My mentor at Harvard/Mass General Hospital, Bert Zarins MD told me to always beware of “the triumph of technology over reason”. Skill and diligence on the part of health care providers is the most important element in quality care; and one of the problems with health care currently is money being spent on items that do not improve health. Now it appears that surgical robots may be part of that equation. A study from South Korea has shown that robotic surgery “was associated with prolonged operating time and higher hospital costs compared with laparoscopic surgery” for patients undergoing radical nephrectomy (kidney removal) for a renal mass with no benefit to the patient for that extra time spent in surgery. The adoption of new, and potentially unproven, technology is used as a marketing tool, because new technology, like new buildings, has commercial appeal to consumers. I am constantly approached by well meaning industry representatives appropriately doing their job to tell me about new technology from their company. However, it is important that I also do my job and not adopt them unless there is evidence that newer is really better. But, unfortunately, as more and more doctors are employed by hospitals, doctors have less and less say about what is offered to their patients, since hospitals often dictate how their employed doctors provide care. The physicians in South Korea are to be commended for providing important evidence that this costly technology is not better, at least in this instance.
