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Da Vinci Surgical Robot Exemplifies Wonders of 'Aggressive Marketing'

Oct 30, 2013

Surgeons have been increasingly using the $1.5 million da Vinci surgical robot to perform a growing number of procedures. Intuitive Surgical, the manufacturer, along with the hospitals and surgeons who support the device, have been credited for fueling sales through the use of aggressive marketing—including Internet promotions and advertising. A recent Bloomberg report unveiled details of the marketing campaigns that have been utilized to prompt purchases.

Many of the marketing strategies deployed to support the da Vinci surgical system—the only robot approved by the U.S. Food and Drug Administration (FDA) for use in soft-tissue surgery in the U.S.—seem to have some common traits. For instance, these materials make wide use of the supposed fact that robotic surgery is superior to standard minimally invasive techniques. However, as the Bloomberg report noted, the ads fail to offer proof—and ignore all contradictory evidence.

The bottom line is that robot-assisted surgery has yet to prove in randomized trials—the gold standard of clinical trials—that it offers significant benefits compared to those customary methods.

In the face of this aggressive marketing push behind Intuitive Surgical’s brainchild, there has been what one investor-research firm, Citron Research, described as a “surprising” surge in adverse events and deaths reported to the FDA during the current year. In fact, some 2,332 adverse event records were posted to the MAUDE (Manufacturer and User Facility Device Experience) database for the first eight months of 2013, compared to 4,603 records posted for the entire 12-year period since such tracking began for the da Vinci in 2000. For this year alone there were between 55 and 60 cases of punctured, burned or lacerated bowel injuries posted, and many of the related surgeries involved simple hysterectomies or prostatectomies—both of which are typically low-risk procedures (when done without a robot). Citron asserted in its report that “the only reason there is not a national outcry is because the da Vinci robot has yet to kill or injure ‘the right person’—like the next of kin of a congress member or a celebrity.”

It is striking how much damage even one doctor can be capable of when using a da Vinci. In April, the Colorado Medical Board filed a complaint against Dr. Warren Kotz, a surgeon at Porter Adventist Hospital in Denver, charging him with 14 counts of unprofessional conduct related to his use of the robot, including failure to advise patients on alternatives to the da Vinci, Bloomberg News reported. Ten of Kotz’s patients suffered injuries or complications between 2008 and 2011, according to the complaint. Five had arteries punctured or torn; others had nerve damage. One died and another needed cardiopulmonary resuscitation.

A 2011 study by doctors at Johns Hopkins School of Medicine found that 164 hospital robot-surgery websites surveyed “overestimate benefits, largely ignore risks and are strongly influenced by the manufacturer,” according to research in the Journal for Healthcare Quality. The American Congress of Obstetricians & Gynecologists has questioned the benefits of da Vinci surgery for most hysterectomies.

Considering how many da Vinci surgical robots have been sold despite the aforementioned developments, one can only wonder about the astonishing power of marketing.

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