Although the predictions of flying cars and robot butlers may have been a far off for the year of 2017, the technological advances that exist in this day and age are endless. Levitating objects, televisions as hats, refrigerators that talk to us, and yes, even Marty Mcfly’s famous self-tying shoes all exist today. It seems as though these new innovation are pointless and some days we wish we could go back to simpler times. This being said, new medical innovations have made thousands of procedures possible that were not before. These innovations range from new medication, medical tools, and something seemingly out of a movie; robotic surgery. Robotic surgery, in some cases, has made procedures possible that were not before. Some day robotic surgery could be the “gold standard” of surgery. It could be the only way humans perform surgery in years to come. Whether or not all of that is true, it is not accurate in the world one lives in today. There are still years of improvements and experimentation to be done before such claims can be made about robotic surgery.  Although, many testimonies from the companies that produce these instruments state otherwise. Some parties who wrongfully benefit from robotic surgery claim it is undoubtedly the way of future; however by using experiments conducted, testimonies from individuals, and statistical data it will become clear the downfalls unquestionably out shadow the benefits. 

It is important to note that all patients are giving the choice on whether or not they would like to opt for futuristic surgical approach. Physicians give their patients the information and allow them to choose their surgical path. The information the patients are receiving and the information they view online may not be entirely accurate if one follows where that information is coming from. In an Ebsco video, robotic surgery is clearly depicted on how it is implemented. A surgeon is in the operating room overviewing the procedure as it is performed with the assistance of a robotic surgeon (Ebsco). As of now robotic surgery is not completed by a robot alone, a surgeon is always present and controlling the robot. All of this information seems reassuring and if a patient was told this by their surgeon it may seem that it is in their favor to choose this path; however many factors are not disclosed by the surgeon.

The most significant difference between robotic and traditional surgery is the cost. A study conducted by a team of physicians sought out to find how much more robotic assisted surgery cost compared to traditional surgery. They followed all hysterectomies treated at the Mayo Clinic in Rochester, Minnesota. They found that, on average, a hysterectomy implemented with assistance of a robot would cost the patient $2,253 more than traditional surgery (Andrews). It is no mystery that robotic surgery is more costly than traditional surgery; physicians and medical instrument companies are not trying to hide this fact. Patients are aware of this cost difference and some are still opting this way of surgery, why is this? Physicians and medical instrument companies find a way to justify this cost. The justification is their main selling point. Doctor Rajesh Laungani, a urologist trained in robotic prostatectomy, claims “Patients are in significantly better shape after robotic surgery because they have less pain, they’re moving sooner, they feel better quicker, and they have less transfusion risk” (MediMedia). This notion that costs become equal when one factors in costs of hospital stays and post operative measures such as medication and blood transfusions is just untrue. In the same study mentioned above, out of all the hysterectomies the complications in both types of surgeries were not significantly different (Andrews). This leaves the only difference of the two surgeries to cost.

Traditional surgery has been taking place for decades. The earliest recorded surgeon, Sushruta, vividly described plastic surgery as early as 600 B.C. (Saraf). This lucrative way of medicine is an ever-changing operation; however the introduction of robotic surgery paved the path for these medical instrument companies to dominate the world of surgery. When the potential for this much money is available it seems plausible that these companies would skew some facts to make them even more successful. An important factor to keep in mind is the manufactures of robots involved in surgery. The cooperations that produce these medical instruments are extremely limited; with Intuitive Surgical almost completely monopolizes the whole business (Bertalan). Intuitive Surgical produces the da Vinci robot; the most popular robotic surgeon with over 3,800 units across the world as of April 2016 according to their website. Each robotic surgeon from Intuitive Surgical has a price tag ranging from 1.5 to 2 million dollars (Lee 2014). One may ponder why hospitals with such strict budgets are wiling to dish out huge sums of money for this controversial presence in the operating room. An easy answer to this mystery is due to its wow factor.

If a hospital possesses a multi-million dollar piece of equipment, especially one that is considered as “futuristic” as a robotic surgeon, it acts as a huge selling piece. Hospitals can advertise themselves as being innovative and modern; something patients, especially in this age, will admire. Martin Makary, a pancreatic surgeon at John Hopkins, perfectly explains that robotic surgery “can be useful in some procedures but is spreading too fast in a culture that marvels at new technology” (Pinkerton). A patient picking the best surgical path is changing from what is best for them, to what is the newest and most “flashy”. Paul Levy, a former hospital executive, was taken back when he came across a da Vinci advertisement in The New York Times. The advertisement showed white coats employed by the University of Illinois hospital grinning with the text reading “We believe in da Vinci Surgery because our patients benefit”. On further investigation Levy discovered that some of these men and women pictured were not even surgeons; some were not even medical professionals at all. Needless to say this advertisement violated the University’s code of ethics. The advertisement was later suspended due to controversy exposed by Levy (Ornstein 2014). If this hospital is willing to break its own code of ethics in order to keep up with this world of technological advances, why should anyone believe this is an isolated incident?

Intuitive Surgical is fairly accustomed to being in legal trouble. A startling $67 million was set aside by Intuitive Surgical in order to settle roughly 3,000 claims relating to the da Vinci Surgical Robot (Compton). Intuitive Surgical settled on all these cases, which means that they refused to accept the lawsuits in order to save themselves further embarrassment and bad publicity. The law team at Intuitive Surgical is well aware of the information that could be presented in a courtroom, information that could possibly ruin their whole cooperation. By settling these claims they limit the risk of exposure and continue to operate as normal despite the copious amounts of claims made against them. Along with these 3,000 claims was a class action lawsuit that landed the legal team of Intuitive Surgical in the courtroom to defend themselves. The lawsuit was filed by Gabriel Nasser and Dr. Alan Kozarsky on behalf of the patients who received mitral valve surgery. The surgery that was completed with a da Vinci Robot left metallic pieces in the body of the patients that later traveled to their brain. The judge however did not have enough evidence to come to a conclusion so that case was dismissed (Perriello). Its no mystery Intuitive Surgical is an extremely successful, powerful cooperation. When a single cooperation is as big as Intuitive Surgical is may seem impossible to uncover the truth they so desperately hide in the shadows.

Since the robot is controlled solely by the surgeon it is vital that the surgeon has amble knowledge and experience using a robot with such complexity. It seems like in this age of technology it would be routine for medical students to be taught this new way of surgery. If surgical students are trained in all surgery and then after have the opportunity to choose what specialty of surgery they would wish to go into, it seems obvious to train them in robotic surgery. However, this is not the case. In an experiment conducted by five doctors, training and many other factors involving testimonies from students were researched. These doctors found that the percent of residents who were involved in at least one robotic assisted surgery (RAS) dropped 22% from 2011 to 2016. The number of cases that each resident was assigned to was also accounted. The research shows that out of the 100 residents surveyed roughly 40 were the console operator of less than 5 RAS. Only 3 of those residents were the console operator in 11-20 operations and only 1 who was the console operator of more than 40 RAS (Locke). This data proves the majority of resident students are given limited exposure to robotic surgery. If the statement from Intuitive Surgery is correct, that robotic surgery in undoubtedly the way of the future, why is the education of these young doctors so limited on the matter?

The education these doctors to-be have been receiving has continuously failed to provide sufficient exposure and knowledge regarding robotic surgery. As a result the interest that these residents have in learning more about RAS is not reassuring. In the same study the researchers found that 50% of residents surveyed claimed that they did not desire more console time operating a robotic surgery device. 60% of those residents who did not have a da Vinci robot in their program said that it is actually beneficial to their education (Locke). 

The research shows that the “inevitable” fact that robotic surgery is undoubtedly the superior option is just false. Some of the main selling points offered by Intuitive Surgical is that patients will save money when they choose robotic surgery because they will not have to pay for lengthy hospital stays and other post-operative costs. Physicians in Austria sought to find differences between robotic assisted and traditional prostatectomy surgeries. They followed 151 men who underwent traditional surgery and 157 men who underwent RAS. They noted any intraoperative issues as well as any post-operative complications in all the men. During the operation factors such as blood loss, time taken for each surgery, and any other miscellaneous issues were noted. It was discovered that there was no significant difference in any of these elements listed. The men were observed 12 weeks later. Again, there was no evidence that showed significant differences between the two groups. The one difference that is however significant, is the price tag of the robotic assisted surgery, a cost of $1,400 more than its counterpart (Johnson). It seems illogical, even ignorant to opt for a costly futurist surgery that does not present any benefits to the patient.

In a similar experiment researches followed patients who received a donor nephrectomy. Seventy-three of the patients received laparoscopic surgery and 22 received RAS. The BMI, age, and health status were all similar in both groups. Again the data showed that between the different types of surgery there were no significant differences. Length of the patient’s hospital stay was relatively the same along with differences in blood loss or need for blood transfusion. Patient’s pain post-operative was also similar between the two groups. The total time of surgery in RAS was however, on average, longer than laparoscopic surgery; this leaves possibility for more complications. Patient’s hemoglobin, the oxygen in their blood, was lower in the robotic assisted group. The researches also followed the patients who received the donor kidney. The differences between those patients were again, not significantly different between the two groups (Yang). These experiments and the data it provides should be troubling to anyone. What are the reasons these surgeons and medical instrument companies are encouraging patients to opt for the more expensive option of surgery if it does not prove superior? 

A common fear many have in this day and age is lack of stability. Hard working people want to know that the job that have or are aspiring to have will be available to them for as long as they need to work. Countless jobs have been stolen from these hard working people because of technological advances. Simple algorithms made the necessity for occupations like travel agents and phone operators obsolete. Since these technological advances crept their way into medicine, medical professionals in the field are left wondering if their job is safe. A Silicon Valley investor Vinod Khosla made a statement that struck fear in the hearts of all medical professionals. Khosla claimed that soon “technology would replace 80% of doctors” and that it “would not only be cheaper but more accurate and objective than the average doctors” (Bertalan). Every advance that robots make into medicine leaves fear in these hard working men and women. It seems absurd a robot that fails to benefit the patient is capable of taking the job of a mother or father trying to provide for their family.

All of this concludes that robotic surgery is not the “way of the future” that many have claimed. Research has proved that robotic surgery does not serve as an answer to all surgical problems. It is frankly unethical to make such remarkable acquisitions about robotic surgery without having statistical proof. Companies such as Intuitive Surgery are so successful because of the “technology-obsessed” society that exists today. It is no longer about what is beneficial and what is logical; this society today has deemed “wow factors” more significant. It is no mystery that robotic surgery has infected its way into many hospitals. If a hospital is left behind in this technology tidal wave they will lose patients and credibility. They are willing to spend large sums of money on pieces of technology if it enhances their popularity. Sadly, this is done unethically. 

When hospitals and surgeons go this route of favoring what is “new” over what is right it leaves behind one key party, the patient. Patients are not benefiting from this amateur risky surgery; in many cases more harm than good is being done. Even after thousands of lawsuits against companies like Intuitive Surgery nothing has been accomplished. It may be too late to stop the entity that is huge cooperations shoving false narratives down the throats of those ill informed, but it is not too late for patients to take a stand. Today more than ever it is vital for everyone to do his or her own research. It is imperative to understand that the newest option does not always mean the best option. Surgeons benefit from robotic surgery more than their patients. Factors like this are ones that patients need to be aware of and take account for when he or she decides what surgical path is optimal for them. Several pieces of evidence has been uncovered that shows how these medical providers wrongly benefit from robotic surgery. It is plausible they would push for the new way of surgery while making it seem like the patients choice. So, in this world of corruption and dishonesty, where it seems that anyone and everyone has an alternative motive, who do you trust? 
