Rock Center   |  June 14, 2013

Robotic surgeries on the rise, but are there risks?

The majority of the hundreds of thousands of robotic surgeries performed in the U.S. each year are done safely. However, as use of the machine increases, so are reports of injuries: The U.S. Food and Drug administration has received more than 200 reports since 2007 of burns, cuts and infections – including 89 deaths – after robotic surgery. Rock Center’s Dr. Nancy Snyderman investigates Intuitive Surgical Systems and meets a woman who blames her devastating complication on the robot.

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This content comes from Closed Captioning that was broadcast along with this program.

>>> with a report on one of the most sought-after and still- emerging technologies in medicine . it's robotic surgery with an assist from the skilled hands of a hun surgeon . of course all surgery comes with significant risks, no operating room or technique is immune from error. but some high-profile critics have been wondering about this technique. is it possible some health care providers are so much in favor of it that it's actually adding to patient risk? we start off here tonight with dr. nancy snyderman .

>>> you have some stunning wedding photos in your house.

>> thank you.

>> when you look at that young woman , do you see you?

>> i see who i used to be.

>> just one year into her second marriage, michelle zarrick learned she needed a hysterectomy, and her long-time doctor wanted to use the latest high-tech device to make the surgery easier on michelle .

>> the procedure that she focused on and was very excitable about was the robotic-assisted hysterectomy.

>> that's right. a hysterectomy with the help of a robot that has bionic arms. it's called the dra vinci, and it's the hottest trend in surgery.

>> the da vinci surgical robotic system --

>> its dazzling technology is promoted everywhere. there are television ads, glossy brochur brochures, and public demonstrations at science museums and shopping malls . even president obama was invited to test drive a surgical robot . as the patient lies on the operating table, the doctor sits at a console several feet away. remotely manipulating surgical instruments while watching every move through a three-dimensional viewfinder. many surgeons say that makes it easier to see and to navigate hard-to-reach places as the robotic instrument go where the human hand cannot. there are also smaller incisions and less bleeding. michelle says her doctor, an o ob-g ob-gyn, convinced her it was the way to go.

>> she mentioned that doing the robotic-assisted hysterectomy would shorten my recovery time at home.

>> you'd feel better and bounce back faster.

>> right. right.

>> okay. instead, she suffered a horrific complication that's impossible to imagine. when you signed your consent form, was one of the complications the fact that your intestines could fall out of your vagina?

>> no.

>> michelle says that's exactly what happened. five weeks after her surgery in february, 2009 , she was rushed to the hospital.

>> i knew that the -- the situation that i was in at that moment was dire. i knew that it was -- that it wasn't good.

>> surgeons were able to repair the damage from the devastating complication . michelle says the damage to her physical relationship with her husband has been profound. you know, women get hysterectomies all the time.

>> yeah.

>> you don't have to blame yourself forever.

>> i'm starting to see that now. for a long time, i assumed that i just was one of the unluckiest women in the world.

>> until?

>> until i met with a new ob-gyn in october of last year.

>> while giving her medical history , michelle brought up her hysterectomy complication .

>> and i said, "i realize i'm very rare." he said, "well, not as -- not as rare as you would think. did you have the da vinci robot ?" i said, "yes, i did."

>> michelle learned the fda has received reports of problems with many kinds of da vinci surgeries. over 200 instances of burns, cuts, and infections, including 89 deaths since 2007 .

>> we have shown that these injuries are occurring.

>> dr. francois bordeaux is a gynecologic surgeon .

>> hospitals have to be careful about credentialing surgeons , inbound informed consent with patients, overbranding or overmarketing the robot as this great thing. maybe it's just another tool, right? maybe it's not as great as they say it is.

>> the vast majority of the nearly 400,000 robotic surgeries performed in the united states every year do not have complications. but here's what has many medical experts concerned -- they say the demand for the robot is being driven by a very aggressive marketing campaign . dr. marty mccary is a surgeon at johns hopkins university hospital.

>> when hospitals feel that they have to have a robot just to compete with other hospitals that are marketing the robot on the afternoon news, then we've got a sad state of affairs in american medicine .

>> he says the robotic approach is not always better than existing surgical techniques.

>> we've got great state-of-the-art, minimally invasive techniques that have worked for years, sometimes decades, that are now being replaced with more expensive robotic technology without a benefit to the patients.

>> a recent study in a major medical journal found that the robotic surgery did not reduce complication rates for hysterectomy. though it did add over $2,000 more to the cost of the surgery. and this spring, a leading organization of gynecologists cautioned members to "separate the marketing hype from the reality when considering the best surgical approach" for their patients.

>> the robot is a technical tour de force . but i think patients need to know that for some procedures, there's no benefit.

>> how do you think robotic surgery helps patients?

>> it allows the surgeon to be able to do a better procedure.

>> dr. katherine moore, the director of medical research at intuitive surgical , says the robot is especially good for complicated cases.

>> it gives the surgeon more dexterity. it gives them better vision. and it gives them the ability to give that patient a minimally invasive procedure , but with no large incision to recover from.

>> demand is growing. annual sales have increased 41% in the last decade.

>> the question facing intuitive --

>> herb greensburg has been reporting about da vinci for cnbc. he says when a hospital spends $1.5 million to buy a robot , there's pressure to use it for as many surgeries as possible in order to rekuhn the hefty investment.

>> it can take quite a long time, especially if you're a smaller procedure that doesn't do as many procedures.

>> why would a smaller hospital need a robot ?

>> every hospital needs a robot . that seems to be the push. again, this is remarkable as we look at the story. this was sold originally to major medical centers, major clinics. and now it's filtering to community hospitals.

>> critics say that salespeople should not be persuading doctors to change their surgical approaches. i have a -- an e-mail here from a clinical sales director. and i'm going read this verbatim verbatim. "be proactive in finding cases to convert. be prepared to challenge each trained surgeon every time you see a laparoscopy or open case. be unsatisfied with the thought of ending a day without a converted case." that feels like an intrusion.

>> that is a looking for cases that are being done open that could be done in a minimally invasive way, and reminding the surgeon that there is another option. that is not practice of medicine .

>> be unsatisfied with the thought of ending a day without a converted case? that's changing medicine .

>> that --

>> that's changing medicine .

>> at the end of the day , the summerons made the ultimate -- surgeons made the ultimate decision on what was best for their patient.

>> da vinci is being criticized for pushing summrgeons through the training process too quickly.

>> uh-huh.

>> tell me from your vantage point, what should someone who wants to embrace this technology have to do to prove their proficiency?

>> well, first, they need to be a proficient surgeon . the company is not going to teach someone how to do surgery. the company says it's the hospital's responsility to determine who is qualified and allowed to use the robot .

>> it isn't up to a company who gets to operate.

>> shouldn't you have a voice?

>> is it the role of a company to decide the practice of medicine ?

>> i think if you give a damn it is.

>> i -- i believe that we can do our best to teach people how to use our systems and our instruments as well as they can.

>> the fda is looking into a growing number of reported injuries with the da vinci to see if they are simply the result of more robotic surgeries being done or because of a problem with the machines or even the surgeons using them. as for michelle zarick's devastating complication , intuitive surgical has denied all allegations that it was caused by the da vinci . meanwhile, michelle says she's learned to ask tougher questions of her doctors.

>> i think the most important thing is to be your own advocate in any situation when it comes to your health.

>> the story of the robot is really the story of american medicine . expensive technology , poor evaluation, and little communication with patients about the research and the data about robotic surgery .

>> dr. nancy snyderman here with us. one of the more thought-provoking stories we've done in a long time. the first of the lawsuits against intuitive surgical just went to trial. what happened?

>> surgeons settled the malpractice claim before the trial. intuitive surgical did not settle and was found not flyball a patient's death. so -- not liable in a patient's death. so that's been closely watched. the real take-home for people is when you talk to your surgeon ask if a robot is going to be involved. then ask your surgeon how many have you done, are you well equipped to do this. and frankly, i think that's the patient's right, but i think the hospitals have a responsibility to set the bar higher than they have to make sure they're not setting up doctors who have done three, four, and five. this is really exciting technology . the great technology does not make great surgeons . great surgeons make the technology even better.

>> great work on your part, dr. nancy snyderman . thank you as always.