Editor's Memo

Robotic Surgery Comes at a Price, But So Does Every New Technology

John Marcille

The antihero Gordon Gekko doesn’t exactly whip out his cell phone in the 1987 film Wall Street. He hoists the Motorola DynaTac 8000X — nicknamed “the brick” — to his ear. Gekko is rich, for only the rich could afford “the brick,” which sold for about $10,000 in today’s money. See for yourself. Watch Wall Street at home on a flat-screen television set that sold for about $6,000 in 2004, but can be bought for $500 these days.

Which brings us to robotic surgery, the subject of our cover story. As author Richard Mark Kirkner explains, there’s no consensus that robotic surgery produces better outcomes across the board. Robotic prostatectomy is widely accepted as the standard of care for radical prostate removal, with results at least as good as (some argue better than) traditional open prostatectomy. However, the outcomes have not been so hopeful for other procedures, most notably hysterectomy.

Never mind. If you’ve got it, flaunt it, which is exactly what hospitals with da Vinci surgical robots do. They tell potential patients about their state-of-the-art technology because they believe in it. They also have to pay for it. The equipment can cost from $1.5 million to $2.1 million, not counting the expense of an additional operating room, contract service, and disposable tools.

Brent James, MD, executive director of the Institute for Health Care Delivery Research at Intermountain Healthcare, wonders what will happen if the shift toward fee-for-value continues, a shift that puts providers at more financial risk. No matter, says Marty Makary, a cancer surgeon, who predicts that “the technology will advance to where it will be a real tool for surgeons to have in their tray.”

Technology generates its own momentum, and certainly its own verbs. A few years ago, someone Skyped me. Not because she had information that could be relayed only visually, but just to show that she could.

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