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This Surgeon Isn't Falling Out of Love With Intuitive Surgical Or Its Robots

In 2009, a very similar, negative report was published in JAMA claiming the long-term effect of minimally invasive prostatectomy was inferior to open surgery. Three years later, my good friend Dr. Quoc-Dien Trinh to totally crushed that myth. A similar fate looms for the doubters of robot-assisted gynecologic surgery.

Here's some history: In 1996, Lancet published a randomized, controlled trial on open versus laparoscopic cholecystectomy (gallbladder removal.) The study's conclusion: Open procedure was superior because there was no difference in hospital stay or recovery compared to "lap chole." Ten years later, surgeons are performing lap chole procedures as outpatient procedures and open cholecystectomy is thought of as medieval torture. Comparing surgical techniques is not like comparing two different pills. There is massive intra-surgeon heterogeneity even within the same procedures, which makes most surgical studies (including this JAMA paper) examinations of statistical noise.

I'm sure you've noticed lawyers love litigation. Intuitive Surgical has deep pockets, so I'm not surprised in the least that the company is now wearing a target on its back. You can whine about the company's over-the-top marketing, its bullying salespeople and its heavily financed surgeon spokespeople. Despite all that, the doctors I admire most in my field -- and who get no Intuitive Surgical money -- have all adopted robotics in their surgical practices. Why? Because it's a transformative surgical approach that benefits our patients -- decreased blood loss, less pain, shorter hospital stays and fewer complications. When other fields begin to understand and learn the technology, I have no doubt they will find similar success.

Disclosure: Davies doesn't own Intuitive Surgical stock and has never been compensated by the company in any way.
Benjamin J. Davies, MD, is an Assistant Professor of Urology at the University of Pittsburgh School of Medicine. He is the Director of the Urologic Oncology Fellowship and Chief of the Urology Section at Shadyside Hospital. Dr. Davies graduated from Columbia College and earned his medical degree from Mount Sinai Medical School in New York City. Following surgery and urology residencies at the University of Pittsburgh, he completed a postdoctoral fellowship in Urologic Oncology at the University of California, San Francisco. He has written over 30 peer-reviewed scientific and clinical publications on prostate cancer and bladder cancer.
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