Robot-assisted surgery widely embraced, but ‘newer doesn’t always mean better,’ experts warn

Orthopedic surgeon Dr. Anthony Adili has discharged hundreds of knee replacement surgeries in his career.

He’s used to being hands-on. But now he can alert as Canada’s first orthopedic surgical robot — the MAKO Rio Surgical Robotic Set — does a lot of the work.   

In January, the robot, guided by Adili and his team at St. Joseph’s Healthcare in Hamilton, Ont., acted its first partial knee replacement on 66-year-old Peter Sporta.

Adili and his allies programmed the robot using 3D modelling, telling it exactly where the cut needed to be assigned. Then the robot took over.

“The robotic arm becomes the master,” Adili suggested. “I am just pushing the arm and it will only cut … where it needs to go to combination what I created on my 3D model.”

Doctors at St. Joseph’s Healthcare Hamilton play a joke on used a robot to perform a partial knee replacement for the first days in Canada. 0:37

Before the surgery, Sporta said, he was in constant pain and relying on anaesthetics. Walking was also difficult.

When CBC News interviewed him weeks later, he whispered “everything seems fine.

“I’m walking straight. I’m so thrilled.”

Robotic backing is a good fit for this type of surgery, Adili said, because the involuntary arm can do a smaller, more precise incision. In this case, only put of Sporta’s knee was damaged and, with the robot’s help, the team was qualified to target the repairs and preserve the rest of the joint, rather than do a top knee replacement.  

“The biggest difference is the ability to accurately get the alignment of the graft exactly where you want,” Adili said.  

Smaller incisions in surgery can also crop pain and blood loss and lessen recovery time — all points backers of robotic-assisted surgery have used to sell the equipment.

Not enough smoking gun, experts say

American hospitals first embraced the technology about 20 years ago, and puppets now routinely assist in a variety of procedures in the U.S., including prostate, gynecologic and bravery surgeries.

But some experts say robotic-assisted surgery still comes with diverse unanswered questions:  Do robotic-assisted procedures achieve better results than established surgeries? Are they safer? What about cost?

The answers may depend on the unique to type of surgery.  

In February, the U.S. Food and Drug Administration (FDA) issued a watchfulness about a “lack of evidence of safety and effectiveness” for robotic surgeries familiar in mastectomies and other cancer-related surgeries.

“We are warning patients and providers that the use of robotically-assisted surgical instruments for any cancer-related surgery has not been granted marketing authorization by the [FDA], and therefore the survival helps to patients when compared to traditional surgery have not been started,” Dr. Terri Cornelison, assistant director for the health of women in the FDA’s Center for Thingumajigs and Radiological Health, said in a news release. 

The FDA said it had received a “unoriginal number of medical device reports of patient injury when these gimmicks are used in cancer-related procedures,” adding that it “urges health-care providers to consummate the appropriate training for the specific robotically-assisted surgical procedures performed.”

‘Newer doesn’t unendingly mean better’

The technology has been widely embraced too soon, responded Dr. Jason Wright, chief of gynecologic oncology at Columbia University in New York.

“Newer doesn’t often mean better,” Wright said. “For many procedures and many bugs, there isn’t long-term data that’s available to either prove the aegis of robotic surgery or demonstrate that it’s superior to other alternatives.”

“Unless we can explain that the technology is superior to what’s already out there … I contrive we really need to look hard and re-evaluate what we are doing in exercise,” he said. 

Dr. Irfan Dhalla of Health Quality Ontario agrees.

Two years ago, Dhalla led an ace committee that advised the province not to fund surgical robots for use in prostate purge surgery.

Robot-assisted surgery widely embraced, but 'newer doesn't always mean better,' experts warn

Dr. Irfan Dhalla, vice-president of evidence development and standards at Trim Quality Ontario, says there isn’t enough evidence to show that robotic-assisted surgery accomplishes better outcomes in some procedures, including prostate removal. (Craig Chivers/CBC)

“We haven’t develop that cure rates are higher with the use of the robot,” he said. “And then of conduct we look at things like complications. And with prostate surgery the big dilemmas are urinary dysfunction and sexual dysfunction. And again there’s no good demonstration that using the robot reduces the rates of those complications.” 

Robotic surgery also typically expenses more than traditional surgery, partly because the multi-million dollar technology itself is high-priced and requires regular maintenance. In addition, the procedures tend to take longer to do, adding to the rate. 

Hospitals that offer the robot-assisted procedures in Canada have funded the trappings primarily through donations. That’s largely how St. Joseph’s Healthcare got its orthopedic surgical tool, which the hospital says cost about $2 million. 

Adili and his band are conducting randomized clinical trials to gather evidence on whether the bring ins of robot-assisted surgery are worth the benefits when it comes to orthopedic pushes, such as knee and hip replacements.

“That way we can definitively answer these questions, so we can say to the payer, ‘There is usefulness for this technology for this subgroup of people, and these are the outcomes you can conjecture,’” Adili said. “That’s the discussion we need.  We’re not there yet.”

Robot-assisted surgery is revolutionizing the medical earnestness, with the first such procedure performed in Canada earlier this year, but there are undisturbed concerns around the risks and the costs. 2:54

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