Legislation Poses the Question: Are Surgical Robots Automatically Good?

Friday, September 13, 2013

Senator Dick Moore is one of those legislators who know how to “move an issue,” as they say at the State House.  That’s a good thing for anyone who may ever become a patient at a Massachusetts hospital or surgical center.

Moore sits today in the second-highest place in the upper branch of the Massachusetts legislature: Senate President Pro Tempore.  But for years he was the Senate’s point person on health care as the co-chair of the Joint Committee on Health Care Financing.

There are few state legislators across the nation, and certainly in Massachusetts, who know as much about health care practices, policies and costs as Moore.  Senator Minority Leader Bruce Tarr likes to tease Moore during Senate budget debates by referring to him as “the high commander of health care.”

Moore’s knowledge and leadership proved crucial in 2006 to the enactment of the state’s universal health care legislation, which in turn became the template for federal health care reform in 2009, the Patient Protection and Affordable Care Act, also known as Obamacare.

So if Dick Moore thinks we need a new law governing the use of robotic surgical devices, you can bet that surgeons and hospital administrators everywhere in Massachusetts are taking notice.   

And you can reasonably expect that the doctors and hospitals who have lately made big investments in robotic surgical training and equipment will be represented in some effective way at the State House on Tuesday morning, September 24, when the Joint Committee on Public Health holds a hearing on Moore’s “Act Relative to Robotic Surgery in the Commonwealth,” Senate Bill 1069.

SB 1069 would create a special commission to investigate and review the use of robotic surgery throughout the state.  This commission would develop a process for certifying applications by hospitals for any new robotic surgery programs, and establish guidelines for the training and experience of all surgeons who wish to perform robotic surgery.

I’m probably like most folks in that I have been vaguely aware of the existence of robotic surgical devices.  I’ve heard they’re supposed to be good for removing prostate glands, for example. I never want to find out how good.   

I’m like most folks, too, I assume, in not wanting to dwell on the mental image of a computer-driven robot slicing me open on an operating table someday. I was born too long ago to have an ingénue-like trust in anything that runs on microchips.

There seems to be no stopping the rise of the robots in the surgical suites of America.

“…robotic surgery has grown dramatically,” the New York Times reported on September 9, 2013, “increasing more than 400 percent in the United States between 2007 and 2011.”

According to that article, headlined “New Concerns on Robotic Surgeries,” U.S. hospitals have acquired approximately 1,400 surgical robots known as the da Vinci system from a California company called Intuitive Surgical, Inc.  The da Vinci systems cost between $1.5 and $2.5 million apiece.

If they buy it, you can be sure they’ll use it as much as possible.

There’s conflicting evidence on whether there are more or less surgical errors associated with robotic equipment, and the federal government is looking into the question.  But there can be no doubt that innovations like surgical robots are adding to the nation’s already staggering health care bill.

Dr. Martin A. Makary, an associate professor of surgery at Johns Hopkins University, asserted in that September 9th New York Times piece that the expansion of robotic surgery has occurred without proper evaluation and monitoring of the benefits.

“This whole issue is symbolic of a larger problem in American health care, which is the lack of proper evaluation of what we do,” Dr. Makary was quoted as saying.  “We adopt expensive new technologies, but we don’t even know what we’re getting for our money – if it’s of good value or harmful.”

That article may be found at:

I’ve never spoken with Senator Moore about his robotic surgery bill, but I am certain he considers it one means to the end of getting good value for all the money we spend on health care in Massachusetts.  I’m basing that on the senator’s many persuasive public comments on the importance of controlling health care costs so that we can maintain our state’s popular system of universal health coverage over the long haul.

It will take many measures like SB 1069 to get us where we need to be.  The sooner it’s passed the better.

ADDENDUM:  There are at least two other New York Times articles I'd recommend to anyone interested in robotic surgery and its implications for the health care system.  One was written by Roni Caryn Rabin: "Salesmen in the Surgical Suite," 3-25-13, the other by Ezekiel J. Emanuel: "In Medicine, Falling for Fake Innovation," 5-27-12.  They may be found, respectively, at the following:

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