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.
What was the rate of complications? (Score:5, Insightful)
I wonder what the actual numbers were of complications.
If it reduced deaths from 2 to 1 per 1,000 and only increased the rate of incontinance from 1 per hundred to 2 per hundred then that seems like a good trade off. But two unrelated statistics without the details are difficult to compare.
If you had a procedure that killed 70% of the people and could reduce it to 10% but only increased the chance of side effects by 1% then it's a no-brainer.
Re:These devices are not robots. (Score:3, Insightful)
They're remote manipulation systems
What we need is companies like Da Vinci making lots of money and evolving the technology into real robots.
The first phase in the evolution path is likely to be first adding tactile sensors, then chemical sensors, and relying all that information to the doctor, processing it before presentation so the doctor can use all that information in an easy way.
Second phase would be to add more autonomy to the tool, so it makes "decisions" like identifying tissues and for example warning before cutting through nerves or scaling the surgeon movements depending on the area and tissue type it is working at that point, as to make it safer.
Third phase would be to add more autonomy and let some of the tools to be moved by the computer in coordination of the surgeon actions, so for example the computer could take care of draining blood without the surgeon intervention. In order to do that, the computer needs to be able to tell one tissue type from another, and understand the organization of the body area it is working in.
Then some stereotypical parts of the operation could be carried on completely automated.
Finally, eventually the full operation would be carried by the computer.
I would really like computers take over. Even if they are worst than actual surgeons. There are two advantages.
The first one is price. A lot of operations are not carried because of economic reasons. People in that situation would prefer even a "bad" robotic surgeon than nothing.
The second would be consistency. There would be no variability between one robot and the next. Now the outcome of your operation depends so much on what surgeon performs it and if he has a good day.
Re:Unanswered question (Score:3, Insightful)
Okay, so DaVinci is by far the market leader
And we know with a far higher degree of certainty than any of the bogus stats in the article that that means they have mediocre technology but great marketing.
Being "market leader" in a cutting edge (as it were) field is in my experience almost always an indication that the tech is poor to middling but the company is brilliant at marketing. I'm not just talking about Microsoft here, although they are a prominent example of the phenomenon. In the areas I've worked in professionally (which includes image-guided surgery) the best technology has never been close to the market leader.
Personally, I don't want a surgeon using a machine from the market leader on me until the technology is mature, which doesn't happen for decades.
IANAL math (Score:3, Insightful)
fewer in-hospital complications
minus
worse results for impotence and incontinence
plus
210 systems seven years ago to 1,395 today
equals
It is a lot harder to sue for impotence and incontinence than it is for in-hospital complications
Sounds likely, but IANAL.
Re:These devices are not robots. (Score:3, Insightful)
the hospital forces him to use the robot even on cases that would be much better done hands-on
No one is "forcing" him to do anything. He just doesn't have the guts to do the right thing and say no to his bureaucratic overlords. He is willing to do harm--in his own estimation--to other innocent human beings who have put their deepest trust in him, for the sake of his own comfort and security.
Your friend is a coward, and the most appalling thing is that you apparently see nothing wrong with that.
When people say, "For evil to triumph it is merely necessary for good people to do nothing", this is exactly the kind of behaviour they mean.
The skill of the person using the tool (Score:3, Insightful)
really matters. No matter if you are using a so called robotic tool or an X-ray generating tool, the Doctor you choose and his or her experience and success rate will determine the outcome far more than the type of treatment you choose.
When you talk to a doctor, ask him how many of the procedures he did last year and what his success rate was. I had the choice of a Doctor who answered "3 and I don't know" and a Doctor who answered "several a day and people with your 'scores" have had a success rate of x and a complications rate of y". Show me the Doctor who measures the success of the way he does a procedure and tries to improve and I'll show you the increased success active learning brings.
Plug ProstRcision into your search engine.
Re:Incontinence or Death (Score:2, Insightful)
Would you rather be dead or incontinent? I'll take the diapers. Impotent? I'll have to think about it.
For me, the notion of diapers in my fifties was far worse than impotence. As another prostate cancer patient observed, you've got a lot better chance getting a woman into bed if you have bladder control. Luckily, the odds are better for continence than potency, and the former comes back much faster. (But neither one comes back soon enough!)
FWIW, I considered both open and Da Vinci surgery, and I chose the open surgery after lots of reading and discussion, but mainly because I felt like the Da Vinci surgeon was trying to sell me on his method, while the traditional surgeon didn't seem to even be selling surgery; he freely explained reasons that I might want to consider radiation. In one of my meetings with my surgeon, I asked him which he would choose if he were in my situation, and he said "Open, without question!" He said the feel of the tissue was more useful than seeing it. He also said that more Da Vinci patients report dissatisfaction about recovery than open surgery patients, mainly, he believed, because their expectations for Da Vinci were too high. He is learning to use the Da Vinci robot only because more people are demanding it.
The bottom line, though, is that if you are in the situation of needing a prostatectomy, you don't want to look at the statistics of method A vs. method B. You want to look at the statistics of the individual surgeons you are considering and go with the one you are completely confident with. There are no guarantees of full recovery, no matter whom you choose, and when you're recovering, you do not want to be asking "What if?" It's a moot question, anyway: there is only what is.
Re:These devices are not robots. (Score:3, Insightful)
While I see you point, I have to disagree. In your extreme logic noone can ever be forced to do anything. Because when it comes to it, you can always refuse (and die).
My friend is a very skilled surgeon - which may be one of the reasons why he feels that hands-on would be better in many cases. And he's not "doing nothing". He's an out-spoken critic and opponent of overuse of the technology and he's actually trying fairly hard to overturn the hospital's decision. Admittedly, not to the point of losig his job.
I applaud your life if you really have the clear consciousness to call people who make compromises cowards.