"Our institution is publishing many articles on patient satisfaction, we're publishing on long-term outcomes, things that need a little time," says Dr. Nguyen. "A lot of people have a reaction, but robotic surgery has not been around long enough to make those kinds of decisions already. Major institutions should continue to do [robotic surgeries] so we can see the long-term benefits," he says.

An important lesson that Dr. Fabrizio took away from doing the study is the fact that most facilities in the United States don't keep prospective quality of life outcome data for their radical prostatectomy or prostate cancer patients.


"I think that's important because one part of the prostate cancer equation is cure but the second part of the equation is quality of life and we need to balance both the cure and the quality of life. I think you need to track both data," he says.

No matter how many new robotic surgery studies trickle in, surgeons emphasize that the role of the expert trumps the type of the treatment.

"I think one thing that everybody agrees on is that prostate cancer surgery is very difficult and it's the experience of the surgeon that is most important in the outcome, not necessarily the technology," says Dr. Patel. "However, I can tell you that if you do have experience, the robot does help you achieve very, very good outcomes. And [the outcomes] have been published; they are out there. People have to read them."

Many robots, one creator
Intuitive Surgical, Inc. is the sole manufacturer of the robotic system used in hospitals nationwide. There are 1,091 da Vinci Surgical Systems in place in the United States., 264 in Europe and 127 in other world markets, according to Aleks Cukic, vice president of strategy for Intuitive Surgical.

"We are focused on trying to create products that work for all size hospitals," says Cukic. "There are various price configurations for various price points that range somewhere between $1 million and roughly $2.3 million for the da Vinci System. There is some price stratification that does work for hospitals regardless of their size."

The company has released three versions of its da Vinci System so far. It generated $329 million in revenue in the first quarter of 2010, up from $188 million for the first quarter of 2009. Profits for instruments and accessories also went up to $123 million in the first quarter of this year from $80 million in the first quarter of 2009.

Some surgeons say the cost of the system, its parts and service contracts is a huge burden on their practice.

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