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Robotic Surgery – The Outcome Lies in the Hands of the Magician, Not Necessarily the Wand

By: AMFS OBGYN/Gynecologic Surgeon

The biggest paradigm shift in surgery these days lies in the mechanical hands of the DaVinci robot. This multi-armed technological breakthrough was used in nearly 400,000 surgeries nationwide last year. This device was created by Intuitive surgical, Inc of Sunnyvale, California.

Its origins come from the development of medical robots for use in combat.  They would be able to perform surgery in a field hospital by a surgeon at a remote site. When it was first released for commercial use, it was initially created for cardiothoracic surgery, minimizing the size of the incision on the chest wall. This advancement allows patients to heal more quickly than they would with an open incision. It is now commonly used by urologists and gynecologists for various procedures. The general surgeons are beginning to use it for single site cholecystectomies  and  various other procedures. The future also looks promising for use in head and neck cases where there is a small space to operate in. The technology is solid and the model currently being used is the third generation from its inception. The problem does not lie in the technology, but in the novelty of its use.

The criterion for credentialing surgeons in hospitals has not been standardized. Once a robot is purchased, the surgeon must complete a training program created by Intuitive Surgical. It includes observing other physicians using the robot as well as technical training and practice in an animal lab. Once this is completed, the surgeon must be proctored by an experienced surgeon, provided by Intuitive Surgical. This training program must be completed before a hospital is willing to award a surgeon credentials to perform these cases on their own. The non-uniformity lies in how many cases need to be completed before a surgeon can be released from proctoring.

The FDA is currently taking a look at this technology and determining whether the reported complications associated with use of the DaVinci system are within the norm. The complications that have been reported include bowel or blood vessel nicks and perforations. Some have led to death.  Complications can occur with any type of surgery, and it is unclear if they are more common in robotic cases.

Robotics has provided a surgical breakthrough. Patients, who would have severe postoperative complications, such as large wounds on obese patients, are now going home 24 hours after their surgery, with minimal narcotic use. Patients are returning to their activities of daily living sooner with better outcomes. So, when complications occur, look at the surgeon’s skill set- like any other case. Robotic systems are effetively master-slave technology and cannot do anything without the operator.

Any opinions expressed are those of the author and do not necessarily represent those of AMFS Medical Directors or other members of the global network of AMFS physicians, surgeons, nurses, dentists and other healthcare professionals.

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