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The State of Robotic Surgery
kkleiner writes "Robotic surgery is experiencing explosive growth in America's operating rooms, and the unquestioned industry leader in this field is the DaVinci robot, made by Intuitive Surgical. Only 14% of prostate surgeries in the US last year took place not using the DaVinci. Installations have grown from 210 systems seven years ago to 1,395 today. Although typically used for smaller surgeries like prostate removal and hysterectomies, the system was recently used for a kidney transplant, and more complicated procedures are expected in the future. The DaVinci is really just the first wave of robotic surgery as technology continues to push clumsy human hands out of the operating room." The article mentions some of the downsides, or perhaps the growing pains, of DaVinci robotic surgery: "According to a large study of Medicare patients, robotic prostate surgery led to fewer in-hospital complications, but had worse results for impotence and incontinence ..." Another company makes a simulator to train surgeons on the DaVinci. Embedded in the article is a 2009 TED talk on DaVinci by a surgeon.
Would you rather be dead or incontinent? I'll take the diapers. Impotent? I'll have to think about it.
I haven't read the summary. But, given the title, I'd say...
They're taking our jobs!
Where else could you pay to put an actual Da Vinci in your rectum? Vegas, baby.
while the impotence and incontinence may seem a minor inconvenience to our silicon brethren, I'm a little fond of the constitional and occasional shag, that's some bleeding edge there
And what effect this sort of technological uptake have on health cost containment?
It would be interesting if robots like the DaVinci could in future operate on a smaller scale and in trickier parts of the body. Some cancers (for example) are inoperable because of their location in the body. Maybe a robot could cut out most of the tumor in these cases and leave chemotherapy or radiotherapy devices behind the clean up the rest.
http://michaelsmith.id.au
So how long until there's completely unmanned surgical automats? That would be pretty scary and at the same time pretty cool, in a dark cyberpunk future kind of way...
I wonder what the actual numbers were of complications.
If it reduced deaths from 2 to 1 per 1,000 and only increased the rate of incontinance from 1 per hundred to 2 per hundred then that seems like a good trade off. But two unrelated statistics without the details are difficult to compare.
If you had a procedure that killed 70% of the people and could reduce it to 10% but only increased the chance of side effects by 1% then it's a no-brainer.
Talking about growing pains
Is there a website or something where someone might be able to read more of this?
I for one welcome our robotic overlords... I mean, helpers!
Last month I got to play with one of the Da Vinci units at a car show (why it was there is anyone's guess). I am amazed at how intuitive it was to use- even though I was just putting tiny rubber bands on small rubbery cone-thingies, the 3D display and 1:1 motion mapping really made it feel like an extension of my body. Even though the unit doesn't use force feedback, it almost seemed like it did (just my brain, I guess). The most amazing part? My 7-year-old niece had absolutely no problem using it, and now she wants to become a doctor.
Cool stuff.
--- At my sig, unleash hell.
These robot doctors are very professional, except for their entrance into the operating room:
http://www.youtube.com/watch?v=JqlawTD_9B0
Being nerds I know you guys all love testing out brand new tech, but the one thing these robots have taught me working in a major metro hospital is that you don't want to be a beta tester. It takes years for surgeons to 'perfect' a surgery, and if you put them in front of a machine it will take years to figure out the kinks. Always go for the tried and true tested way. New machines are dangerous while they are new and their users are inexperienced.
Only 14% of prostate surgeries in the US last year took place not using the DaVinci.
Okay, so DaVinci is by far the market leader - but of that minority 14%, how many are using Medibot?
#DeleteChrome
The best use for this would be to put one on the ISS (or other "nearby" manned spacecraft where speed of light time-lag is not too long).
That way, you'll have an emergency "surgeon" available in case of a medical emergency. Nowhere near as good as a real live doc but better than nothing.
I understand a few years ago, a female scientist had to be evacuated from the Antarctic base in the dead of the ANTARCTIC(!) winter because she had breast cancer. This could have prevented that (and eliminated the risk to the rescue crew. I think they had to keep the plane's engines on so that the skids wouldn't freeze to the ice).
Now what was the name of that "emergency medical program" on Star Trek?
They're remote manipulation systems, also known as "waldoes". Robots operate under the control of a stored program, not the direction of a human operator.
-jcr
The only title of honor that a tyrant can grant is "Enemy of the State."
(ducks)
I see I have been labeled off topic. I find that amusing, considering my relationship to the person in the video. I plan to have a WebGL interface to the operating system later this year. I suppose I got marked off topic , just for the Nosferatu label. I am sure that when it is done, Google will know. Google seems to know about everything. You seem to have a reasonable knowledge of the field from your posts. It is certainly an area that will yeild many new technologies. The ability to convert a skin cell to an omnipotent stem cell is one. The interesting thing is that contained in the genetic code is the instruction for that transform and once found is just a string of bases. It is very much like writing the code for life.
when laparoscopic surgery came in there were all these studies done that showed one thing or another. for example, a laparoscopic cholecystectomy (removal of the gallbladder) is a very common operation. apparently there are studies done that show 10% of the time you will have damage to the common bile duct (which would be bad). any general surgeon worth his salt these days will tell you that 10% chance is more like 0.5% or better.
my point is, maybe people just need to get better at using these things? it's not like playing a computer game, the surgery is still very complicated.
of course I'm no expert but hey, this is /. isn't it?
After spending some weeks in the hospital as observer and talking to various surgeons about these robots I was basically told that a prostate surgery using DaVinci takes about as much time as with Minimal invasive surgery, but costs a lot more (instruments can be used 10 times (DRM) on the DaVinci and are really expensive ($2000+ I think)). You also have absolutely no feedback ( I got to play with one for 30 seconds before I got crazy about the 50Hz 3D screen and I broke stitching wires with it by pulling them apart).
The coolest operation with the DaVinci I hear about was an Aorta replacement. Save splitting your breast plate.
The company I work for also makes robots for surgery, but this time for brain surgery.
neuromate®: the No. 1 image-guided neurosurgical robot
You can't win Darth. If you mod me down, I shall become more powerful than you could possibly imagine
Robotic surgery is actually pretty straightforward. You just pop off a few screws and open the front panel on the robot's torso, and then you can get at the insides pretty easily.
fewer in-hospital complications
minus
worse results for impotence and incontinence
plus
210 systems seven years ago to 1,395 today
equals
It is a lot harder to sue for impotence and incontinence than it is for in-hospital complications
Sounds likely, but IANAL.
Orwell: "In a Time of Universal Deceit, telling the Truth is a Revolutionary Act"
really matters. No matter if you are using a so called robotic tool or an X-ray generating tool, the Doctor you choose and his or her experience and success rate will determine the outcome far more than the type of treatment you choose.
When you talk to a doctor, ask him how many of the procedures he did last year and what his success rate was. I had the choice of a Doctor who answered "3 and I don't know" and a Doctor who answered "several a day and people with your 'scores" have had a success rate of x and a complications rate of y". Show me the Doctor who measures the success of the way he does a procedure and tries to improve and I'll show you the increased success active learning brings.
Plug ProstRcision into your search engine.
Sorry, there's NO way I'm letting a robot with scalpels anywhere near that portion of my anatomy. I prefer not to be one integer underflow exception away from singing soprano.
Welcome to the Panopticon. Used to be a prison, now it's your home.
Before prostate surgery for you or someone you know, whether robotic or human, check it out very carefully. I did on behalf of someone else, and came to the conclusion that the optimal treatment is intermittent hormone blockage. The technique is, you have total hormonal block for about 9 to 15 months - until PSA falls to zero. Then you go off the blockade.
The rationale is that prostate cancer grows in the presence of testosterone. When testosterone is removed, it dies. It then, in the total absence of testosterone, becomes hormone refractory, that is, it grows in the absence of hormone. You then restore the hormone, and it reverses again.
That at least was my own conclusion, and what I will try if need be. I concluded that local treatments have almost universal side effects of impotence and incontinence, which I think are underreported. And that the dangerous forms of the cancer are probably inoperable locally anyway.
If over some age, don't know quite what, perhaps 80, I concluded there is no point in surgery. We will almost all of us die with prostate cancer. Very few of us will die of it. Over 80, local treatment is probably almost never a good idea.
And do not forget that the biopsy procedure is not risk free, particularly for older men. It can induce total urinary blockage. This then leads to permanent catheterization, which will inevitably result in blockages, followed by hospital visits in the middle of the night, followed by MRSA infections. This happened in a case I knew well. The result was real misery for quite a few years, followed eventually by death from the complications of repeated MRSA infections.
As I said sadly at the time, the tragedy is, he was one of the few men of his age in the country who when biopsied did not test positive. But even if it had, surgery was impossible given his heart health. It wasted the rest of a life, for no good reason.
http://www.nytimes.com/2010/03/10/opinion/10Ablin.html
Read that article if you're considering having a PSA test. The key assertion, that there are tremendous number of false postives and that for each man saved by PSA + Prostate surgery, 47 men are needlessly harmed frequently resulting in incontinence and erectile disfunction.