No Other Surgical Benefit? Seriously!?

By Danny Vena - September 1, 2012 | Tickers: ISRG, MAKO | 0 Comments

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Imagine you have been experiencing medical symptoms:  You have a lump in your throat, near the Adam’s apple; hoarseness when speaking; difficulty swallowing and breathing; pain in your throat.  Thinking it is probably just the flu, you go to your doctor for tests.  Then, the unimaginable – thyroid cancer!  You doctor tells you not to worry (yeah, right).  You have caught it early enough that surgery is an option and you should make a full recovery.  You have two options: traditional or robotic surgery. 

Traditional or Robotic?

This is a decision that is faced by over 50,000 men and woman per year, according to the National Cancer Institute.  Although the procedure was approved by the FDA in 2009, it is currently considered off-label, and surgeons continue to perform the procedure.  Naturally, you would do as much research as possible to determine what course of action you should take.  In doing so, you would likely come across the results of a recent study.  This study was conducted by Dr. James Broome and his colleagues from Vanderbilt University in Nashville, Tenn.  They concluded that when factoring in the cost of the robot, robotic surgery to remove all or part of the thyroid gland was twice as expensive when performed with a robot as when performed by a surgeon alone. 

Two important quotes from an article on the study: 

The only pure benefit for the operation is the cosmetic benefit, nothing else. 

None of those procedures have shown any improved outcomes for the patient," [Broome] said. Patients "should be very cautious about whether it actually does anything better for them.

Let's explore whether there is any improved outcomes for the patient that would justify the additional cost. 

The robot in question is the da Vinci Surgical System by Intuitive Surgical (NASDAQ: ISRG).  Robot-assisted surgery has been very popular with both patients and investors.  The number of robot-assisted surgical procedures over the last decade numbers in the hundreds of thousands, with much of it being consumer driven.  Long-time investors in Intuitive Surgical have seen their investment grow from under $20 in 2000 to over $500 per share recently.

The medical community has been divided over whether the benefits of robotic-assisted surgery outweigh any additional cost.  Those surgeons that are considered the cream of the crop in their respective surgical fields seem convinced that robotic-assisted surgery offers no benefit.  Those that have trained and gained experience in robotic surgery extol the benefits over that of traditional surgery.  Many studies have shown that with robotic surgery there are fewer complications, less blood loss and faster recovery than with their traditional counterparts. 

Intuitive Surgical is not the only robot in town.  Mako Surgical (NASDAQ: MAKO) is revolutionizing both knee replacement and hip replacement surgery.  Makoplasty allows surgeons to resurface parts of the knee joint damaged by injury or arthritis before an entire knee replacement is necessary. The knee has three compartments, and people with osteoarthritis often suffer damage to only one or two. Yet the most common surgical procedure for osteoarthritis is total knee replacement.  I have previously written about why I believe Mako will ultimately be successful. 

However, the issue at hand is whether, as the researcher states, none of the robotic procedures have shown any improved outcome for patients.  In order to judge this statement, we must be familiar with the differences between the traditional method and the robotic equivalent. 

The traditional surgery involves removing all or part of the thyroid via a 3–5 inch incision in the front of the neck, below the Adam’s apple.  The patient will typically have a large noticeable scar. 

Photo courtesy of A Mama's Blog.

Several years ago, a robotic thyroidectomy was developed by doctors in South Korea. Using the da Vinci Surgical System, surgeons remove the thyroid gland by making a small incision under the patient's right arm and another incision in the chest, which eliminates the neck incision.

Photo courtesy of East Carolina University.

Let me make it clear that I am not a doctor – but I am a human being.  Given the choice between a large noticeable scar on my neck, or a smaller, less noticeable, less invasive scar under my right arm, I am quite sure I would choose the latter. 

According to Dr. Pier Cristoforo Giulianotti, the Lloyd M. Nyhus Professor of Surgery at the University of Illinois Medical Center at Chicago, the benefits are clear:  The cosmetic and psychological benefits to patients are evident immediately.  Young patients in particular are often concerned about a large visible scar and this technique provides an alternative to traditional surgery. 

As an investor, I believe that the consumer-driven trend to robotic surgery is a trend that both patients and investors will continue to benefit from. 

With all due respect to Dr. James Broome and his colleagues, quality of life is a factor to be considered, and I would personally feel that the absence of a 5-inch scar a significant benefit and a much improved outcome. 

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