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Robotics Medicine Hardware Science

The State of Robotic Surgery 72

Posted by kdawson
from the cut-on-dotted-line dept.
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.
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The State of Robotic Surgery

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  • Cost benefit? (Score:2, Interesting)

    by S1ngularity (1635987)
    And what effect this sort of technological uptake have on health cost containment?
    • Re: (Score:2, Interesting)

      by gmhowell (26755)

      It will cost the insurance companies less (shorter hospital stay) so therefore, it's all benefit to them. Expect to see this tech continue to expand, even at the cost of customers' leaky, flaccid weiners.

  • by MichaelSmith (789609) on Wednesday March 17, 2010 @02:52AM (#31505408) Homepage Journal

    It would be interesting if robots like the DaVinci could in future operate on a smaller scale and in trickier parts of the body. Some cancers (for example) are inoperable because of their location in the body. Maybe a robot could cut out most of the tumor in these cases and leave chemotherapy or radiotherapy devices behind the clean up the rest.

    • by nanoakron (234907) on Wednesday March 17, 2010 @08:23AM (#31506958)

      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.

      • There's a new "look" for robotic surgery that uses intraoperative imaging (ultrasound, MRI, CT, fluoro), as the "eyes" as opposed to cameras, which merely duplicate the function of the eyes. It will be especially useful for percutaneous operations, but the possibilities go beyond that...
      • Re: (Score:3, Informative)

        by quantumghost (1052586)
        Actaully, being a surgeon who has used the robot, you stand a greater chance of injury.

        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

        • Software analogy:

          I am a C programmer with 25 years experience in real time systems. If a client needs a database to track their pencils then I am the best person to come to because I understand all the implications: race conditions, middle ware, infrastructure; you name it, I know it.

          But the fact is that they client will pay some guy half what I earn to knock their database up in MS Access. It will fall over from time to time but do a reasonable job.

          So can I get cheap but acceptable surgery with a robot?

          • Software analogy:

            I am a C programmer with 25 years experience in real time systems. If a client needs a database to track their pencils then I am the best person to come to because I understand all the implications: race conditions, middle ware, infrastructure; you name it, I know it.

            But the fact is that they client will pay some guy half what I earn to knock their database up in MS Access. It will fall over from time to time but do a reasonable job.

            So can I get cheap but acceptable surgery with a robot?

            Well...no. First the robot costs more to use...the instruments are of limited use - they only function X times before the lock out - that way the company can keep making money after the robot is sold. Those intruments also cost a lot more than standard lap instruments (and don;t last as long).

            Second, as was noted in another post, this isn't really an automaton. It is still _very dependent_ upon the skill and judgement of a trained, experienced surgeon. A teenager may be able to operate it, but won't h

  • So how long until there's completely unmanned surgical automats? That would be pretty scary and at the same time pretty cool, in a dark cyberpunk future kind of way...
  • by im_thatoneguy (819432) on Wednesday March 17, 2010 @02:57AM (#31505426)

    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.

  • by Anonymous Coward

    According to a large study of Medicare patients, robotic prostate surgery led to fewer in-hospital complications, but had worse results for impotence

    Talking about growing pains

  • It's Cool. (Score:3, Interesting)

    by stuffman64 (208233) <stuffman@gm a i l .com> on Wednesday March 17, 2010 @03:15AM (#31505484) Homepage

    I for one welcome our robotic overlords... I mean, helpers!

    Last month I got to play with one of the Da Vinci units at a car show (why it was there is anyone's guess). I am amazed at how intuitive it was to use- even though I was just putting tiny rubber bands on small rubbery cone-thingies, the 3D display and 1:1 motion mapping really made it feel like an extension of my body. Even though the unit doesn't use force feedback, it almost seemed like it did (just my brain, I guess). The most amazing part? My 7-year-old niece had absolutely no problem using it, and now she wants to become a doctor.

    Cool stuff.

    • by Jedi Alec (258881)

      My 7-year-old niece had absolutely no problem using it, and now she wants to become a doctor.

      Why not become a roboticist instead? All the fancy toys and none of this nasty bloody stuff. Less lawsuits too, from what I hear.

    • Re: (Score:3, Informative)

      by radtea (464814)

      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...

    • Last month I got to play with one of the Da Vinci units at a car show (why it was there is anyone's guess). ... My 7-year-old niece had absolutely no problem using it, and now she wants to become a doctor.

      Getting kids interested of course.

  • These robot doctors are very professional, except for their entrance into the operating room:
    http://www.youtube.com/watch?v=JqlawTD_9B0 [youtube.com]

  • Only 14% of prostate surgeries in the US last year took place not using the DaVinci.

    Okay, so DaVinci is by far the market leader - but of that minority 14%, how many are using Medibot?

    • Frankly, I find that number very hard to believe. Maybe 14% of prostate surgeries in hospitals with a DaVinci took place without one, but there are less than 1400 machines nationwide according to TFA. That's less than one per 200 000 people.

      If anything, they perhaps meant they have 86% of the market for radical prostatectomies. Most prostate surgery is done via the urethra because it's done for benign prostatic hypertrophy that impedes urine flow, not for cancer.
    • Re: (Score:3, Insightful)

      by radtea (464814)

      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-gu

  • by wisebabo (638845) on Wednesday March 17, 2010 @03:35AM (#31505524) Journal

    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.

    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).

    Now what was the name of that "emergency medical program" on Star Trek?

    • Re: (Score:3, Informative)

      by careysub (976506)

      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 her

    • Re: (Score:1, Informative)

      by Anonymous Coward

      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 us

  • by jcr (53032) <jcr@mac. c o m> on Wednesday March 17, 2010 @03:35AM (#31505528) Journal

    They're remote manipulation systems, also known as "waldoes". Robots operate under the control of a stored program, not the direction of a human operator.

    -jcr

    • by janek78 (861508) on Wednesday March 17, 2010 @04:16AM (#31505684) Homepage

      That's a valid point. Also, every technology - and medicine is no different in this - has it's phase of enthusiastic adoption, eventual disappointment when it's found out it's not as good as previously hoped, and then a phase of rational use in indications where it makes sense. I remember the time when surgeons would do 6-hour laparoscopies because it was IN. Later they realized that a 2-hour open surgery is actually better for the patient and laparoscopies were limited to cases where they make sense.

      I am a doctor in a university hospital and I recently went out to have beer with a friend of mine from the urology department. He's the chief "robot operator" for our hospital and he hates the machine with a vengence. No only are the operations several times more expensive (and longer), but to get the money they paid for the machine back, the hospital forces him to use the robot even on cases that would be much better done hands-on. Patients with more complications and longer hospital stay are no exceptions. To me this still seems like a technology we are yet to learn to use properly. Use it for remote operations where the surgeon is not physically available, use it in indications where it makes sense, but don't believe in all-saving robotic future of surgery. It's not here yet. The adoption cycle of many older technologies should serve as a warning.

      • Re: (Score:3, Insightful)

        by radtea (464814)

        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 exac

        • by Caue (909322)

          Resistance to new techs + distorted sence of justice = medieval nightmare.

          You obviously don't have a boss, a family to support, house payments, etc. Even more obvious is that hospital "overlords" are in the harming people business and doctors are the executioners. please.

        • Re: (Score:3, Insightful)

          by janek78 (861508)

          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

      • by jcr (53032)

        I remember the time when surgeons would do 6-hour laparoscopies because it was IN. Later they realized that a 2-hour open surgery is actually better for the patient and laparoscopies were limited to cases where they make sense.

        I can see why people would assume that the laparoscopic approach would be better (small incision, etc, etc.) I take it that being under general anesthesia for the shortest time possible outweighs other advantages that laparoscopy would offer?

        Does it seem to you that it would be frui

    • Exactly what I wanted to say. Nowadays the mob of idiots describe every remote-controlled machine as a robot.
      I wonder if they would call my door opener a “roboter”... since it’s obviously remotely controlled.

    • Re: (Score:3, Insightful)

      by javilon (99157)

      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

  • when laparoscopic surgery came in there were all these studies done that showed one thing or another. for example, a laparoscopic cholecystectomy (removal of the gallbladder) is a very common operation. apparently there are studies done that show 10% of the time you will have damage to the common bile duct (which would be bad). any general surgeon worth his salt these days will tell you that 10% chance is more like 0.5% or better.

    my point is, maybe people just need to get better at using these things? it'

  • After spending some weeks in the hospital as observer and talking to various surgeons about these robots I was basically told that a prostate surgery using DaVinci takes about as much time as with Minimal invasive surgery, but costs a lot more (instruments can be used 10 times (DRM) on the DaVinci and are really expensive ($2000+ I think)). You also have absolutely no feedback ( I got to play with one for 30 seconds before I got crazy about the 50Hz 3D screen and I broke stitching wires with it by pulling t

  • The company I work for also makes robots for surgery, but this time for brain surgery.
    neuromate®: the No. 1 image-guided neurosurgical robot [renishaw.com]

  • by commodoresloat (172735) * on Wednesday March 17, 2010 @05:03AM (#31505882)

    Robotic surgery is actually pretty straightforward. You just pop off a few screws and open the front panel on the robot's torso, and then you can get at the insides pretty easily.

  • IANAL math (Score:3, Insightful)

    by ibsteve2u (1184603) on Wednesday March 17, 2010 @07:42AM (#31506688)

    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.

    • by Carnildo (712617)

      "In-hospital complications" are things like life-threatening infections, uncontrollable internal bleeding, and the occasional dead patient. I don't know about you, but given the choice between wearing a diaper and wearing a body bag, I know which I'd pick.

  • by mikefocke (64233) <<mike.focke> <at> <gmail.com>> on Wednesday March 17, 2010 @07:56AM (#31506788)

    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.

  • Sorry, there's NO way I'm letting a robot with scalpels anywhere near that portion of my anatomy. I prefer not to be one integer underflow exception away from singing soprano.
  • by Budenny (888916) on Wednesday March 17, 2010 @11:13AM (#31508866)

    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.

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