The demands for robotic surgery

Many months ago,
I wrote about the da Vinci Robot Surgical System and expressed doubts
about whether there was evidence to support the clinical efficacy of
this equipment, as opposed to the marketing efficacy of the company
selling it. Well, the time has come to graciously say, “Uncle!”

making any representations about the relative clinical value of this
robotic system versus manual laparoscopic surgery, I am writing to let
you know we have decided to buy one for our hospital.

Why? Well, in
simple terms, because virtually all the academic medical centers and
many community hospitals in the Boston area have bought one. Patients
who are otherwise loyal to our hospital and our doctors are
transferring their surgical treatments to other places.

residents who are trying to decide where to have their surgical
training look upon our lack of the robot as a deficit in our education
program. Prospective physician recruits feel likewise. And, these
factors are now spreading beyond urology into the field of
gynecological surgery. So as a matter of good business planning,
concern for the quality of our training program, and to continue to
attract and retain the best possible doctors, the decision was made for

So there you have it. This is an illustrative story of the health care system in which we operate

Paul Levy is the President and CEO of Beth Israel Deconess Medical
Center in Boston. He blogs about his
experiences at, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.

13 replies »

  1. Truth is that men are fickle about this. I live in a rural California town with great urologists. But we’ve seen a trend of men choosing to go to the big cities for their prostate surgery. Anecdotally, we hear that they admire our local cancer center and think it’s great for their wives for breast surgeries and such, but when it has to do with such a sensitive part of their own anatomy, they’ll spare no trouble to pursue what they think is best for them!

  2. Thanks Paul…I had been looking for credible opinions on the da Vinci systems for quite sometime.

  3. Testimonial- I, an internist, while demonstrating a stethoscope discovered I had severe mitral regurg/ ruptured chordae. After a lot of research on my part, had robotic repair- a perfect repair. I was discharged in 48 hrs, 1 mile walk on day 4, 7 mile hike day 10, 35 mile moderately hard bike ride day 30… with four 2cm chest wall incisions. Amazing. Efficient. Time /work saving. It isn’t just a toy-.

  4. “if the person I trust as my surgeon states that he does not operate with robots (for reason XYZ), I would be just fine … ”
    Absolutly, I pick the person not the machine. I had radial keratotomy years ago when they were using knives and not lasers. When it came time to do an adjustment the surgeon was still not using a laser. He explained he had tried laser but found he had much more control to make fine adjustments with cuts and I had complete trust in him. To this day my vision is 20/20 distance, age still catches up for the near vision though.

  5. 1) My own huge MSG advertises with their robots for 3 years or so.
    2) I do agree with epson >>Patients will show up at the doctor’s office asking if they can perform the operation with a shiny toy rather than “traditional surgery.”<>Afterall, everybody wants for themselves the latest, best, and most expensive.<< – if the person I trust as my surgeon states that he does not operate with robots (for reason XYZ), I would be just fine … and so would be the overwhelming majority of patients in Europe … in the US, too many patients have an unhealthy tendency to prefer the newest, shiniest, most expensive option.

  6. Peter, that’s actually a good question you bring up. I wonder if women do have the same response to hearing “we now have a da Vinci surgical system,” and if a survey of female residents regarding their residency decisions might shed some light. Female urologists are an extreme minority, however, so until robotic MIS becomes more prevalent in gynecological surgeries we’ll probably never know.
    My personal guess? Men care quite a bit more about it.
    In regards to patients driving this – patients undergoing urological surgery are more likely now to communicate online about what they understand to be the “cutting edge” in the procedure. Patients will show up at the doctor’s office asking if they can perform the operation with a shiny toy rather than “traditional surgery.” Afterall, everybody wants for themselves the latest, best, and most expensive. There doesn’t need to be TV commercials and print ads, because they’re not trying to target the general public, but only the subset that require prostate surgery. In a way it’s a result of both the strength and weakness of Healthcare 2.0 – pseudo-educated consumers falling prey to well executed marketing campaigns.

  7. “sometimes you just really need a new shiny toy to survive the day”
    Sounds like a man thing. Do women docs drool over this equipment as well?
    rbar, how would patients drive this? I havn’t seen any TV commercials or print ads about this. Are sales brochures scattered ingeniously throughout the waiting rooms? Maybe the Musak has subliminal messages.

  8. One would like to believe that ultimately clinical efficacy will triumph, and that the money saved from not buying superfluous equipment (and services) can be applied elsewhere to improve clinical outcomes. Rather than cater to the short-sighted demands of a fickle generation, true clinical efficacy at reduced costs should guarantee future organizational success. Unfortunately, idealism is often impractical, and sometimes you just really need a new shiny toy to survive the day.

  9. One should not forget that it is to a large extent the patients who are driving this. I would want to quip about robotic rounds&rectals, but I do think that this medical arms race (incl. the newest drugs, the most scans, the most specialized specialists) is at the core of our medical inflation.

  10. “Me-too” drugs or “me-too” medical equipment, that is the question.

  11. It’s just an arms race isn’t it. Weapons of mutual destruction. Are you able to at least charge less for surgery and pass the savings along?