The researchers were surprised with the differences in the return to function scores when it came to robotic surgery.

"The patients who had the robotic prostatectomy, they did well, but when you look at an outcome study, a prospective study, I think some of that data are surprising in the fact that they didn't do as well as you probably thought they were doing," says Dr. Fabrizio.


The ICER report also found that "there are no definitive head-to-head studies" that compare the available treatment options, a fact that prompts much of the criticism about the effectiveness of robotic surgery.

"There's never been a randomized, blind study of the patient looking at open versus robotic surgery, in part because no entity would pay you to do that study," says Dr. Wood. "There is a lack of clear benefit but on the other hand, there are very few operations that have ever been tested against the gold standard to see if it's better because surgery continually improves," he says.

Dr. Wood has been performing robotic surgery for eight years but doesn't think that the technique is necessarily better than open surgery.

"I think that you can do a great open surgery and you can do a great robotic surgery," he says. "It's just that because of better vision and a more controlled environment, you are more likely, case after case, to have good results with the robot than you are with the open surgery because of reproducibility."

Dr. Patel believes that it would be hard to directly compare the two surgical methods because patients want to be in control of their treatment options.

"Patients don't want the flip of a coin to decide which surgery they're going to have. I think the actual comparison will be very difficult to do," he says.

Many of the immediate benefits of robotic surgery are clear and the focus of more and more studies is shifting to evaluating long-term outcomes. At St. Luke's Hospital, the limited clinical guarantee also serves a research purpose.

"The future of health care reimbursement is such that I think a lot of things are going to be predicated on outcomes, quality and patient satisfaction. When it comes to robotic surgery, it doesn't really exist," says Dr. Mayer. "In other words, no one has done that before or done the research as part of the background of seeing what those measurements are. So we thought of it not only as an advertising modality, but as a way of generating data in order to build a case for this type of a procedure," he says.

Others argue that it takes time to produce comprehensive data and that a lot of information is already out there.

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