There is no doubt that robotic assisted surgery (RAS) is on the increase. Looking at prostatectomies in England, the procedures most commonly performed using RAS, a report was commissioned by the iFHP from the Economist Intelligence Unit to understand the clinical effectiveness of RAS compared to conventional laparoscopic surgery.
The report focused on prostatectomy, hysterectomy and lung resection.
Results from January 2008 to August 2019 yielded 5,829 records. However when sifted for quality, relevance and study type, 62 studies were reviewed. Only 11 were randomised clinical trials (RCTs), seen as the gold standard. Even these RCTs were at risk of bias, as the outcomes were assessed by the same surgical teams that performed the surgeries.
What can we take from this for our members? Tom Sackville, CEO of the IFHP said:
“We commissioned this report from the Economist Intelligence Unit aware that many iFHP health insurers around the world were paying premiums for robotic surgery across a range of specialties, despite being doubts uncertain as to whether their insured patients were receiving any additional benefit over conventional laparoscopy. A comprehensive trawl of the medical literature showed these fears to be fully justified. The report clearly demonstrates an almost complete absence of quality trials showing improved outcomes. We hope this will enable our members to more effectively negotiate with providers based on the evidence available.”
The evidence does not seem to fit well with the degree of hype over outcomes and wide use, maybe overuse of the robot. Medical techniques become advances when they deliver improved outcomes, improve overall effectiveness and better serve the needs of the patient.