Robotic surgery: is it for you?
Robotic surgery has indeed arrived. The approved device in the United States, the Intuitive Surgical System's daVinci System, is installed in about 80 hospitals worldwide. That number is rising rapidly. Once other companies, Computer Motion for example, receive Food and Drug Administration approval for their systems, the number of robotic-equipped operating rooms will begin to increase enormously. The current outcry regarding the expense of these systems is certainly not without merit. However, I would urge surgeons interested or even just curious about these systems to try one in a laboratory setting. The ease of accomplishing difficult tasks and the vividness of the 3-dimensional imaging create an experience that is both extremely impressive and enjoyable. There are currently no data to justify the expense of these systems in terms of patient outcomes or reduced complications. Such data will take a great deal of time and effort to accumulate. However, having become accustomed to the robotic system, this surgeon would have difficult moving back to standard laparoscopic instrumentation. Imagine during a standard open operation that your scrub assistant rubbed grease on your glasses and took away your favorite forceps and needle holder and gave you clumsy instruments 18 inches too long with less-than-reliable action at the tips. With enough struggling you would be able to accomplish the operation, and perhaps over time, even become facile with subpar instruments. However, you would certainly rather see well and have the instruments that you know work best in your hands. It would be very difficult to design a study to prove that your patients are better off when you use your normal instruments and clean glasses as opposed to fogging glasses and difficult-to-use instruments. But, you would know that there is a difference. That in large part is the feeling of surgeons who have had the good fortune of becoming accustomed to the current robotic systems for minimally invasive surgery. They can see much better and can manipulate tissue much better. Most of them are also convinced that when they can see better and manipulate tissue better, the outcomes for their patients are better. Is robotic surgery right for you? The answer is complex and has a myriad of elements. This author would suggest that a great start in determining the answer would be to try the current systems and keep track of both the literature and the technical evolution regarding these systems as time progresses.
Talamini
Mark A
MA
Johns Hopkins University School of Medicine, Baltimore, Md., USA.
D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy / Q000379:methods; D012371:Robotics / Q000295:instrumentation; D013514:Surgical Procedures, Operative / Q000379:methods*