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How a lucrative surgery took off online and disfigured people
https://www.nytimes.com/2023/10/30/health/hernia-surgery-component-separation.html
Surgeons paid small fortunes.
Learning a new technique from videos.
Slicing into wrong muscles.Unbelievable but all true apparently.
You’d think ethics would come into it. And anatomical knowledge. But apparently not.
Surely professional bodies should take action to prevent this?
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3 Replies
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I think you’re right Good Intentions. I was amazed companies were pushing inexperienced surgeons into complex, and what sounds like unnecessary and unneeded, hernia repair technique purely for profit.
I shouldn’t be amazed after gleaning similar reports on here from time to time, including your links, but I was still astounded.
Where’s the regulating boards?
Ethic committees?
Government agencies?I would have thought surgery and surgery methods were better regulated.
And you’re right it isn’t comfortable reading for anyone, myself included, considering surgery.
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That is a very interesting article William, thanks for posting it. I see another familiar name, Dr. Rosen of the Cleveland Clinic, is quoted in it too. He’s one of the good guys.
What I got from the article was not so much that surgeons were learning incorrect techniques via YouTube but that the technology companies facilitated it. They didn’t care that it was wrong they just wanted to get people buying and using their equipment. Like paying to have a training center built on a public university campus. Whatever it takes to get that revenue. Patient health is secondary. It’s just the world we live in today.
I pulled a bunch of pieces from it for anybody who doesn’t want to click through. It’s pretty incredible. Worth reading the whole thing but it won’t make anybody more comfortable about any future surgery.
“Over the next 15 years, the number of times that doctors billed Medicare for a hernia component separation increased more than tenfold, to around 8,000 per year. And that figure is a fraction of the actual number, researchers said, because most hernia patients are too young to be covered by Medicare.”
” “It’s unbelievable,” Rosen said. “I’m watching reasonably healthy people with a routine problem get a complicated procedure that turns it into a devastating problem.” ”
“Component separation must be practiced dozens of times to master it, experts said. But 1 out of 4 surgeons said they taught themselves how to perform the operation by watching Facebook and YouTube videos, according to a recent survey.”
“One instructional video, paid for by another major medical device company, showed a surgeon slicing through the wrong part of the muscle with the da Vinci.
Peper Long, a spokesperson for Intuitive, said the company hired “experienced surgeons” to lead its training courses. “The rise in robotic-assisted hernia procedures reflects the clinical benefits that the technology can offer,” she said.”
“In interviews with the Times, more than a dozen hernia surgeons pointed to another reason for the surging use of component separations: They earn doctors and hospitals more money. Medicare pays at least $2,450 for a component separation, compared with $345 for a simpler hernia repair. Private insurers, which cover a significant portion of hernia surgeries, typically pay two or three times what Medicare does.”
“Intrigued by the hype, Dickens taught himself component separation by watching online videos. His first operation went well, he recalled, but a later patient developed a serious complication, necessitating an additional surgery.
Then, at a dinner meeting in Houston, he presented a video of one of his own surgeries to a group of about 50 other doctors, Dickens recalled. A more experienced surgeon interrupted to say he was operating on the wrong part of the muscle. The rebuke felt like a “red flag,” he said, and he stopped doing the procedure, although he is still a proponent of the da Vinci for other operations.
In June 2021, W.L. Gore & Associates, a medical device company that makes surgical mesh used in hernia repairs, posted a video tutorial on its website. It promised to be a step-by-step guide to component separation surgery.
A surgeon narrated as he cut the patient’s abdominal muscles, releasing tissue so he could close a hernia. But he was operating in the wrong place and likely created a new hernia, according to four surgeons who reviewed the video.
“It absolutely trashed the abdominal wall,” said Jeffrey Blatnik, who directs the Washington University Hernia Center. “It was so offensive to the point that we reached out to the company and told them, ‘You guys need to take this down.’”
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