Robotic Surgery: the Impacts of Costs, Access, and Quality

As technology improves, surgical robots are rapidly gaining support among both doctors and patients across America. Today more than 900 hospitals have the da Vinci robot which is double the number in 2007. (Freyer, 2010) Da Vinci robots were first approved by the FDA in 2000 for prostate removal, but now da Vinci robots are used for a variety of other surgical procedures (Freyer, 2010). Robot assisted surgery offers advantages such as smaller incisions, reduced blood loss, less pain and faster healing time (Vijay, 2010), as well as making surgery less demanding for the surgeon.

Robotic surgery involves many obvious advantages but the impact of cost, access, and quality must also be examined. Surgeons are finding that robots are necessary for their hospital to have. “Robotic surgery represents a huge leap over laparoscopic surgery” (Ronning, 2009). Both involve inserting surgical instruments and cameras through small incisions, but da Vinci technology is much more advanced. It provides three-dimensional, high-definition images of the surgical site and uses a sensitive surgical wrist that rotates 540 degrees (Ronning, 2009).

A robot’s small arms and 540 degree rotation allows for robots to reach places human hands cannot. This may be a reason robotic technology is growing in pediatric surgeries. “Unaccommodating places are what robot-assisted surgery is all about” (Berlinger,2006). The robot can move through the body freely which is a definite advantage over the human hand. Also human hands are not nearly as stabile as a robot which makes a difference when there is only a small area to work with (Berlinger, 2006).

Doctors also prefer robotic surgery because it is less physically demanding and it allows for less people in the operating room. Normally multiple surgeons are needed because a human only has two hands but the da Vinci robots have 4 arms. More and more doctors are using robots during surgery because of its advantages to both them and the patients. Along with the advantages to the doctors, robots also present advantages to the patient.

Robotic surgery is much less invasive than conventional surgery. It allows patients to recover quicker, and return home days before they normally would (Ronning, 2009). “The pain, discomfort, and disability, or other morbidity as a result of surgery is more frequently due to trauma involved in gaining access to the area to perform the intended procedure rather than from the procedure itself” (Mack, 2010). Robots require much smaller incisions to get inside the body, helping to keep the patient in as least post pain as possible. Also studies show that there is significantly less blood loss, and smaller scars which tend to mean less pain during healing (Vijay, 2010).

In a study of men who had prostate cancer surgery, the ones done with robots were able to go home from the hospital in two days on average which is one day shorter than the standard-surgery group, and had fewer post-surgery respiratory problems and other short-term complications (Kowalczyk, 2009). However, patients shouldn’t always assume that robotic surgery is safer and better. They need to find doctors who are experienced with working with these robots. The more experience a doctor has will reduce the time of surgery for the patient.

Many patients are choosing hospitals based on if they have invested in da Vinci robots because the advantages are so high. The quality of care from these robots is one of the most important aspects. Clearly, they present many advantages for both the patient and the doctors. Unfortunately, like any other form of surgery there are disadvantages as well. A major disadvantage in the quality of robotic surgery is that surgeons lose the natural feeling of surgery. “Ordinarily, doctors can feel how forcefully they are grabbing tissue, how well they are cutting, how their stitches are holding.

With the robot, that is lost” (Kolata, 2010). Many experienced doctors can relate how well a surgery is going based on comparing the overall feeling on cutting and stitching to past surgeries. This is all lost when using robots because the technology is not advanced enough to relay those feelings to the doctor controlling the robot. Other disadvantages include having a doctor who may be extremely experienced with traditional surgery, but hasn’t had enough practice with robots. It takes about 200 to 300 robot-assisted operations to become highly skilled (Kolota, 2010).

Another disadvantage is that the robots take up a large area of the operating room (Berlinger, 2006). This makes it difficult for nurses, anesthesiologists and other surgeons to move around freely. Many traditional hospital operating rooms are not nearly big enough for these machines; therefore renovations have to be done which add to the costs associated with da Vinci robots. A more specific example of lack of quality is from a done by Harvard Medical School researchers of men who had prostate cancer surgery.

It showed that men who had robotic surgery were more than twice as likely to experience incontinence or impotence a year and a half after their operations, compared to patients who had traditional surgery using an open incision (Kowalczyk, 2009). Although these new robots are helping the immediate recovery for patients, complications in the long run seem to be higher. Some patients and doctors believe the benefits of robotic surgery outweigh the negatives while others prefer to rely on the old fashion way that has been being conducted for years.

Cost is another factor impacting both doctors and patients when deciding on robotic surgery. A robot costs the hospital at least $1 million, not including the maintenance which is about $100,000 a year on top of that (Morgan, 2005). Also the disposable items used by the robot after each operation is costly (Morgan, 2005). Small hospitals do not have the funds to have this technology. With larger hospitals investing in the robots, smaller hospitals are losing patients. It is essential for any hospital who can afford this technology to invest in it, because patients who strongly believe in the robots will travel the extra distance.

Therefore, the race to have the technology is making for hospitals to purchase the equipment without knowing the full benefits and disadvantages to using it. Part of the problem is that currently only one company makes these robots. There is no competition to drive the price down (Freyer, 2010). Robotic surgery also adds anywhere from an estimated $1,000 to$2,000 the cost of each operation (Freyer, 2010). Most insurance companies will cover these expenses, but some HMO plans will not. Medicare will pay the hospital the same price whether robots are used or not.

Since payment is based on the diagnosis rather than the treatment method, the hospital won’t be able to collect extra reimbursement when it uses the robot therefore losing money (Ronning, 2009). Hospitals initially may lose money on the robots but if they attract more patients because of them it will help. Also shorter hospital stays because of robotic surgery will help make room for more patients which means more money for the hospital. Another impact of cost is that no one can predict future technology. These robots will eventually be outdated and money will either need to be spent to upgrade them or to buy new.

Hospitals need to decide if they can afford investing in such new technology. The da Vinci robots still aren’t capable of doing everything a surgeon can, therefore there will be new models in the coming years. Also since robotic surgery is rapidly growing eventually all hospitals will have it and in order for the company to continue its profits it must improve its technology requiring hospitals to invest in upgrades. This technology is a growing investment for hospitals and it certainly doesn’t stop after the initial purchase. Access to this new technology is another major concern.

In the past few years the number of hospitals with da Vinci robots has doubled. Twelve hospitals in Connecticut and 19 in Massachusetts now have bought robots (Freyer, 2010). Most major hospitals have at least one robot available. Even if hospitals have the equipment doesn’t necessarily mean all patients qualify. Some insurance companies will not cover robotic surgery because of lack of research and others only cover certain doctors who do not offer the option. Doctors who are trained and experienced with the robotic machines may be hard to find.

They are all required to take a two day training course, but the true learning comes from practice (Kolota, 2010). Surgeons are considered beginners until they have performed at least 200 surgeries. Since this is such new technology to many hospitals, very few doctors have had that kind of experience. To top it off patients search for the most experienced doctors with robots and neglect the doctors who have been doing traditional surgery for years but have less experience with the newer robots (Mack, 2010). This makes it hard for traditional surgery doctors to get familiar with the new technology and become experienced.

Access to this new technology is improving rapidly as more people demand it. Overall, the future for robotic surgery is promising. The advantages seem to overweigh the disadvantages causing for more hospitals to invest. The more hospitals that buy the robots will cause for easier access for patients. Luckily surgeons are trained to use both the robots and the traditional method giving patients a choice in their surgery. The quality of these robots is not yet fully proven, but based off previous surgeries doctors and patients are demanding them. Feasibility and accessibility will hopefully improve as this technology grows as well.

The coming years are an essential trial and error period for this new technology. Works Cited Berlinger, Norman T. “Robotic Surgery ? Squeezing into Tight Places. ” The New England Journal of Medicine 354 (2006): 2099-101. 18 May 2006. Web. Freyer, Felice J. “Hospital Set for Da Vinci Robot. ” The Providence Journal 14 Feb. 2010. Web. 5 Apr. 2010. <http://www. projo. com/news/content/SURGICAL_ROBOT_02-14-10_KHHE381_v12. 38ad83a. html>. Kolata, Gina. “Results Unproven, Robotic Surgery Wins Converts. ” New York Times. 13 Feb. 2010. Web. 5 Apr. 2010. <http://www. nytimes. com/2010/02/14/health/14robot.

html? pagewanted=1>. Kowalczyk, Liz. “Caution Sounded on Robot-aided Prostate Surgery. ” Boston Globe. 14 Oct. 2009.

Web. 5 Apr. 2010. <http://www. boston. com/news/local/massachusetts/articles/2009/10/14/study_scrutinizes_robot_assisted_prostate_surgery/? page=1>. Mack, Michael J. “Minimally Invasive and Robotic Surgery. ” The Journal of the American Medical Association 285 (2001): 568-72. 7 Feb. 2001. Web. 5 Apr. 2010. <http://jama. ama-assn. org/cgi/content/full/285/5/568? maxtoshow=&hits=10&RESULTFORMAT=&fulltext=robotic+surgery&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT>.

Morgan, Jeffery A. “Does Robotic Technology Make Minimally Invasive Cardiac Surgery Too Expensive? A Hospital Cost Analysis of Robotic and Conventional Techniques. ” Journal of Cardiac Surgery 20. 3 (2005): 246-51. Print. Ronning, Andrea. “Oregon Hospitals Use Robots For Surgery. ” Maine News, Weather, Sports Channel 6 NBC Portland. 2009. Web. 05 Apr. 2010. <http://www. wcsh6. com/news/local/story. aspx? storyid=109722&catid=45>. Vijay, Soni. “Da Vinci Robotic Surgery: Pros and Cons Medical Questions, Weight Loss, Pregnancy, Drugs, Health Insurance. ” Steady Health. 30 Mar.

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