Jeroen Heemskerk Jeroen Heemskerk Sacha Ruland

Surgical robots slower and more expensive than humans

In Body
Written by  Graziella Runchina Wednesday, 14 May 2014 08:56
Contrary to the common claim, a surgical robot does not work faster and more accurately than a pair of human hands. This is the essence of new research by Jeroen Heemskerk (41), a surgeon at the Laurentius Hospital in Roermond. On 16 May, Heemskerk will defend his PhD research on robot-assisted laparoscopic surgery at Maastricht University (UM). “The use of robots can lower the quality of healthcare and certainly makes it more expensive. And that while we’re seeing cutbacks from all sides.”

“Although surgical robots were developed to assist surgeons during operations, their use in laparoscopic surgery has been controversial for some time”, Heemskerk writes in his dissertation. “The clinical added value of these robots has not yet been established, yet their users and manufacturers do all they can to sing the praises of their expensive showpieces.”

Faster recovery

Laparoscopic surgery, also known as keyhole surgery, is less invasive for patients and thus allows them to recover faster. Because it can be technically difficult, the surgeon is often assisted by a surgical robot. In his PhD research Heemskerk tested the daVinci robot, which has been used in keyhole surgery at the Maastricht University Medical Centre + since 2002.

The results are striking. “In a test environment, the use of a robot appears to make tasks like suturing wounds faster and more accurate. In a clinical setting – that is, in the operating theatre – the opposite is true.” The robot is expensive, slow and, crucially, does not lead to better results. “Although the robot has been in use for over a decade, the results remain dubious. This can be seen in the Dutch prostate cancer records, for example: significantly worse results are observed after robotic surgery compared to open surgery. Specifically, we saw 5% more positive resection margins  in robot surgery compared to conventional open surgery.” This means that tumour cells were still lurking on the edges of the removed tissue; less than ideal if the return of cancer is to be prevented.

Public debate

Heemskerk thus questions the frequent use of surgical robots in Dutch hospitals, calling for a broad public debate on the use and necessity of the robots. “We’re not going to pull our punches”, the surgeon says bluntly. “The number of surgical robots has increased dramatically in recent years. There are currently 19 robots in the Netherlands, each with a price tag of €1.5 million. Add to that the annual maintenance costs of €100,000 per robot and the additional cost of about €2000 per operation with robot intervention compared to a conventional operation, and we can rightly ask: what are the benefits of robot surgery?”

Bankruptcy

With many hospitals on the verge of bankruptcy, Heemskerk wonders whether such expensive robot surgery is socially responsible when it has not been proven to lead to faster and better results. Herein lies the rub, Heemskerk writes in his dissertation. “Both the manufacturers and the users – that is, the specialists – try to promote their expensive surgical robots in the hopes of attracting more patients. Despite the lack of scientific added value, there does seem to be an appeal for patients who think they’re better off being operated on by a robot than a real-life surgeon. In fact, this gives patients false hope.”

 
Marketing instrument

“This is not right”, Heemskerk continues. “Hospitals see these robots as a great marketing tool they can use to increase the number of operations they do. This is facilitated by the government and healthcare insurers, which dictate that hospitals may no longer perform certain operations, such as prostate removal, if they do too few of that type of operation. What could better help you meet your quota than a slick marketing strategy on the superiority of robotic surgery?”

Randomised research

Heemskerk is more than a little surprised that the theoretical advantages of robotic surgery are constantly expounded, while there is insufficient proof of its effectiveness. “It doesn’t seem sensible to me to keep throwing money down the drain.” He would have liked to see randomised research on the use of the daVinci robot before it was put to use in everyday practice. “I’m not radically for or against the use of a surgical robot. Of course robotic assistance has its benefits, especially in the improved ergonomics for the surgeon and thus the potential for reduced mental strain. But this advantage is much too limited to justify the present use of the robots.”

In his view, hospitals that use this robot should be required to participate in a randomised study comparing groups of patients operated on with and without the robot. This is easier said than done, he realises. “There are many proponents of the surgical robot. They don’t want to test it again, nor do the specialists who have a robot in house. But more research on the actual efficiency of the use of surgical robots is essential.” 


Jeroen Heemskerk will defend his PhD thesis 'Robot-assisted Laparoscopic Surgery' at Maastricht University on May 16th.His research was supervised by Professor C. Baeten. Heemskerk currenttly works as surgeon at the Laurentius Hospital in Roermond.


 


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