Link Between Surgical Robot Purchase and Increase in Prostate Cancer Surgery Rate

Jill Stein
Published: Friday, May 27, 2011
Daniel V. Makarov, MD

Hospitals that acquired surgical robots increased radical prostatectomies by a mean of 29.1 per year.

New data suggested that hospitals that purchase a surgical robot experience a subsequent hike in the number of radical prostatectomies (RPs) for prostate cancer. The results indicated that surgical robot acquisition was also associated with increased numbers of RPs at the regional level.

Daniel V. Makarov, MD, with New York University Langone Medical Center in New York City, and colleagues elsewhere reviewed the regional and hospital rates of RP surgeries between 2001 and 2005, and examined whether these rates were affected by the acquisition of a surgical robot.

In 2001, surgical robotic technology was approved by the FDA for the treatment of prostate cancer. The method has been widely adopted, with 85% of men undergoing RP having robotic surgery by 2009.

During the study period, 36 of 71 geographical regions studied had at least one hospital that had acquired a surgical robot and 67 of the 554 hospitals studied had acquired a surgical robot. Hospitals that acquired surgical robots increased RPs by a mean of 29.1 per year. In contrast, hospitals that did not acquire surgical robots had a relatively small mean annual decrease in RPs (ie, only 4.8).

Daniel V. Makarov, MD

The results do not support the idea of a zero-sum game within a region, where hospitals compete for a fixed number of patients without altering regional-level rates of surgery.”
–Daniel V. Makarov, MD

“The results do not support the idea of a zero-sum game within a region, where hospitals compete for a fixed number of patients without altering regional-level rates of surgery,” said Makarov and colleagues. Instead, the purchase of a surgical robot either prompted patients from other hospitals to undergo surgery at the robotacquiring hospital or induced patients who would otherwise have decided in favor of other management approaches (eg, radiation, surveillance) to opt for surgery instead.

The researchers interpreted the results to mean that it is imperative that patients know that if they seek care at a hospital that has a new form of surgical technology, they are more likely to undergo surgery than at a hospital without the technology. Patients should also be encouraged to take a close look at marketing efforts that intend to “capture their business” by promoting the notion that technology is a surrogate for quality.

Finally, they said that the study is the first to determine the effect of surgical robot acquisition on RP volume at either the geographic or hospital level. The observed changes in use patterns are worrisome, given that there is no strong evidence to support the use of surgical robots, coupled with recent reports that have documented an increased complication rate with the use of surgical robots compared with open surgery for RP.

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