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Robot surgery? No thanks

CHICAGO (AP) — The biggest thing in operating rooms these days is a million-dollar, multi-armed robot named da Vinci, used in nearly 400,000 surgeries nationwide last year — triple the number just four years earlier.

But now the high-tech helper is under scrutiny over reports of problems, including several deaths that may be linked with it and the high cost of using the robotic system.

There also have been a few disturbing, freak incidents: a robotic hand that wouldn't let go of tissue grasped during surgery and a robotic arm hitting a patient in the face as she lay on the operating table.

Is it time to curb the robot enthusiasm?

Some doctors say yes, concerned that the "wow" factor and heavy marketing have boosted use. They argue that there is not enough robust research showing that robotic surgery is at least as good or better than conventional surgeries.

Many U.S. hospitals promote robotic surgery in patient brochures, online and even on highway billboards. Their aim is partly to attract business that helps pay for the costly robot.

The da Vinci is used for operations that include removing prostates, gallbladders and wombs, repairing heart valves, shrinking stomachs and transplanting organs. Its use has increased worldwide, but the system is most popular in the United States.

"We are at the tip of the iceberg. What we thought was impossible 10 years ago is now commonplace," said Dr. Michael Stifelman, robotic surgery chief at New York University's Langone Medical Center.

For surgeons, who control the robot while sitting at a computer screen rather than standing over the patient, these operations can be less tiring. Plus robot hands don't shake. Advocates say patients sometimes have less bleeding and often are sent home sooner than with conventional laparoscopic surgeries and operations involving large incisions.

But the Food and Drug Administration is looking into a spike in reported problems during robotic surgeries. Earlier this year, the FDA began a survey of surgeons using the robotic system. The agency conducts such surveys of devices routinely, but FDA spokeswoman Synim Rivers said the reason for it now "is the increase in number of reports received" about da Vinci.

Reports filed since early last year include at least five deaths.

Whether there truly are more problems recently is uncertain. Rivers said she couldn't quantify the increase and that it may simply reflect more awareness among doctors and hospitals about the need to report problems. Doctors aren't required to report such things; device makers and hospitals are.

It could also reflect wider use. Last year there were 367,000 robot surgeries versus 114,000 in 2008, according to da Vinci's maker, Intuitive Surgical Inc. of Sunnyvale, Calif.

Da Vinci is the company's only product, and it's the only robotic system cleared for soft-tissue surgery by the FDA. There are other robotic devices approved for neurosurgery and orthopedics, among other things.

A search for the company's name in an FDA database of reported problems related to medical devices brings up 500 reports since Jan. 1, 2012. Many of those came from Intuitive Surgical. The reports include incidents that happened several years ago and some are duplicates. There's also no proof any of the problems were caused by the robot, and many didn't injure patients. Reports filed this year include:

— A woman who died during a 2012 hysterectomy when the surgeon-controlled robot accidentally nicked a blood vessel.

— A Chicago man who died in 2007 after spleen surgery.

— A New York man whose colon was allegedly perforated during prostate surgery. Da Vinci's maker filed that report after seeing a newspaper article about it and said the doctor's office declined to provide additional information.

— A robotic arm that wouldn't let go of tissue grasped during colorectal surgery on Jan. 14. "We had to do a total system shutdown to get the grasper to open its jaws," said the report filed by the hospital. The report said the patient was not injured.

— A robotic arm hit a patient in the face during a hy

by Anonymousreply 604/09/2013

[quote] Advocates say patients sometimes have less bleeding and [bold] often are sent home sooner [/bold]than with conventional laparoscopic surgeries and operations involving large incisions

That is the reason for robotic surgery. It's to get you out of the hospital ASAP. "Look! It's a robotic arm! It's brand new technology and you can go home sooner!"

When I started in open heart surgery, the average stay was 11 days. Then came managed care and we were told to "fast track" everyone for discharge on the 5th postop day -- which became the fourth postop day.

Then came "minimally invasive" heart surgery. THREE days, baby! Get 'em out.

The very first robotic surgery they did, they wanted the patient out by 11 am the second day after surgery. They were harassing me to discharge the patient NOW. But when I went in to get his signature on his discharge papers. he couldn't lift his arm. He'd told the surgeons this at 6 am, and they ignored him because of their fever to discharge the first robotic arm patient.

I refused to discharge the patient until he was looked at by physical therapy, because I believed he had a brachial plexus injury. No way was my name going on his discharge papers. I told the surgeons, "You want him out, you sign all the paperwork. Oh, and I already documented that he can't lift his arm in his chart, you know... that LEGAL DOCUMENT, the patient chart. And it is Sunday, and we don't have any physical therapists here."

They allowed him to stay one more day and threw him out the next day with a PT referral.

When invasive cardiology (angioplasty, ablation, etc) came along, the surgeons had to hurry up and get their patients out as fast as the cardiologists did. If they could discharge you in 12 hours, they would.

by Anonymousreply 104/09/2013

Johnny Five is alive!

by Anonymousreply 204/09/2013

Love that scene in "Prometheus" where the female astronaut gets into that "surgery pod" and just programs her own alien removal. But it's formulated for males, so she has to get a caesarean by typing in "abdominal something-or-other".

by Anonymousreply 304/09/2013

I have had 2 robotic heart surgeries with no problems. The first surgery fixed a hole in my heart and repaired the mitral valve. I was in the hospital for 5 days after due to afib. Roughly six weeks later I had to go back to have the valve replaced. I was in the hospital for 4 days after surgery.

Only 4 incisions - 3 on the right side of my chest and one in the groin. I was so afraid they were going to have to cut my chest open.

My surgery was 3 years ago and I had never heard of robotic surgery. My surgeon was great. Surgeons were coming in from all over the country to train with him. There were even some surgeons from out of the country coming to train with him.

by Anonymousreply 404/09/2013

A robot doing surgery? Make me laugh, why don't you!

by Anonymousreply 504/09/2013

Yeah, yeah, when are we gonna get these virtual sex dolls? I'm tired of technology failing to benefit humanity.

by Anonymousreply 604/09/2013
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