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A Black Eye for Robotic Surgery

Do aggressive marketing tactics neglect surgeon training and patient safety?

Published: March 26, 2013

Robotically assisted surgery lets surgeons operate with more precision, be less invasive and produce better outcomes than conventional open surgery. But a lawsuit set for trial next month raises new questions about the aggressive tactics the company that makes the robotic equipment uses to pressure inadequately trained surgeons to use it.

A report in The New York Times details damning internal company e-mails from Intuitive Surgical, the company that makes the da Vinci Surgical System, that:

  • urge Intuitive sales staff to persuade surgeons to convert upcoming cases to robotic ones.
  • ask hospitals to relax credentialing requirements for surgeons, saying that requiring surgeons to do 5 supervised operations using the robot before going solo was "on the high side" and could have "unintended consequences." Hospital officials replied, saying, "We will review and most likely will decrease the 5 down to 3."
  • persuade surgeons to choose the da Vinci procedure for patients even when they were planning to use a different method.

In one e-mail, as reported by The Times, a clinical sales director wrote to his team: "Be proactive in finding cases to convert. Be prepared to challenge each trained surgeon every time you see a lap or open case. Be unsatisfied with the thought of ending a day without a converted case."

Intuitive says 1,371 U.S. hospitals have purchased a da Vinci system, and many have purchased 2. Nearly 500,000 procedures worldwide were performed robotically last year.

Meanwhile, in Massachusetts, reports of complications from robot-assisted surgery are rising, so much so that state health officials sent hospitals an "advisory" letter last week alerting them about their safety concerns, according to a report in The Boston Globe.

The state's advisory says some Massachusetts surgeons have used the robots to perform cases that were too complex for the technology (hysterectomies and colorectal surgeries, for example), or to perform cases that were too advanced for their own skill and experience in using the robots. The state's advisory recommends that hospitals consider whether direct-to-patient marketing is leading patients to seek out the procedure from their doctors. It also cautions hospitals to make sure their websites include the risks as well as the benefits of robotic surgery.

Dan O'Connor

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