I'm sure you've heard and seen the advertisements – hospitals soliciting your business because they offer robotic surgery – with the da Vinci robot.

Medical robots are expensive, nifty tools that offer the opportunity for surgeons to do things they couldn't do as easily on their own. But there are very few good randomized control studies showing that robot surgery is any safer than conventional surgery.

In many ways, the rapid use of robots is not due to good science, but rather to the billion-dollar-plus industry pushing hard on our health care system.

Each hospital and doctor is looking for a competitive advantage. Companies get large prestigious hospitals to use these tools – often by offering them at a discount. They then go to the many smaller hospitals and propagate an all-out technology "arms race." They tell these hospitals that without these expensive tools they are falling behind and insinuate that they may be offering second-rate care.

Well, they are not – at least we don't know they are.

This is peer pressure, pure and simple, with the end result being that health care costs skyrocket for everyone.

One study suggests a hospital needs to do at least 520 robotic surgeries a year before robotic surgery costs the same as traditional surgery. Each da Vinci robot costs $1 million to $3 million without maintenance, upgrades or replacement equipment.

Time and again, we've seen cases in which expensive technology gets out in front of science. The technology is attractive, and we just assume it improves care.

Now is the time to slow down and do some careful studies looking at safety, recovery, quality of care and cost.

Unlike robots that can assemble products in factories or vacuum your living room, robots in surgery simply are tools operated by skilled surgeons. And these surgeons need practice. Malpractice cases have not faulted the machine itself but rather the lack of surgical expertise in those using them.

I've tried using these machines, and it's tough. It takes a long time to master the techniques, and it takes skilled teachers to mentor those more junior.

Robots may very well improve surgical outcomes, but my point is that right now we don't know that for sure.

Questioning robots seems almost un-American, but without good studies, how can they be sure that these devices are truly superior to conventional surgery and worth the enormous heath care costs they generate?

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Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Reach him at drwilkes@sacbee.com.

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