demonstrated."
4) Another Canadian study published in the Canadian Urological Association Journal, strongly criticises the use of (Y. Fradet, Arguments against investing widely in robotic prostatectomy in Canada: a wrong focus on tool box rather than surgical expertise, Can Urol Assoc J. 2009 December; 3(6): 486–487): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792425/
5) Finally, a last comprehensive literature review on patients benefits with similar conclusions https://www.oxhp.com/secure/policy/robotic_assisted_surgery_610.html
Very interesting and pretty worrying. Looks like a very good business for Intuitive and surgeons but not for the patients and taxpayers. How many pharma/medical devices companies are taking advantage of the health care system?
ReplyDeleteOk this text may not be here that long
ReplyDeletehttp://en.wikipedia.org/wiki/Titan_the_Robot
you may not believe this but that robot above has a spirit, and it visited me in my room.
It looked at me through my bedroom wall.
When I watched the movie on internet I felt nervous of it, it walked towards the people in the movie more moody, but jokey because it sensed that I was nervous of it.
You may laugh but I am a spiritual person and sense spiritual stuff.
The robots spirit is cable of free wondering without the shell that is the indication that the robot has a spirit body that is clever that can think for it self.
I don’t know whether this is the forces that are spiritual that control it I can’t be certain but its information you should be aware of.
If something gains confidence through fear and is capable of reading your mind then it’s not just metal with a program, its spiritual being that can gain power through your fears
. Think about it draw your own thoughts and conclusions.
This is not funny I just sensed an AI program like Alice chatter bot reading this text.