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Robotic Surgery is all the Rage, But Price is High

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The last few decades have led to great advances in health care — new breakthroughs in medical therapies and treatments seem to make the impossible possible. One of the most valuable therapies has been the development of endoscopic surgery, which involves using very tiny incisions and small endoscopic tubes to perform a variety of procedures.

With this minimally invasive technique, it is now possible to remove gall bladders, the uterus and ovaries, perform back and sinus surgeries and many more. Recovery occurs within days, there is little pain, and side effects are reduced. This approach has not only shortened hospital stays and improved quality of life, but it also has reduced the cost of care.

In recent years, the development of robotic surgery has offered a new and exciting frontier for surgical procedures. Marketed as the Da Vinci system, this device allows the surgeon to perform highly complex procedures without ever touching the patient. Working from a console, the physician uses the robot to make small incisions. And with miniaturized instruments and a high definition 3-D camera, is able to perform the most delicate of procedures.

Robotic surgery allows the surgical treatment of colon, rectum, bladder and kidney cancers and is now widely used to perform prostatectomies for prostate cancer. The machine has also been used to repair heart valve abnormalities and coronary bypass surgery. Like endoscopic surgery, the robotic approaches allow a shorter recovery time, less blood loss, less pain and a lower risk of infection. This technology has created a great deal of excitement in the health care community, and the use of this approach has shown explosive growth.

Though the robotic surgery has brought many medical advances and benefits, it comes with a high price tag. In a recent article published in the New England Journal of Medicine, researchers examined the significant impact that this technology has had on health care costs. In the past three years, the number of robotic surgeries performed in the United States has increased from 80,000 to 205,000, and the number of Da Vinci systems available in hospitals rose from 800 to 1,400. Each system ranges in price from $1 million to $2.5 million, and the use of robotic surgery increases the cost of procedures anywhere from $3,200 to $8,000.

Overall, robotic surgeries increases the annual cost of health care by $2.5 billion.

And if the number of procedures continue to increase at the current rate, the total cost could run higher in the billions.

In addition to cost, there are other concerns with robotic surgeries. While it has opened up complex and very difficult surgeries to minimally invasive approaches, the system is often used for operations such as gall bladder surgery and hysterectomies, which could just as easily be performed using cheaper endoscopic approaches.

There is also evidence that the availability of the robotic surgery increases the number of procedures performed. Between 2005 and 2008, prostatectomies increased by 60 percent, despite a reduction in the incidence of prostate cancer. It has been suggested that the availability of the robotic approach has led to more surgeons recommending prostatectomy over other forms of treatment.

Making matters more complicated, studies have shown the robotic surgery for prostate cancer has the same risk of adverse effects as earlier surgical approaches. The incidence of erectile dysfunction, incontinence or infection is identical with all forms of surgical treatments for prostate cancer.

The case of the robotic surgery is a perfect example of how great breakthroughs come with great challenges. Robotic surgery is a valuable and exciting advance in surgical treatment. However, it should be used in circumstances where other approaches are not available or effective. We must be aware of the cost implications and use the tried, proven, highly effective therapies when possible. More research is also needed to compare the various approaches to treatment, so the health care community truly understands all the alternatives.

Your physician is not the only one responsible for determining when to employ the greatest advances in medicine. You, the patient, must be an empowered and active participant in your medical decisions.

This is the only way to assure the most appropriate treatment possible. Remember, newer does not always mean better. In medicine, while the tried and true therapy may not be the most exciting option, it is often the most reliable.

Dr. David Lipschitz is the author of the books "Breaking the Rules of Aging" and "Dr. David's First Health Book of More Not Less." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com.

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