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What do you know about Robotic Surgery?
Your surgeon tells you that he can do the procedure using the robot. That sounds exciting, up to date, high-tech. You consent.
You may have made a mistake.
The robotic operating system is manufactured by an Intuitive and is known as the DaVinci, named after the great inventor. In the last decade, hospitals all over the country have spent billions of dollars buying and installing the DaVinci robot. Unfortunately, there are no standard guidelines on how much training the surgeon must have before he can use the robot on live patients. Many surgeons who trained before the invention of robotic procedures go to a weekend class, operate on pigs a few times, and come back home ready to use the robot on people. Unfortunately, the complications for newly trained robotic surgeons can be high and they can be deadly.
In using the robot, the surgeon is like a teenager playing Xbox. The surgeon loses all tactile sensation because he is at a remote “play station” and not over the patient. Even in a laproscopic procedure surgeons still rely on a sense of feel. Could I have just bruised that section of bowel? Does that stitch feel tight? With the robot these kinds of questions may go unanswered.
The vast majority of robotic surgeries are performed on either hysterectomy patients or men undergoing prostate surgery. Only a very small percentage of them are done on general surgery cases, like appendectomies or gallbladders.
Unfortunately, the rate of vaginal dehiscence, or wound opening, is three times higher on robotic hysterectomies than on ordinary laproscopic procedures. Netflix has a film on robotics known as the “Bleeding Edge” . In it women describe their colons literally falling out through their vaginas and nearly bleeding to death.
After 14 years of collecting FDA data on adverse events in robotic surgery, it is believed there have been 144 deaths, 1,391 patient injuries and over 8,000 device malfunctions. A large portion of these adverse events have occurred in surgeries other than hysterectomies or prostatectomy where surgeons had less experience with the robot. For further information you can look at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4838256/ titled “Adverse Events in Robotic Surgery: A Retrospective Study of 14 years of FDA Data.”
Before surgery, especially robotic surgery, don’t be afraid to ask “how many procedures have you done with this device? How many complications have you had?” Size up the surgeon. If he’s over 50 he probably did not train in residency on the robot and it is fair to ask and assume that while he may be very experienced the robot may be new to him.