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Robot use in surgery debated

| Saturday, July 6, 2013, 12:01 a.m.

For all the millions UPMC spends on marketing, you won't see a single ad promoting robotic surgery. Not on TV, not in newspapers and not on its colorful, purple-hued website. Officials promoting the region's health giant skillfully avoid trumpeting its use of a popular but controversial procedure.

You can't blame them. The Food and Drug Administration this year opened an inquiry into the safety of the da Vinci Surgical System, perhaps one of the most talked about technological advancements in medicine. Surgeons use the da Vinci robots to do hysterectomies, gastric bypasses and even kidney transplants. Last year, robots assisted in more than 400,000 surgeries nationwide.

UPMC owns eight robots, which come with the promise of smaller incisions and quicker recovery time. The machines cost more than $2 million each and California manufacturer Intuitive Surgical Inc. is raking in about $610 million in sales.

Product liability lawsuits filed against the company allege that surgeons aren't properly trained and the robots have defects that cause surgical complications. The FDA is reviewing circumstances of five deaths tied to the robots and several incidents in which patients sustained complications. None of those incidents is local.

One of the robot's most prolific users is Dr. Jeff Cohen, a urologist at Allegheny General Hospital in Pittsburgh's North Side, which has one robot (West Penn Allegheny Health System has two others, at West Penn and Forbes Regional hospitals).

Cohen said he initially was skeptical of the robot, which he began using about six years ago to remove prostates. He's certain that problems with robotic surgery arise when surgeons aren't properly trained.

“Have you ever heard a doctor say ‘I'm really bad at something?' ” Cohen asked me. In other words, some surgeons aren't willing to admit they're not good at using the robot.

When Cohen started using the robot, by manipulating its arms through a console of hand controls and foot pedals, it took him six hours to finish one surgery. He now can do that in about 90 minutes.

Cohen estimates he and his partners have performed well over 500 surgeries using robots. The upshot? Less blood loss, less time in the hospital and less recovery time.

Dr. Joel Nelson, chair of urology at UPMC, said there's no significant difference in outcomes when you compare robotic surgery for prostate cancer to the standard open procedure.

He led a study published last year that showed the robot-assisted surgery is significantly more expensive than the traditional surgery to remove the prostate. The study found that UPMC Shadyside lost $4,013, on average, on each robotic-assisted prostate surgery.

Nelson doesn't do robotic-assisted surgery, but his colleagues do. He conceded that about the only benefit of using the robot is having a “more cosmetically pleasing result” with smaller incisions.

“You have to ask yourself, ‘What price are you willing to pay to get that?' ” Nelson said. “It's a personal choice.”

Indeed, a personal choice that comes at a price. Though robots might have a place in medicine, they never will replace humans. It's up to humans to make sure robots do what they're expected to do — without taking over medicine.

Luis Fábregas is a Trib Total Media staff writer. Reach him at 412-320-7998 or lfabregas@tribweb.com.

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