Why Robotic Surgery Isn’t The Best Method for Male Infertility Treatments
When it comes to many treatable conditions, people often equate the successful treatment of those conditions with latest technology available to treat them. Would it surprise you to learn that the latest technology might not be the best method of treatment delivery for certain conditions? Take robotic surgery for example. There’s a lot in the news today about the ability of robotic technology to minimally-invasively, safely and successfully treat a wide range of conditions. No matter what you’ve read or heard, I can confidently tell you that the treatment of male infertility really shouldn’t be among them. Here’s why:
It Can’t Match the Skill of an Experienced Micro Surgeon: Because robotic equipment is considered “intuitive,” the training and experience required of surgeons in order to use it on patients are far less strict than what is required of true microsurgical experts who treat male infertility conditions. This may be fine when a procedure is deemed “ordinary.” But not every procedure is ordinary. In my experience, there have been many occasions where a patient required the correction of a blockage or other issue that wasn’t known before the intended surgery. When that’s the case, it is the trained and skilled micro surgeon who is able to correct these issues in order to safely and successfully perform the intended procedure. A robot at the hands of a surgeon trained in a matter of hours simply cannot match the expertise and brain power of a micro surgeon who has decades of experience in treating the many conditions that affect the male reproductive anatomy.
It Wasn’t Designed With Microsurgery In Mind: Robotic surgery was initially the intended method of treatment for patients needing to undergo open heart surgery. It evolved from there to treat urologic, gynecologic and other conditions. Simply put, the system was not designed for microsurgery. This means the availability of the right microsurgical instruments for use with the robot is low. Remember, the vas deferens (the duct that moves sperm from the testicle to the urethra and the primary subject of a vasectomy and vasectomy reversal) is as small as the diameter of spaghetti noodle. When it comes to vasectomy and vasectomy reversal, the surgeon’s ability to look directly at and actually feel the involved anatomy is crucial to the safety and successful outcome of the procedure. A skilled micro surgeon’s hands and state-of-the-art microscope are far superior to a robot in working with such small and delicate structures. Because this direct sense of touch is so important in microsurgery, male infertility procedures approached robotically can also take longer since the ability of the surgeon to actually “feel” the patient isn’t possible.
It Can Cost More: Most insurance companies don’t cover male infertility treatments. Because robotic surgery involves the use of very expensive equipment and teams trained to use it, the price for a robotic vasectomy reversal, TESE or varicocelectomy can be driven up significantly to help justify the expense of the robot and dedicated staff. While the price for these treatments can vary greatly no matter the method of treatment delivery, the robotic approach is one modality in which the added expense hasn’t yet proven to equal better treatment, safety or a more successful outcome long-term.
Long-Term Outcomes Have Yet to Be Proven: When it comes to any procedure used to treat a specific condition, patients should always pay careful attention to outcomes. Most of the recent studies pointing to the positive outcomes associated with robotic surgery for conditions such as vasectomy reversal, are based upon short-term data. To be fair, this is mainly because the treatment of male infertility conditions using robotic technology is also a relatively recent endeavor. Either way, when it comes to robotic surgery for the treatment of male infertility, long-term studies aren’t yet available to show that the use of a robot is better than the microsurgical approach.
In order for robotic surgery to surpass the quality of microsurgery at the hands of a skilled expert for the treatment of male infertility conditions, long-term studies will need to be published. Those studies must demonstrate whether robotic technology can actually improve quality of care for men with fertility concerns or whether it simply serves as a “work-around” tool for less-experienced surgeons to perform a procedure they weren’t otherwise trained or qualified to perform.
For patients, my recommendation remains the same. When it comes to the treatment of male infertility, your most important focus should be on the surgeon who will be performing the procedure, his or her training, experience and success rates or outcomes. Everything else, including the technology used, should be secondary to that.