An Alternative Reason for Free Hernia Screenings?
Victoria Montei, the system director of surgical services at Midland-based MidMichigan Health system, told Kaiser Health News that with the word “free,” people are more drawn to being tested and screened. Though small in cost, some copays prevent people from getting screened and testing is put on the back burner.
There’s no research to support the effectiveness of hernia screenings and there are significant risks associated with all types of hernia surgeries. And according to science, there’s simply no need to rush under the knife — or the robot. A 2016 study found that patients with few hernia-related symptoms can safely watch and wait.
While all surgeries pose common risks such as infection, a 2016 study found that groin hernia surgeries result in chronic pain, some of which is debilitating, for as many as 12 percent of patients, Kaiser Health News reported.
“My question is: Why are we doing this (i.e. screenings)?” Dr. Dana Telem, University of Michigan Medical School associate professor and director of Michigan Medicine’s Comprehensive Hernia Program, told Kaiser Health News. “Even with the best intent, it makes me worry about the unintended consequences down the line.”
“A screening for hernia? That makes no sense to me,” Dr. Michael Rosen, director of the Cleveland Clinic’s Hernia Center and medical director of the Americas Hernia Society Quality Collaborative, told Kaiser Health News. “Obviously, it’s just there to drive people to the operating room.”
Is Robotic Hernia Surgery Really Any Better?
Surgical robot manufacturer Intuitive Surgical features research published in the journal Hernia in 2018 on its website, which found that robotic hernia surgery leads to fewer post-surgical complications from conventional surgery 30 days later. However, another 2018 study published in Surgical Endoscopy concluded that outcomes from robotic groin hernia surgeries were similar to those from laparoscopic and conventional surgery. Not only that, but the longer robotic operation times may be contributing to increased rates of skin and soft tissue infections.
There have also been serious concerns when using the da Vinci robot for hysterectomies, according to Kaiser Health News, and with cancer-related robotic surgeries in women, according to the Food and Drug Administration.
More definitive information is on the way. Results from randomized clinical trials comparing robotic hernia surgery outcomes with conventional laparoscopic surgical outcomes are expected this fall.
Robots or Doctors?
Robots Don’t Perform Surgeries, Doctors Do
The da Vinci System robot uses a “3D HD vision system and special wristed instruments that bend and rotate far greater than the human hand,” according to the Austin Regional Clinic. This is sophisticated technology, and there’s some question as to whether surgeons are being properly trained to use it.
“So you have surgeons who operate for half a day on pigs, take a ten-question multiple-choice test and have a proctor, another surgeon, do two surgeries and then they’re turned loose with the machine,” attorney Richard Friedman said to imarc Research.
Follow the Money Trail Into the Future
With each da Vinci robotic device costing an average of $1.5 million, many questions remain not only about the purported medical advantages of robotic hernia surgery but about the economic impacts. In the 2016 study mentioned earlier, which was conducted between 2012 and 2016, robotic surgeries averaged $7,162 each versus $4,527 for laparoscopic procedures and $4,264 for conventional open surgery.
Are there benefits to paying more for longer operations with potentially increased infection rates? Only time will tell.
Footnotes
"Open versus robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair: a multicenter matched analysis of clinical outcomes." 26 April 2018. R. Gamagami et al.
"Inguinal hernia repair: is there a benefit to using the robot?" 24 October 2017. Eric J. Charles et al.