My last few posts on telemedicine addressed some advances in the diagnostic aspects of medicine. While one commenter brings up the great point that we are not at the place where we can do full diagnostic physical exams for primary care via telemedicine, there are some areas of procedural medicine where doctors do their work without ever touching the patient. Robotics and the surgical field of Urology is one great example.
For those of you who thought that surgery by robots was something out of a futuristic science fiction novel, that day has already come for Urologic surgeons. The da Vinci robot created by the company Intuitive Surgical is an expensive but top selling robot that is a must for any health center that claims to be cutting edge. Many of you might already have heard of Intuitive Surgical as their company stock has been a top performer in the device industry for several years. I do not own stock in the company or get anything from mentioning them, but they are the pioneer for Urologic robotics.
At any rate, the da Vinci robot is an actual robot that is controlled by a surgeon who is sitting at a computerized console in the corner of the room. The actual robot is a different machine that can move above the patient and has several “arms” that contain instruments on the end. The surgeon controls the arms and moves the “wrists” at the end of the arms. Sophisticated software now allows the robot to learn the movement patterns of the surgeon. The robot can filter abrupt movements of the surgeon and smooth out the movements to minimize any trauma to the patient.
When robotic surgery first came out, it was met with resistance. Common complaints included the high cost of the machine and the sterilized add-on components, the lack of “tactile feedback” from the instruments, and the steep learning curve. Older surgeons have been hesitant to retrain and obviously are not as facile with the machine as the younger generation who trained with robotics. On the whole, Urologists who use this machine regularly for prostate cancer surgery have excellent outcomes and are able to incise, cut, sew, and handle tissues delicately with the machine. Outcomes continue to improve and there have even been reports of surgeons remotely operating the machine on patients.
Thus, for the surgical field of Urology, robotics is here to stay.
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Dr. J.C.,
Da Vinci machines are awesome. If it worked well, no surgeon in their right mind would resist it.
You see, one of the hazards of surgery is what we call a “sharps injury”. This is where you accidentally cut your finger with a scalpel or suture needle while performing surgery. This is a big deal, because if the patient you are operating on has HIV, Hepatitis C, etc… the surgeon could get infected because there may be patient’s blood on the scalpel/suture needle.
With davinci, the risk of getting HIV/Hep C from a patient is eliminated.
So, why aren’t all urologists/surgeons using da vinci? Cost is a major factor.