Surgical Robots Under Examination
Surgical robots are used for many operations, including radical prostatectomy, hysterectomy, heart surgery and organ transplantation. During robotic surgery, the surgeon sits at a 3-D computer screen and uses controls to move surgical instruments and a camera attached to the robot’s arms. The da Vinci Surgical System is the only robot approved for soft-tissue surgery in the US.
Proponents of the robots claim that patients often have less blood loss and shorter recovery times after robotic procedures. The da Vinci Surgery website states that the benefits for surgeons include greater surgical precision, enhanced visualization and improved access.
However, data does not indicate that robotic operations are substantially better for patients. A study published in the Journal of American Medical Association reported that complication rates were similar for laparoscopic and robotic hysterectomy, but the financial cost of the robotic surgery was significantly higher. A study published in the Journal of Clinical Oncology concluded, “Medicare aged men should not expect fewer adverse effects following robotic prostatectomy.”
Increase in Reports of Complications
News sources recently reported an increase in lawsuits and alleged patient complications and deaths connected to the robots, including a rise in adverse reports filed with the FDA. See www.drcatalona.com for links to several relevant articles.
The FDA surveyed surgeons at key hospitals about the robots in January. The reports submitted to the government agency speak of patient injuries—and even deaths—during or after robotic surgery, as well as equipment malfunctions that did not harm patients. The reports do not always blame the robots for the patient injuries or deaths; some suggest the surgeons are at fault. The FDA seeks to determine to what extent the rise in reported incidents result from the robots or from other issues.
A CNBC Investigations review found that surgeons and lawyers were concerned with training procedures for robotic surgery. An essay published in the New England Journal of Medicine in 2010 said that surgeons need to perform 150 robotic surgeries to be adept at using the system. However, increasing the number of supervised surgeries increases the hospital’s cost of having the robot. Also, the CNBC review found that a sales culture with quotas on robotic surgeries prompts sales people to lean on surgeons to perform more robotic surgeries.
As with any machine, mechanical problems can occur with surgical robots. For example, electrical shorts caused by faulty insulation of the instruments can burn the patient’s internal organs. Some question if these complications have been adequately reported to the FDA, which is responsible for certifying that the robot is safe and effective.
New England Journal of Medicine