Thyroid surgery costlier with robotic system

NEW YORK Wed Aug 22, 2012 2:59pm EDT

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NEW YORK (Reuters Health) - Surgery to remove part of the thyroid gland is twice as expensive when it's done with the help of a robot rather than by a surgeon alone, according to a new study.

In recent years, robotic systems have become more popular for prostate and gynecologic surgery, for example, but data is mixed on whether using a robot makes procedures any faster, safer or cheaper.

Because robotic surgery isn't currently approved in the U.S. to treat thyroid conditions such as cancerous and non-cancerous nodules, it's considered "off-label" by the Food and Drug Administration - but some surgeons still do the procedures.

Known as the da Vinci Surgical System and sold by Intuitive Surgical, the robot runs for about $1.5 to $2 million, not including regular maintenance and replacement parts.

The new research suggests using the tool doesn't provide any ultimate cost benefits that would make the initial investment worth it, researchers reported this week in the Archives of Surgery.

"You have to be dramatically quicker than the standard thyroidectomy to make it cost-effective," said Dr. Rasa Zarnegar, an endocrine surgeon from Weill Cornell Medical College in New York who wasn't involved in the new study.

"The safety looks exactly the same, and the recovery looks exactly the same - maybe even a little longer," he told Reuters Health. "The only pure benefit for the operation is the cosmetic benefit, nothing else."

Robotic surgery leaves a less obvious scar, so it could benefit people who form scars easily - or models, Zarnegar added.

For the new study, researchers from Vanderbilt University in Nashville, Tennessee compared the cost of standard thyroid surgery when performed by two experienced surgeons to using a robot for the procedure.

Dr. James Broome and his colleagues factored in the price of the robotic system - spread out over the number of times it would be used in five years - as well as the length of the procedures.

They found the average cost for thyroid surgery using the robot was $5,795, compared to $2,668 for standard surgery. (Neither price tag factors in the cost of the operating room or staff salaries, which the researchers figured would be the same between the two operations.)

‘BE VERY CAUTIOUS'

Broome told Reuters Health that the findings are in line with data on a range of robotic surgery uses.

"None of those procedures have shown any improved outcomes for the patient," he said. Patients "should be very cautious about whether it actually does anything better for them."

Despite the limited evidence on the possible benefits of robotic over standard surgery, many hospitals aggressively market the technology, without mentioning its potential downsides (see Reuters Health story of July 20, 2012).

An Intuitive Surgical representative said the cost of robotic surgery needs to be evaluated separately case-by-case.

"Robotic thyroidectomy is generally a very low volume procedure in the U.S.," Angela Wonson told Reuters Health by email.

"It is currently an off-label use of the technology and not a focus of the company in the U.S. In certain markets, such as Korea, patients have shown a strong preference due to the location of the incision in the axilla (underarm), which is less visible than the traditional neck incision."

Dr. David Terris, a thyroid surgeon and professor at Georgia Health Sciences University in Augusta, said that for some people, not having a visible scar could be a very important consideration. One option, he said, would be to have patients chip in for some of the extra cost if they would prefer robotic surgery.

"I think the consideration here is the patient/consumer deserves to have a choice in the procedures," Terris, who wasn't involved in the research, told Reuters Health.

"Thyroid disease mostly commonly occurs in young women, so they are particularly interested in the appearance of their neck," he added.

Zarnegar said it's likely that the cost of robotic surgery will go down and the technology will improve as more devices come on the market in the next few years - so it's not time to turn away from robots completely.

SOURCE: bit.ly/PcSKJP Archives of Surgery, online August 20, 2012.

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