Uptake of robot-assisted radical prostatectomy in the Netherlands

There is an interesting article just published in Social Science & Medicine that addresses the social, “emotive”, and other drivers for uptake of da Vinci robot-assisted radical prostatectomy over the past few years in the Netherlands.

The full text of this paper by Abrishami et al. will be available though September 12 on the ScienceDirect web site. After that, only the paper’s abstract will be easily accessible.

We need to be clear that this paper is not in any way about whether the outcomes after surgery using a da Vinci robot are really better or worse than the outcomes after open surgery. It is much more about whether people think that in some way the use of a robot “must” in some way be “better” or provide other benefits that have nothing to do with actual patient outcomes. The authors address this by measuring what they refer to as “affordances” of differing types.

One is tempted to wonder whether this sort of assessment of why and how new technologies are rapidly adopted into medical practice may really be of far greater interest to sophisticated marketers of such devices than they are to the medical and scientific community.

To quote the authors:

The da Vinci robot can propagate competition among urologists, between hospitals, insurers or even between cities, regions, and countries. Once the competitive privileges of the robot are disseminated, an increasing number of surgeons and hospitals may feel under pressure to deliver da Vinci surgery. The promises of technology result in a socially-constructed shared obligation to adopt/use it. Many respondents recognised it and described it literally as a “pressure” (as opposed to a choice).

This statement certainly mirrors a sense of pressure to use the robot that we had heard some American urologists feel from the hospitals that they work at. The urologists themselves did not believe that patient outcomes were necessarily being improved.

2 Responses

  1. I was advised by my urologist to choose “open” surgery “because I can see everything better and get my hands on it”. My results were excellent. Perhaps it is best not to trust in new technology too quickly? Not to mention that, in my opinion, hospitals are engaging in what seems to be an “arms race” with each other to have the “latest and the greatest”. This causes much unnecessary expense.

    The take-away — maybe it is wise to wait and see if the “new thing” is really better.

    Thanks for reading,

    Michael Balin

  2. I am a Dutch citizen who fortunately escaped probable inadequate treatment in the Netherlands. I will read this as soon as I can and comment if I can.

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