Patients are still unsure about robotic technology

Amsterdam, Netherlands-The extent to which American patients comprehend the technology behind robot-assisted radical prostatectomy is surprisingly limited, according to a prospective questionnaire evaluation from St. Peter's Hospital, Albany, NY.

The investigation involved a single surgeon's first 50 consecutive patients (average age, 62.5 years; range, 41 to 74 years) who received questionnaires regarding familiarity with intelligent digital technologies and their consideration of the impact of technologies on their lives. Patients received the questionnaires during discussions about robotic prostatectomy.

Specific questions included: Do you like computers? Are you frightened by computers? How did you first hear about the daVinci robot? Do you understand that the surgeon guides the robot? Do you understand how the surgeon and the robot work together? Do you think that a robotic prostatectomy is better, same, or worse than an open prostatectomy?

Study patients were well educated: 82% had a college degree and 46% had postgraduate education. Ninety-two percent of the subjects had at least one computer. Despite the high degree of education in this initial population, most were unaware of lasers in their homes. Only 14% knew they had operational lasers in their households (the average American has four).

Technophiles vs. technophobes

More than one-fourth (28%) of the subjects felt that technology was progressing faster than society could comfortably cope with it. The majority of patients (80%), nonetheless, were in favor of further space exploration; for instance, manned missions to Mars.

Almost all patients (96%) said they understood the "master-slave" principle behind the complex electronics embedded within the daVinci Surgical System. Similarly, responses to a follow-up question confirmed this perceived understanding by demonstrating a 96% positive awareness of the surgeon's role in managing the robot during surgery, study co-author Michael E. Moran, MD, a clinical associate professor at Albany (NY) Medical College, reported at the World Congress on Endourology here.

All of the patients in this prospective evaluation thought that the robotic prostatectomy was superior to other available surgical methods, which Dr. Moran said reflected a possible selection bias for inclusion, but was interesting in light of the high degree of advanced education in this cohort.

Most patients could name Hollywood robots, most frequently recalling the favorable stereotypes. Only 20% were unable to name any stereotypic Hollywood robot. Interestingly, the 12 patients favoring a robotic surgical approach (24%) could name no Hollywood robots.

"Patients are mostly unable to understand the nuances of complex surgery. Informed consent, in fact, is a precarious dilemma for surgeons at the moment," Dr. Moran said.

But, he cautioned, truly informed consent would make the patient aware of all of the technical possibilities and subtleties involved with this device. He noted that there is clear evidence from the orthopedic sphere that the average patient does not understand what an artificial joint is, much less the technical aspects of the surgery itself.

"In fact, the whole concept of informed consent is flawed by the patients' inability to comprehend the technology. Technology is accelerating and surgeons themselves are at risk of approaching the 'event horizon' of understanding the technology. We are only seeing the beginning of this technologic maelstrom. Those embracing it are the 'early adapters'."