Over the past couple of months there has been a mini-flood of negative coverage regarding robotic surgery. First was the article in JAMA, indicating that robotic hysterectomy wasn't any better than laparoscopic hysterectomy, but just cost significantly more. http://jama.jamanetwork.com/article.aspx?articleid=1653522
I'm not a gynecologist, but I never really understood the need to wheel in a 1.8 million dollar machine to take out a uterus, when most GYN's, even those without great laparoscopic skills, can do the same thing quickly, safely, and pretty easily with a laparaoscope. There's not much sewing, no fine dissection, and really the case lends itself well to pure laparoscopy.
Then there's this one: http://abcnews.go.com/Health/wireStory/robot-hot-surgeons-fda-taking-18911544 "FDA Probing Spike in Robotic Surgery Problems". Newsflash: Bad surgeons, with expensive instruments, are still bad surgeons. Surgeons who don't really know how to use an instrument, but go ahead and operate on people with it, are dangerous.
My $0.02: What do you need the robot for? Fine sewing and fine manipulation, deep in the body. Can I sew a bladder to a urethra water-tight, with 12-16 stitches by hand? Probably not, most open surgeons are happy to get 6 good sutures in place. Laparoscopically? Probably not. With the robot? Absolutely. And that water-tight closure means better healing, getting a catheter out faster, less scar tissue formation, and (I think) better return to urinary continence for guys having a prostatectomy.
Can I sew up a kidney more securely, and get its blood vessels unclamped faster during a tumor removal faster with the robot than I can with a laparoscope? I certainly think so. If I'm betting someone's kidney, I don't have 5 minutes to lose.
Robotics may be suffering from its own success. There is a lot of over-use, both in case selections where the benefit is marginal, and by doctors who don't have much experience, and shouldn't be messing around with the technology.
I'm not a gynecologist, but I never really understood the need to wheel in a 1.8 million dollar machine to take out a uterus, when most GYN's, even those without great laparoscopic skills, can do the same thing quickly, safely, and pretty easily with a laparaoscope. There's not much sewing, no fine dissection, and really the case lends itself well to pure laparoscopy.
Then there's this one: http://abcnews.go.com/Health/wireStory/robot-hot-surgeons-fda-taking-18911544 "FDA Probing Spike in Robotic Surgery Problems". Newsflash: Bad surgeons, with expensive instruments, are still bad surgeons. Surgeons who don't really know how to use an instrument, but go ahead and operate on people with it, are dangerous.
My $0.02: What do you need the robot for? Fine sewing and fine manipulation, deep in the body. Can I sew a bladder to a urethra water-tight, with 12-16 stitches by hand? Probably not, most open surgeons are happy to get 6 good sutures in place. Laparoscopically? Probably not. With the robot? Absolutely. And that water-tight closure means better healing, getting a catheter out faster, less scar tissue formation, and (I think) better return to urinary continence for guys having a prostatectomy.
Can I sew up a kidney more securely, and get its blood vessels unclamped faster during a tumor removal faster with the robot than I can with a laparoscope? I certainly think so. If I'm betting someone's kidney, I don't have 5 minutes to lose.
Robotics may be suffering from its own success. There is a lot of over-use, both in case selections where the benefit is marginal, and by doctors who don't have much experience, and shouldn't be messing around with the technology.
But, with all that negativity flying around, don't miss the point that at least in urology, there are specific surgical cases -- robotic prostatectomy and robotic partial nephrectomy -- where in good hands the technology makes a massive difference.
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