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OBJECTIVE: While internet marketing of robotic cardiac surgery is an appropriate response to growing demand for less invasive procedures, the value of this information to the public depends on transparency. We compared the content and quality of information on websites of hospitals with active, low volume and inactive robotic cardiac surgery programs.
METHODS: A national database was queried for cardiac surgical volume of programs that performed at least one major robotic cardiac procedure (CABG, mitral valve repair) within the last 10 years. The websites of these hospitals were analyzed for the content and quality of data regarding these procedures.
RESULTS: In the US, 372 programs have performed robotic cardiac surgery, distributed amongst programs that are active (i.e. >50 robotic cases in 2011, n=24), low volume (between 1-49 cases, n=136) and the remainder inactive (n=212). Out of 372 total programs, 195 (52%) have websites that specifically mention that they perform robotic cardiac surgery, including 100% (n=24) of active, 52% (n=71) low volume and 47% (n=100) of inactive programs. Regarding content, institutional superiority was claimed in 88% of active programs and 18% of low volume programs. In fact, there were 8 inactive programs (4%) that claimed to be the best in the region. Very few websites provided a description of limitations or a comparison group and almost all used stock images and text from the robotic manufacturer’s marketing toolkit. Only 3 evaluated websites met criteria for objective, balanced information and therefore eligible for certification by HONcode guidelines. Many contained egregious and obviously inaccurate claims (Table 1).
CONCLUSIONS: Internet marketing of robotics was noted to be widespread and often provides information of poor quality, rarely adhering to HONcode guidelines. There is a risk of patients being misdirected when information about robotics is provided on cardiac surgical websites that are not currently active.

Table 1

Serial Number	Volume Category	Claim
1	Inactive	yet claim superiority, region’s busy center
2	Low Volume	Surgeon claim to revolutionize heart surgery with robot (performed 1 surgery during a span of 18 months)
3	Low Volume	Deceptive packaging of information to mislead patients (claim 4700 robotic procedures experience, mask as prolific cardiac center (performed 10 surgeries during 18 months)
4	Low Volume	Claim as the first center to perform robotic CABG surgery in the US (performed first case 2010)