Robotic surgery. The phrase itself brings about mental images from scenes set in our favorite science fiction movies. Seeing the machines only serves to cement the vision. Looming towers with arms cascading down like metallic tentacles, they look like something that could be used to bring life to the galaxy’s newest cybernetic organisms.
The truth, however, is that robotic surgery is hardly new, and has been used for the past 15 years primarily as a way of trying to enhance the successes of cancer surgeries. High definition cameras with pinpoint lighting are a key aspect of the suite of tools that a robotic system puts at a surgeon’s disposal. The intent was to augment a surgeon’s skills with the kind of precision and accuracy that can only come from the merging of human and machine.
New information from the FDA, however, has cast doubt on the notion that the use of such technology is having any sort of positive impact on survival rates. In some cases, it even appears that patients who have undergone robotic surgery may actually have lower survival rates than those who had more traditional, non-robotic procedures.
The FDA recently cited two studies that had been published last year in the New England Journal of Medicine; one which was stopped early because the results were so damning. In that study, researchers discovered that women who had undergone minimally-invasive procedures to treat cervical cancer; including those using robotic systems, were four times as likely to have a recurrence of the cancer and six times as likely to have that cancer prove fatal when compared to women who had a more traditional radical hysterectomy – a procedure with a track record of success in completely curing the cancer in many instances.
The other study found that in a sample size of 2,461 women with cervical cancer who had some sort of surgery over the course of their treatment, 9.1 percent of those who had robotic surgery had died four years later. Only 5.3 percent of women who had undergone open surgery had died in the same timeframe.
When publishing its findings, the FDA stated that it wants “doctors and patients to be aware of the lack of evidence of safety and effectiveness for these uses so they can make better informed decisions about their cancer treatment and care.” Such knowledge could be critical when faced with surgeons who, even in the face of such startling statistics, provide robotic surgery as an option and even openly encourage their patients to take that option.
Citing benefits like decreased risks of infection and lower post-operative pain, they neglect to inform patients that the alternative may be a recurrence of the cancer that put them in the hospital in the first place. “If you tell a patient you may stay in the hospital one or two days longer versus going home the same day, but there is a higher likelihood your cancer is going to come back, what are you going to choose as a patient,” says Dr. Pedro Ramirez, lead author of the first study the FDA cited when making its report. Dr. Ramirez is also the director of minimally invasive surgical research at the M.D. Anderson Cancer Center in Houston, Texas. “My feeling about this is patient care.”
If only Dr. Ramirez’s colleagues could share his concern for their patients. “Several surgeons,” he tells the New York Times, “have said to me, ‘I can’t find a flaw in your study, but I just can’t stop doing [robotic surgery].”