Serious injuries from the Da Vinci Surgical System(ROBOTIC)

One of the purposes of this dicscussion board is to offer assistance to club members, club members in waiting and their caregivers not to unneccessarily scare peple and solicit cases for ambulence chasers.

Most of Georjean's earlier postings were removed which focussed on her Neph at Mayo Clinic in Arizona where the doctor at mayo Clinic did not confirm her Kidney Cancer before doing the surgery. As we all know that is not what doctors do before a Neph. Now she wants to highlight the Medical Malpractice attorneys  (the jewells and ambulance chasers of the profession to  which I belong ) in their quests for more cases. Sorry Georjean I am not one of your fans.

Of course in the old days my forefathers used ice tongs and ice picks for surgery or was that merely to collect a debt.

I assume the American Cancer Society will remove these posts anyway since someone flagged it before me, but I just wanted to put in my 2 bits worth.

Icemantoo

GeorjeanParrish said:

Robotic Surgery Claims on United States Hospital Websites

Keywords:

• laparoscopy;
• marketing;
• robotic-assisted surgery

Jump to…

Abstract

To examine the prevalence and content of robotic surgery information presented on websites of U.S. hospitals. We completed a systematic analysis of 400 randomly selected U.S. hospital websites in June of 2010. Data were collected on the presence and location of robotic surgery information on a hospital's website; use of images or text provided by the manufacturer; use of direct link to manufacturer website; statements of clinical superiority; statements of improved cancer outcome; mention of a comparison group for a statement; citation of supporting data and mention of specific risks. Forty-one percent of hospital websites described robotic surgery. Among these, 37% percent presented robotic surgery on their homepage, 73% used manufacturer-provided stock images or text, and 33% linked to a manufacturer website. Statements of clinical superiority were made on 86% of websites, with 32% describing improved cancer control, and 2% described a reference group. No hospital website mentioned risks. Materials provided by hospitals regarding the surgical robot overestimate benefits, largely ignore risks and are strongly influenced by the manufacturer.

In today's competitive environment, hospitals increasingly market their services on the Internet and patients often turn to hospital websites to learn about treatment options. While serious deficiencies have been documented in the educational value of direct-to-consumer drug advertising, a similar analysis has not been performed for advertisement of a hospital service. Patients increasingly search the Internet for reliable information on state-of-the-art care (Hartzband & Groopman, 2010; Johnson, Chen, Eng, Makary, & Fishman, 2008; Wald, Dube, & Anthony, 2007), and often consider information provided on a hospital website as trustworthy. Although there are few regulations governing what hospitals can report regarding the quality of care on their website, many patients consider content on a hospital website to be a physician's voice (Pronovost, Miller, & Wachter, 2007). However, we postulate that some hospital websites are overestimating the benefits and underestimating the risks associated with the use of expensive technologies. Robotic surgery is one service that has been the focus of significant advertising efforts from both hospitals and manufacturers. Use of robotic surgery in the United States has increased 400% over the last 4 years (Intuitive Surgical Inc., 2010a, 2010b [Intuitive Surgical 2010b, Investor Report 2010 Quarter 1]), despite limited evidence demonstrating benefit. Seven of the eight randomized-control trials in general surgery procedures show no patient benefit from this new technology (Baik et al., 2008; Cadiere et al., 2001; Draaisma et al., 2006; Morino, Pelligrino, Giaccone, Garrone, & Rebecchi, 2006; Morino et al., 2004; Muller-Stich et al., 2007; Muller-Stich et al., 2009; Nakadi et al., 2006; Sanchez et al., 2005), with one unblinded study demonstrating a decreased length of stay (Baik et al., 2008). One of the largest comparative effectiveness reviews of robotic surgery to date, including 111 studies, concluded that robotic surgery was “unproven with potential” pending further long term, controlled studies (Institute for Clinical and Economic Review, 2009). Meanwhile, robotic surgery costs significantly more than standard laparoscopic surgery, including a capital cost of up to US$2.3 million per robot, a service contract of up to US$180,000 per year, and a disposable parts cost of up to US$2,200 per operation (Intuitive Surgical Inc., 2010a, 2010b). The use of the robot adds on average US$3,200 to the overall cost per procedure (Barbash & Glied, 2010). Even with increased costs and no clear evidence of superiority, robotic surgery has become an important marketing tool for hospitals in attracting patients and generating revenue (Carreyrou, 2010; Intuitive Surgical Inc., 2010a [Hospital Resources-Broad Economic Impact] 2010b; Kolata, 2010).

As information provided on hospital websites can have significant influence on patient choice in treatment, it is important to ensure that the information presented is not misleading. Our study aimed to characterize the nature of hospital website marketing of robotic surgery by analyzing the prevalence, prominence, and content of robotic surgery information on hospital websites.

 

http://onlinelibrary.wiley.com/doi/10.1111/j.1945-1474.2011.00148.x/full

If what you say in your blog as well as what I read by simply googgling your name, you should own the Mayo Clinic by now.  Some of it seems morphine induced but I'm here only six months so I won't dive in too deep here.  Others seem to know you well.  Thousands of people have had completely successful laparoscopic nephrectomies.  Truth is the only difference between normal laparoscopic and di Vince robot are two things.  The trocar where the camera enters is about 1/2 inch larger and the doctor is at a console instead of standing over you with monitors above.  Same difference really.  Just something new.  If what happened to you did happen, well then this board is not for you.  You need the finest medical malpractice attorney in the country, not somebody who would lower himself to a television commercial with the words One Eight Hundred.....BAD DRUG.  What you're typing here is basically spam, whether you know it or not, and to come her for the specific reason to scare people..........well I would just say....................[Rude remark deleted by CSN administrator.]

MedScanMan said:

I read you blog

 

If what you say in your blog as well as what I read by simply googgling your name, you should own the Mayo Clinic by now.  Some of it seems morphine induced but I'm here only six months so I won't dive in too deep here.  Others seem to know you well.  Thousands of people have had completely successful laparoscopic nephrectomies.  Truth is the only difference between normal laparoscopic and di Vince robot are two things.  The trocar where the camera enters is about 1/2 inch larger and the doctor is at a console instead of standing over you with monitors above.  Same difference really.  Just something new.  If what happened to you did happen, well then this board is not for you.  You need the finest medical malpractice attorney in the country, not somebody who would lower himself to a television commercial with the words One Eight Hundred.....BAD DRUG.  What you're typing here is basically spam, whether you know it or not, and to come her for the specific reason to scare people..........well I would just say....................[Rude remark deleted by CSN administrator.]

This is definately not the place for that type of post..most of us are already scared enough just coming to the site.

GeorjeanParrish said:

If the American Cancer Society removes this

Then they are not acting in the best interest of the patient.

Either your surgeon was not good, or you had really bad luck.  Reading your blog, I am guessing you we're threatening to sue.  once that happens, things go differently.  Either that, or you are a troll working for a malpractice firm.

roaddr23 said:

Yep, Just what I need to see a week before my Surgery Icemantoo

I am not worried. I have complete faith in my surgeon as he was a pioneer in robotic surgery and has done this procedure many,many times. The odds are there for a freak bad outcome with any surgery whether hands on or robotic..There is always risk and it is a risk I am willing to take..I am a strong person and can make my own decisions but post like that could scare someone so bad they might risk their health because it scared them...

I'm making a "knight's move" (chess metaphor) here because I think there is an important spin-off from this debate and I don't want to see the baby being thrown out with the initial poster's bathwater.  I've seen her previous posts, have noticed her unresponsiveness to questions, and, to me, her opaque motivation.  I've mentally written her off as an oddball with no credentials and I hadn't looked at her blog until this afternoon.  

I can't see how the study she has quoted will serve her ends but I do agree with her that the ACS CSN should NOT remove it.  The merits of the study are independent of her motivation in posting it and I think its contents are important.

Just to be clear - it's not about the actual merits of robotic surgery but about national policy in the dissemination of medical information. 

I'm personally convinced that robotic surgery is a big advance, particularly when long operations are concerned, involving the dangers of serious fatigue for surgeons. It's caught on like wildfire in the States and is also used in the huge Scottish teaching hospital where I'm treated (Wikipedia entry says: "Ninewells Hospital is the largest teaching hospital in Europe, based on the western edge of Dundee, Scotland. It is internationally renowned for introducing laparoscopic surgery to the UK as well as being a leading centre in developing fields such as the management of cancer, medical genetics and robotic surgery").

Robotic surgery has risks, just like traditional surgery does but I'm sure it represents progress and I would be perfectly happy to undergo it myself, so long as I felt the surgeon had sufficient experience with it.  In most of the rest of the World healthcare is the business of government, not the insurance-based commercial "free for all" (an ironic phrase in this context) that it is in the States. Nonetheless robotic surgery is very much approved of in other medically advanced countries.

The Abstract that Georjean Parrish quoted seemed to me to be serious-minded and authoritative and worthy of reading in full (via the link she helpfully provided). For the reason I've alluded to above, its message seems to me to be particularly relevant for the US, where commercial competition is more significant in the medical domain than it is in the rest of the World.  For me, the paragraphs I'm quoting below, from the Discussion section of what I regard as a serious piece of work, capture a truly important message:

"Our study provides further evidence that many hospital websites overestimate the benefits and underestimate the risks of robotic surgery, potentially misinforming patients and encouraging them to undergo robotic surgery. The prominent placement on a hospital website and the use of emotional appeal obscures the lack of support for clinical claims (Pornpitakpan, 2004; Singer, 2009). Moreover, the widespread use of manufacturer-provided images and text raises concerns about conflicts of interest. Stock materials, produced for advertisement purposes, can be understandably one dimensional, even claiming that robotic surgery is the “most effective” or “ideal” therapeutic option for patients. Patients who encounter these superlatives on a manufacturer website can discount them as self-interested, but such language on a hospital website may be more persuasive. At a minimum, hospitals should disclose that the manufacturer provided these materials.

"Our analysis of robotic surgery suggests that more oversight is needed to ensure that the information provided on hospital websites is accurate. Hospitals should be conscientious of their role as a trusted medical adviser, and ensure that information provided on their website represents the best available evidence. Secondly, hospitals should make it transparent when they are using materials provided by a manufacturer and avoid endorsing brand-name medical technologies. While some institutions have policies prohibiting the endorsement of outside commercial products on their official hospital websites, our study suggests that a concerning number of hospitals either lack such policies or do not comply with them. Finally, if hospitals are unable to provide patient-friendly, objective information about a certain treatment option, they should direct patients to a third-party source of information and encourage patients to learn about alternatives.

"While more oversight of hospital websites is needed, it is unclear who should provide this oversight. The Food and Drug Administration (FDA) is a logical choice because they review pharmaceutical claims, but the FDA lacks the resources to monitor the nearly 6,000 U.S. hospital websites. Still, the FDA can develop guidelines for reporting the effectiveness of therapies on hospital websites. State regulators may provide oversight, but they often lack the technical skills to evaluate claims regarding quality of care or clinical effectiveness of various therapies. State regulators could enforce national guidelines for reporting therapeutic effectiveness, and in the absence of guidelines, state regulators could identify egregious claims made by hospitals. In the near term, self-policing by hospitals will likely remain the main safeguard."