Sunday, July 6, 2014

While we're on the topic of marketing robotic surgery, let's note a new article in JAMA Surgery that tells of the real human cost of the rapid infusion of this technology.  From the abstract: 

Importance  Surgical innovations disseminate in the absence of coordinated systems to ensure their safe integration into clinical practice, potentially exposing patients to increased risk for medical error.

Objective  To investigate associations of patient safety with the diffusion of minimally invasive radical prostatectomy (MIRP) resulting from the development of the da Vinci robot.

 Conclusions and Relevance  During its initial national diffusion, MIRP was associated with diminished perioperative patient safety. To promote safety and protect patients, the processes by which surgical innovations disseminate into clinical practice require refinement.

A related news release from UC San Diego, where the authors reside, noted:

Researchers at the University of California, San Diego School of Medicine have found that the risk of patient harm increased two-fold in 2006 – the peak year that teaching hospitals nationwide embraced the pursuit of minimally invasive robotic surgery for prostate cancer.

“This study looked at the stages of innovation and how the rapid adoption of a new surgical technology—in this case, a surgical robotic system—can lead to adverse events for patients,” said Kellogg Parsons, MD, MHS, surgical oncologist, UC San Diego Health System and first author of the paper. “There is a real need for standardized training programs, rules governing surgeon competence and credentialing, and guidelines for hospital privileging when novel technologies reach the operating rooms of teaching and community hospitals.” 

“A responsibility of deploying a surgical technology should include the responsibility to monitor it as it diffuses throughout the real world to ensure safety,” said David C. Chang, PhD, MPH, MBA, director of Outcomes Research at UC San Diego School of Medicine and the paper’s senior author.  “Surveillance of surgical safety should be ongoing, much like the Centers for Disease Control monitor changes in trends of infectious diseases across the country.”

 “One potential intervention would be the development of standardized training and credentialing programs, much like the aviation industry requires of flight crews inexperienced with new types of aircraft,” said Parsons, who is also an associate professor of surgery at UC San Diego School of Medicine. “An independent, continuously updated tracking system for the adoption of new surgical technology is also essential. Prior estimates of robotic prostatectomy uptake, provided exclusively by the robot manufacturer, substantially overestimated the speed with which it was adopted by the surgical community.”


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