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.

Comments

Really difficult surgery

[MichaelSmith]

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.

Re:Really difficult surgery

[nanoakron]

As a qualified surgeon (albeit junior), I'd like to offer my $0.02 if I may.

To be honest, there aren't many parts of the body that are inaccessible to modern surgery. Closed boxes such as the thorax or skull are a couple, but in these cases the main problem is not physical access but the fact that the cancers themselves are often aggressive and deeply embedded. Brain tumours (particularly GBM) are notorious for sending out stray single-celled metastases before the main tumour even shows itself. Small-cell lung carcinoma is another. Basically, by the time the cancer has revealed itself, it's all but too late to do anything about, and no amount of cutting out the primary will remove distant microscopic spread, even with the best tools for the job.

Fortunately, these 'black book' cancers are the rare ones. Common cancers such as bowel, breast and prostate tend to be slower growing and based in parts of the body that are relatively easy to access.

The main use of robotic surgery is not so much to improve physical access, or to 'remove more', but to reduce surgical trauma, and thereby speed patient recovery and reduce peri-operative complications.

And interestingly, we all know surgery for early or localised tumours is the best chance for 'cure', but did you know that radiotherapy actually cures almost the same proportion of cancers? Together they account for nearly 90% of all cancer cures, but where does all the money go? Chemo - because it's sexy. Well, I guess we're also trying to replicate Erlich's 'magic bullet' theory which applied in the early days of antibiotics but unfortunately it's still a way off.

-Nano.

Re:Incontinence or Death

[gmhowell]

If we had two, I'd never get any typing done.

What was the rate of complications?

[im_thatoneguy]

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.

These devices are not robots.

[jcr]

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

Re:These devices are not robots.

[janek78]

That's a valid point. Also, every technology - and medicine is no different in this - has it's phase of enthusiastic adoption, eventual disappointment when it's found out it's not as good as previously hoped, and then a phase of rational use in indications where it makes sense. I remember the time when surgeons would do 6-hour laparoscopies because it was IN. Later they realized that a 2-hour open surgery is actually better for the patient and laparoscopies were limited to cases where they make sense.

I am a doctor in a university hospital and I recently went out to have beer with a friend of mine from the urology department. He's the chief "robot operator" for our hospital and he hates the machine with a vengence. No only are the operations several times more expensive (and longer), but to get the money they paid for the machine back, the hospital forces him to use the robot even on cases that would be much better done hands-on. Patients with more complications and longer hospital stay are no exceptions. To me this still seems like a technology we are yet to learn to use properly. Use it for remote operations where the surgeon is not physically available, use it in indications where it makes sense, but don't believe in all-saving robotic future of surgery. It's not here yet. The adoption cycle of many older technologies should serve as a warning.