The State of Robotic Surgery 72
kkleiner writes "Robotic surgery is experiencing explosive growth in America's operating rooms, and the unquestioned industry leader in this field is the DaVinci robot, made by Intuitive Surgical. Only 14% of prostate surgeries in the US last year took place not using the DaVinci. Installations have grown from 210 systems seven years ago to 1,395 today. Although typically used for smaller surgeries like prostate removal and hysterectomies, the system was recently used for a kidney transplant, and more complicated procedures are expected in the future. The DaVinci is really just the first wave of robotic surgery as technology continues to push clumsy human hands out of the operating room." The article mentions some of the downsides, or perhaps the growing pains, of DaVinci robotic surgery: "According to a large study of Medicare patients, robotic prostate surgery led to fewer in-hospital complications, but had worse results for impotence and incontinence ..." Another company makes a simulator to train surgeons on the DaVinci. Embedded in the article is a 2009 TED talk on DaVinci by a surgeon.
Comment removed (Score:5, Informative)
Re:It's Cool. (Score:3, Informative)
1:1 motion mapping really made it feel like an extension of my body.
Now if we only had a word [wikipedia.org] to distinguish a system such as you describe from a robot...
Re:Should put one on the ISS (or Antarctica) (Score:3, Informative)
The best use for this would be to put one on the ISS (or other "nearby" manned spacecraft where speed of light time-lag is not too long).
That way, you'll have an emergency "surgeon" available in case of a medical emergency. Nowhere near as good as a real live doc but better than nothing.
OTOH, in low Earth orbit you can bring the patient back to Earth very quickly (an emergency reentry vehicle is always available on the ISS) so the space surgery unit isn't needed. It might be useful on a lunar base, but the 2.5 second time lag would make using it tricky.
For extended space missions (e.g. a trip to Mars) I believe NASA intends to send two astronaut-surgeons (out of crew of 8 or so), so that one can operate on the other if needed.
I understand a few years ago, a female scientist had to be evacuated from the Antarctic base in the dead of the ANTARCTIC(!) winter because she had breast cancer. This could have prevented that (and eliminated the risk to the rescue crew. I think they had to keep the plane's engines on so that the skids wouldn't freeze to the ice).
Yes, she WAS the base doctor and thus could not operate on herself. Sending two surgeons to Antarctica, as in the NASA Mars plan, could have spared this rescue mission (they could have dropped any needed supplies without the hazard of landing). This is possibly a cheaper solution than a million dollar machine (the two surgeons would have other research duties and so are not just additional costs. Keeping the engines running was necessary for the engine's sake. They would not have been able to restart them in the cold.
BTW - the doctor in question, Dr Jerri Nielson Fitzgerald, died from a recurrence of her cancer last year (ten years after the rescue): http://www.abc.net.au/news/stories/2009/06/25/2608384.htm [abc.net.au]
Re:Really difficult surgery (Score:5, Informative)
As a qualified surgeon (albeit junior), I'd like to offer my $0.02 if I may.
To be honest, there aren't many parts of the body that are inaccessible to modern surgery. Closed boxes such as the thorax or skull are a couple, but in these cases the main problem is not physical access but the fact that the cancers themselves are often aggressive and deeply embedded. Brain tumours (particularly GBM) are notorious for sending out stray single-celled metastases before the main tumour even shows itself. Small-cell lung carcinoma is another. Basically, by the time the cancer has revealed itself, it's all but too late to do anything about, and no amount of cutting out the primary will remove distant microscopic spread, even with the best tools for the job.
Fortunately, these 'black book' cancers are the rare ones. Common cancers such as bowel, breast and prostate tend to be slower growing and based in parts of the body that are relatively easy to access.
The main use of robotic surgery is not so much to improve physical access, or to 'remove more', but to reduce surgical trauma, and thereby speed patient recovery and reduce peri-operative complications.
And interestingly, we all know surgery for early or localised tumours is the best chance for 'cure', but did you know that radiotherapy actually cures almost the same proportion of cancers? Together they account for nearly 90% of all cancer cures, but where does all the money go? Chemo - because it's sexy. Well, I guess we're also trying to replicate Erlich's 'magic bullet' theory which applied in the early days of antibiotics but unfortunately it's still a way off.
-Nano.
Re:Should put one on the ISS (or Antarctica) (Score:1, Informative)
This idea is always floated around, and it is fantastic in theory, but it fails to take into account that you still need at least some surgical ability onsite to use a DaVinci. Ports have to be placed, some of the work is still done as traditional lap, and one always needs to be ready to perform emergency conversion to an open surgery. All of these things still require human hands trained in surgery. A tech or nurse could theoretically do it, but I'd much rather a surgeon do the work.
The more interesting use of robotics in surgery is in rural areas. Suppose you have a general surgeon, but need to perform a more complicated procedure that requires the expertise of a sub-specialty. In that instance, the general surgeon can do the setup and allow the specialty surgeon to control the robot. This extends the specialty surgeons range and decreases the need to have onsite surgeons in every specialty for rural areas.
Before having prostate surgery (Score:4, Informative)
Before prostate surgery for you or someone you know, whether robotic or human, check it out very carefully. I did on behalf of someone else, and came to the conclusion that the optimal treatment is intermittent hormone blockage. The technique is, you have total hormonal block for about 9 to 15 months - until PSA falls to zero. Then you go off the blockade.
The rationale is that prostate cancer grows in the presence of testosterone. When testosterone is removed, it dies. It then, in the total absence of testosterone, becomes hormone refractory, that is, it grows in the absence of hormone. You then restore the hormone, and it reverses again.
That at least was my own conclusion, and what I will try if need be. I concluded that local treatments have almost universal side effects of impotence and incontinence, which I think are underreported. And that the dangerous forms of the cancer are probably inoperable locally anyway.
If over some age, don't know quite what, perhaps 80, I concluded there is no point in surgery. We will almost all of us die with prostate cancer. Very few of us will die of it. Over 80, local treatment is probably almost never a good idea.
And do not forget that the biopsy procedure is not risk free, particularly for older men. It can induce total urinary blockage. This then leads to permanent catheterization, which will inevitably result in blockages, followed by hospital visits in the middle of the night, followed by MRSA infections. This happened in a case I knew well. The result was real misery for quite a few years, followed eventually by death from the complications of repeated MRSA infections.
As I said sadly at the time, the tragedy is, he was one of the few men of his age in the country who when biopsied did not test positive. But even if it had, surgery was impossible given his heart health. It wasted the rest of a life, for no good reason.
Re:Really difficult surgery (Score:3, Informative)
To set the record staight, the robot is a tool looking for a problem. The robot is no better than a skilled laparoscopic surgeon, and in fact suffers from a "fatal flaw". I'll explain: the most common procedure for the robot is for prostatectomy which involved going deep into the pelvis to remove a walnut sized gland at the base of the penis and below the bladder. To do this using standard laparoscopic instruments is hard beause you would have to stand where the pt's head is to have the proper angle. The robot can operate "upside down" and removes this restriction.
The draw back to the robot is that it does not provide "haptic feedback" or force-feedback....a skilled surgeon relies on his sense of touch as much as his sense of sight. I've removed a pt's colon doing 80% of the surgery not needing to see what I was doing and just going by touch which was more revealing than my sight for those parts of the procedure(hand assisted laparoscopic colectomy). If I can't feel the tumor in the bowel because the robot doesn't provide a sense of touch, guess what - the robot will not provide any advantage.
The true falacy is that the human surgeon is a butcher and that the precision of the robot will be superior. In truth, the surgeon relies on the body's ability to heal to accomplish the miracle of the cure. I cut, but I rely on the body's ability to mend. There are precious few procedures out there that requrie such precise touch...and trust me I've sewn a 1mm vein to a 2mm artery during a bypass operation using my own hand, and with a suture that would break if you sneezed on it (another reason to use a surgical mask!). This case would not be possible with the current generation of robots.
Now, don't get me wrong, there may be some advances in the furture where the robot-assisted surgeon can out perform me, but for at least the next 5-10 years, the robot will be relegate the corner of one of our ORs and used 2-3 times a week for the RALP (robot assisted lapr prostatectomies).
As an aside, the tele-surgery concept may be a valid use in the future, but A) you need 100% up-time on your link B) you still need a semi-qualified individual at the pt's beside to 1) set up the robot, 2) put the ports in so the robot can slip the intruments in to the pt. And in reality, you need someone on stand-by to take over if the case can not be completed and you are stuck at a critical juncition.