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On the Spot With Colleen Hutchinson: Surgical Robotics
ISSUE: AUGUST 2014 | VOLUME: 41:08 —Colleen Hutchinson
In one of his blog posts, Toby Cosgrove, CEO of Cleveland Clinic Foundation, referenced two studies done at his institution comparing robotic surgery with traditional methods for mitral valve repair and prostatectomy. The first study found that technical complexity and longer surgical time were balanced by the benefits of shorter hospital stays and smaller incisions; the second study showed that robotic surgery was no better or worse than traditional surgery.
"The time has come to hear from surgeons beyond sound bytes and to tackle the issues in a dedicated column. While both sides are effectively represented here, and with more objectivity and balance in each individual perspective than one might expect, I was surprised to see agreement on a few major aspects of robotics—most interestingly, the opinion that robotics doesn't necessarily mean more risk for inadvertent injury than with open or laparoscopic surgery."
Thank you to this month’s contributors for sharing their thoughts and expertise. Please contact Colleen Hutchinson at: email@example.com with thoughts on this month’s column, or ideas for future ones.
PLEASE CLICK ON IMAGE FOR DEBATE AND MD'S PERSPECTIVES
Charles Rardin, MD
"The debate over robotics in benign gynecology"
May 1, 2014. A clinical opinion by Charles Rardin, MD
When a woman requires gynecologic surgery, she and her surgeon have several minimally invasive surgical options, including robotic surgery. In recent years, the use of robotic surgery has become more and more common. But questions have arisen about the potential overuse of robotic surgery and its advantages over traditional laparotomy for hysterectomy.
A clinical opinion by Charles Rardin, MD, a urogynecologist in the Division of Urogynecology and Reconstructive Surgery and director of the Robotic Surgery Program for Women at Women & Infants Hospital of Rhode Island, director of Minimally Invasive Surgery at Care New England, and associate professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University, entitled "The debate over robotics in benign gynecology," is published this month in the American Journal of Obstetrics & Gynecology.
"Robotic surgery certainly provides some advantages to some surgeons and has contributed to a decline in laparotomy (large incision) rates for hysterectomy," said Dr. Rardin. "But robotic surgery for benign gynecology needs to be considered as just one of several forms of minimally invasive surgery (MIS) that can be used to provide the best care to patients.
"Dr. Rardin explained that specific features of the patient (ie obesity), the surgeon (ie his or her experience with laparoscopic surgery), or the case (ie the possibility of significant and technically challenging suturing, such as required for a fistula repair) may make the robotic approach preferable over laparoscopic or vaginal surgery.
"However, an institution that adopts a policy of promoting robotic surgery over other forms of minimally invasive surgery is at risk of becoming a 'robotic factory' and allowing volume and quality of vaginal or laparoscopic surgeries to dwindle," he said.......continue reading
Benjamin J. Davies, MD
Benjamin J. Davies, MD,
is an Assistant Professor of Urology at the University of Pittsburgh School of Medicine. He is the Director of the Urologic Oncology Fellowship and Chief of the Urology Section at Shadyside Hospital. Dr. Davies graduated from Columbia College and earned his medical degree from Mount Sinai Medical School in New York City. Following surgery and urology residencies at the University of Pittsburgh, he completed a postdoctoral fellowship in Urologic Oncology at the University of California, San Francisco. He has written over 30 peer-reviewed scientific and clinical publications on prostate cancer and bladder cancer.
Intuitive Surgical's Robots Don't Play Well With Each Other and Docs are Pissed
last week. Intuitive Surgical shares surge higher on news that the FDA approved a new surgical robot, dubbed da Vinci Xi. "Sweet," rang the crowd of analysts. "Sweet," shouted Intuitive's shareholders. But a sad and distrustful note also rang out from hospital administrators and physicians -- voices largely ignored by the analysts and investors. While Wall Street hails Intuitive's da Vinci Xi surgical robot as the shiny delivery vehicle for new sales, those of us expected to pay for and use the new machines are pissed off.
The first problem with Intuitive's new robot is simple. It doesn't work with my current robot. That's right. My "old" $2 million machine became last week completely incompatible with all the goodies that this new sexy, flashy techno-elitist robot is supposed to deliver. Of course, Intuitive had promised vertical integration as a cornerstone policy of its surgical machines, but sadly, that is not the case. None of the advances of the new Da Vinci Xi machine can be translated to the da Vinci machine I have. It's like owning a great razor but having no blades.
Another problem is the secrecy. Had Intuitive been upfront with the rollout of the new machine, hospitals could have prepared and budgeted appropriately. As it stands now hospitals feel slighted and physicians are now forced to use "old" technology that cannot be upgraded. Marc D'allera, Associate Professor of Urology and Vice-Chairmen at the University of California, Davis, just purchased a beautiful (old) Da Vinci robot last month. Upon hearing the news that Intuitive had just rolled out a "new" robot, D'allera tweeted to me: "Here we are thinking we're getting a great deal with firefly and stapler, turns out it was a clearance sale.".......read complete article
During the past few decades, we’ve seen tremendous changes in the field of surgery. Advances in medical technologies and techniques have revolutionized many types of surgical procedures, improving precision, requiring only small incisions, reducing blood loss and enhancing surgical outcomes. Some procedures that once meant a week’s stay in the hospital now have patients going home the same day. Patients report less pain and are returning back to their normal activities much faster than ever before.
One of the latest breakthroughs in surgery is the use of robotic techniques, which has enabled doctors to perform even complex cases – like removal of the prostate or kidney – using only small incisions. Previously these types of cases, such as certain cancer surgeries, were too difficult to perform using traditional minimally-invasive techniques and required surgeons to open up the abdomen.
Contrary to its name, robotic surgery does not mean that a robot is performing surgery. Camera scopes are inserted into the abdomen, giving surgeons a high-definition, 3-D view that allows them to see tissues and blood vessels at a level of detail far beyond what is possible with open surgery or laparoscopic surgery. Seated at a console away from the operating table, the surgeon controls the system’s tiny instruments, which have an even greater range of motion than the human hand. Because only a few small incisions are required, patients have less pain and scarring and fewer complications than those who have had traditional open surgery. Prostate cancer patients return to normal sexual and urological functioning faster, studies show. Hysterectomy patients who underwent robotic-assisted surgery lost half as much blood as those who had laparoscopic surgery in comparative studies.
There is even more good news for patients: Until recently, robotic surgery was only found at large, academic medical centers. This technology has now become more widely available at smaller, community hospitals. Somerset Medical Center surgeons began performing robotic surgery with its new daVinci Surgical System in June to successfully remove a patient’s prostate gland. Robotic surgery is also being used at the medical center to treat bladder and kidney disease and will soon be used in the treatment of ovarian, uterine and colorectal cancers.
If you are facing surgery, talk to your doctor about your surgical options and whether robotic surgery or other minimally-invasive techniques may be right for you.
Dr. Catanese, a board-certified urologist, is chief of surgery at Somerset Medical Center and a member of the Prostate Cancer Institute at Somerset Medical Center’s Steeplechase Cancer Center. For a physician referral, call 800-443-4605.
Emad Kandil, M.D., FACS
Emad Kandil, M.D. about Robotic Transaxillary Scarless Neck Surgery
Traditional thyroid or parathyroid surgery can involve a fairly long incisions at the base of the neck.
With the new robotic transaxillary scarless neck surgery approach, we use the latest high-definition state of the art robotic equipment to make an approximately two inch incision below the arm. The robotic equipments allows maneuvering a small camera and specially designed instruments to access the thyroid and perform the surgery.
The diseased tissue is then removed endoscopically through the incision under the arm without even a scratch on the neck,(that's why its called scarless neck surgery).
The U.S. Food and Drug Administration approved this technique last year. We still advocate further evaluation in the setting of a prospective clinical trial. This is an exciting new treatment option not only for patients who are concerned about having a visible permanent neck scar but also for many patients that need thyroid or parathyroid surgery. Because the robotic camera provides a close up view with 10 times magnification in addition to three-D vision, there is a reduced likelihood of nerve damage and less risk of trauma to the nearby structures including the parathyroid glands.
Application of robotic technology for thyroid surgery could overcome the limitations of conventional endoscopic surgeries in surgical management of thyroid cancer and Graves' disease. We are offering this new approach to many patients who are not candidates for endoscopic video assisted surgery. We are also able to monitor the nerve function during the entire operation to avoid the risk of postoperative hoarseness of voice.
Finally; The skin under the arm has fewer nerve endings than in the neck and not under stretch with repetitive movements as the neck area, so, patients who underwent this procedure have reported less discomfort and faster recovery time. Many patients didn't require any pain medicine postoperatively. Therefore, this new Robotic approach has other benefits that go beyond avoiding a visible neck scar.
Robotic assisted transaxillary thyroidectomy is a feasible approach and with continued efforts, operations are becoming safer and less invasive, allowing a quicker return to normal activity.
Robotic Surgery for Prostate Cancer: An Automatic Choice?
It's essential to consider a surgeon's experience when deciding on treatment.
A diagnosis of prostate cancer comes with a double whammy. The newly diagnosed patient deals not only with the fear of cancer itself, but also with concerns about two of the potential side effects of surgical treatment: incontinence and impotence. Such terrifying prospects have many of the thousands of men diagnosed with prostate cancer each year exploring alternatives to help control their cancer and hopefully minimize the risk of long-term side effects.
For many years, the prostate could only be removed by making an incision in the lower abdomen, a procedure known as "open" surgery. Eventually, techniques were developed to remove the prostate by laparoscopy—that is, by performing the operation through small puncture holes in the abdomen and removing the prostate through a small incision around the belly button. Although laparoscopic surgery leaves less scarring, it wasn't clear, according to surgeons, if it was as effective as open surgery in helping to minimize side effects.
Since 2000, though, a new form of laparoscopic prostate-cancer surgery, performed with the assistance of a robot, has rapidly gained popularity. According to Intuitive, the company that manufactures the DaVinci robot, roughly 75 percent of today's urologists are being trained in "robotic" surgery for prostate removal......continue reading
Patrick C. Walsh, M.D.University Distinguished Service Professor of Urology Johns Hopkins Medical Institutions
What is "robotic" prostate surgery?
When people hear the term "robotic surgery," it's easy to imagine a 21st-century cross between a human doctor and C-3PO from "Star Wars," wielding surgical instruments and operating on the patient with utmost precision.
That's a common misconception, says Patrick Walsh, M.D., a urologist at Johns Hopkins, where both open and robotic prostate surgeries are performed. (The regular laparoscopic surgery is not often performed any longer.) "Patients think the robot is doing the operation. They don't understand that it's the surgeon behind the robot who's actually performing the surgery."
It helps to imagine the actual surgical robot itself: three or four mechanical arms that hold the scalpel and surgical instruments. The movement of those robotic arms, however, is controlled solely by the surgeon, who sits at an attached computer console and manipulates the arms with two extremely precise joysticks.
The robotic technology gives laparoscopic surgeons more precise control and magnified vision. Because the surgeon is moving the instruments indirectly through the robot, any slight tremors of the surgeon's hands are eliminated. In addition, an automobile stick-shift-type control on the robotic console allows the surgeon to reposition his or her hands to a more ergonomic position during surgery, reducing operating-room fatigue. Finally, the screen that displays the details of the robotic surgery (there's a small video camera inserted into the patient's abdomen) shows a three-dimensional image that can be magnified up to 12 times.
"This magnification let's you see things more precisely," says Mani Menon, M.D., a professor at New York University and chair of the urology department at Henry Ford Hospital in Detroit, who pioneered the use of the robot for prostate surgery.
Mani Menon, M.D.
Peter T. Scardino, FACS
Because robotic prostate surgery is billed as minimally invasive, there's a tendency for patients for see the surgery as less serious than it really is.
"Many patients think [robotic prostate surgery] is somehow non-invasive and therefore don't see it as a 'real' surgical procedure," says Peter Scardino, M.D., a urologist at New York's Memorial Sloan-Kettering Cancer Center. "But you're not just putting a needle in and magically making the prostate disappear. You're still going inside the body, cutting out [the] prostate, cutting open the surrounding tissue, and sewing everything back together. It's the same operation but with a smaller incision."
Open vs. robotic prostate surgery: What the research says and doesn't say
When patients weigh the choice between open and robotic surgery, they usually have questions. Which approach is better at controlling cancer? Which approach is best for preserving continence and sexual function?
While the published literature on robotic surgery is growing rapidly, it’s still a developing field with more questions than answers. So far, the published literature has shown that, in the hands of a highly-skilled surgeon, robotic surgery gives quite good results. These results have been documented in a number of "series" studies, in which a single surgeon publishes his results with a particular surgical technique.
The most famous series study for robotic prostate surgery was published by Menon, who has personally performed more than 3,000 robotic prostate surgeries as well as 1,200 open prostate surgeries. Using the robot, Menon has achieved excellent results in controlling cancer, preserving continence and sexual function, and minimizing surgical blood loss. In addition, Menon says the enhanced precision and magnification of the robot allowed him to develop new techniques in prostate surgery, techniques that are now used by open surgeons as well.
However, such "series" studies don’t necessarily prove that robotic surgery is better than—or even equal to—open surgery. Instead, they merely show that the robotic technology itself is viable and that prostate surgeons like Menon are highly talented individual surgeons who are getting good results with the robot.
What’s missing are studies that do a head-to-head comparison of open versus robotic surgery. Known as “randomized clinical trials,” such studies are routinely used in comparing oral medications to alternative medications or placebos.
Although such a study of open to robotic surgery would give patients the clearest indication of which technique is better, both open and robotic prostate surgeons generally agree that a randomized clinical trial comparing the two surgical approaches will never happen.
"When I first started doing robotics, I wanted to do a randomized clinical trial comparing open to robotics, because at that time I felt that I was a very good open surgeon and the field of robotics was just starting to develop," Menon explains.
But as he informally surveyed patients to take their proverbial pulse on the idea, he discovered a significant roadblock. "Although the patients all agreed that a randomized clinical trial would ultimately end up giving the truth, none would want to participate themselves," says Menon. "Patients don’t want to be randomized because they know what they want. Some preferred open surgery because they knew I’d already done 1,200 cases. Others preferred the robot because they could see what the robot enhanced my ability to perform the surgery."
The next best type of research is the prospective study, in which researchers compare the outcomes of prostate cancer patients who chose open surgery with the outcomes of patients who chose robotic surgery. Recently, several such studies have been published.
"If you summarize all the literature we’ve got to date, it basically shows that for the long-term outcomes of curing cancer and recovering sexual and urinary function, the robotic surgery is either comparable to or not as good as open surgery," explains Scardino.
But that doesn’t actually mean that robotic surgery is less effective for cancer control. Rather, the differences are more likely due to differences in surgeon experience, since the robotic technology is relatively new......Continue reading
Dr. David B. Samadi
Dr. David B. Samadi Says: "Talk About Prostate Cancer and Celebrate Life on Father's Day"
-- 06/17/09 -- When you think of June, images of barbeques, sun and fun come to mind. It is also a month filled with weddings, graduations and new beginnings. According to the American Cancer Society, June is full of very important cancer awareness events such as Men's Health/Cancer Awareness Day on Father's Day, June 21. Dr. David B. Samadi, Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center, says this day is as good as any other to talk to the most important men in your life about prostate cancer screening and their health.
There is a reason why there are so many cancer awareness events in June, such as National Cancer Survivors Day (June 7) and National Men's Health Week (June 8-14). Prostate cancer is currently the second-leading cause of death in American men. According to the Prostate Cancer Foundation, more than 65% of all prostate cancers are diagnosed in men over the age of 65. But while it is true that a man's odds of developing prostate cancer increase exponentially with age, it is no longer an "old man's disease." Dr. Samadi treats patients as young as 39.
It is for precisely this reason that Dr. Samadi counsels earlier intervention as preventive medicine. Prostate care and routine screening tests, for example, prostate specific antigen (PSA), or digital rectal exam (DRE) tests, should be proactive when the prostate is normal and healthy. Of course eating healthy foods, regular exercise, maintaining proper body weight, and not smoking, are common sense recommendations for preventing prostate cancer. Samadi asks men to consider their family history because this is an important risk factor. Generally speaking, if someone had a close relative who was diagnosed with prostate cancer, they should be screened at the age of 40. If caught early enough, prostate cancer has a cure rate over 90%.
The best practice in fighting prostate cancer is not to wait until you have warning signs. Some patients may see blood in their semen or urine, or deal with urination problems. When the cancer has spread, it can manifest itself in bone and back pain, or compression of the spine. Also known as the "silent killer," once a patient has symptoms of prostate cancer, it can be too late, which is why frequent screenings are a must. What is important to keep in mind is that while prostate cancer is a serious health problem, it is not a death sentence. Dr. Samadi advises, "There is life after prostate cancer." For complete article Click here
Dr. Myron Murdock, Vibrance Medical Director.
Dr. Myron Murdock, Vibrance Medical Director
Myron I. Murdock, M.D., F.A.C.S. is an educator, surgeon/practitioner, author, clinical trial expert, and Medical Director of Vibrance Associates, LLC, a world-wide medical website company. He was born in Brooklyn, New York and grew up in northern New Jersey. He attended Boston University College of Liberal Arts and received a Bachelor of Arts degree in biology in 1964. In 1968 he graduated from the George Washington University School of Medicine in Washington, DC. While in medical school he received the Alec Horowitz Award for top surgical student in his class. He also became a member of the Smith Russell Reed Honor Society for academic excellence during his medical school training. For more information about Dr. Myron Murdock Click here
In 2001, robotic surgery came to the forefront in urology. Many, particularly younger urologists are learning the skills necessary to robotically remove cancerous prostate glands. Many urological surgeons have voiced tremendous negativity about robotic surgery saying it is a passing fad, that the costs are actually greater, that they were unsure of the results as far as a cancer is concerned, that it may not reduce the incidence of erectile dysfunction in those who have nerve-sparing surgery, urinary control may not be better, that there is a higher incidence of margins-positive and that it is extremely difficult to learn and the learning curve is long.
On the other hand, assuming the surgeon is skilled, the procedure is just another operative procedure using different skills and instrumentation to cure prostate cancer with the advantage that the morbidity is reduced, the hospitalization is reduced, probable less blood loss and better visualization of the neurovascular bundles.
As our surgeons do more and more of these procedures, the one-time, 6-8 hours radical robotic nerve-sparing prostatectomy is now becoming a 2.5 hour operation, similar to the standard open prostatectomy. As urologic surgeons do more of these procedures, the incidence of margin-positive will decrease.
Basically, we cannot stop progress. Patients desire this new technique, which, I believe, is at least as good as, if not better than, the standard nerve-sparing radical prostatectomy. Those of us older than 45 should not fight progress and should allow the younger, under-45 surgeons to hone their skills and continue to improve a technique that will remain in the future.
Every new technology in the past 25 years in which urologist either felt that the technology would diminish their practice and/or was an ineffective procedure has passed the test of time. Lithotripsy, ureteroscopic stone manipulation and laparoscopic renal surgery are now a standard of care, accepted by all and taught in our urological residency training programs.
Robotic surgery will do at least as well, if not better than, the above procedures. Sixty per cent of radical nerve-sparing prostatectomies are now being done robotically, and I am sure a larger percentage will be done in the very near future.
Robotic surgery will replace most open pelvic surgery including hysterectomy and radical hysterectomies for cancer as well as renal surgery with partial and total nephrectomy. I urge urologic surgeons to get used to robotics. Patients want it. It is good for them, and it is probably good for urology and urologic surgeons. (September, 2008)
Dr. Moritz Ziegler, Surgeon-in-Chief at The Children's Hospital in Denver, CO
Dr. Moritz Ziegler, Surgeon-in-Chief at The Children's Hospital in Denver, CO.,
states that the robot has added advantages, because "mechanically, you can make a device that has more degrees of freedom in the movement of the mechanical arm than the human wrist. Any kind of tremor factor, which all surgeons have to one degree or another, is totally eliminated by the mechanical device so that the precision of placing a stitch, or doing a maneuver in an operation can be better defined." Degrees of freedom refer to the number of independent movements an object or 'entity' can make. Six degrees of freedom are required to reach, position, and orient an instrument at any point in space. The seventh degree of freedom is the function of the operation itself (e.g., grasping or cutting). The da Vinci Surgical System's instruments subsume all seven degrees of freedom; this is in contrast to the human wrist, which is only capable of 4 degrees of freedom while using a laparoscopic instrument. Essentially, these characteristics of the robot, along with the 3D visual display, provide the surgeon with an increased capability that allows him or her to perform minimally invasive surgery more precisely.....Continue reading
Peter Johnson, MD Oncology: Gynecology
Robotic surgery here to stay
We would like to respond to the July 24 article, "Health care's robot wars." As noted in the article, minimally invasive surgery is here to stay because of its many benefits for patients. Robotic surgery is helping make this possible by enabling a larger number of specialists to master complex surgeries with minimal cutting and scarring.
There is a wealth of clinical data showing decreased hospital stays and improved patient satisfaction with minimally invasive surgery. The surgical robot allows for more rapid sewing, reconstruction and faster recoveries for kidney surgeries. In 2012, more than 70% of all gynecological cancer surgeries in the United States were performed robotically.
However, some statements in the article regarding uneven safeguards and significant costs should be addressed. Aurora Health Care's surgical safeguards are uniform, stringent and enforced to enhance patient safety. Aurora Health Care received the top performing U.S. Health Care System-6-year Hospital Quality Incentive Demonstration (HQID) from CMS, Premier Quality Initiative.
The best way to care for patients is to provide the highest-quality care in the most cost-effective manner. We have found that when factoring in days of hospitalization, narcotic usage and other factors, costs are actually lower when treating certain types of cancer patients with robotic surgery. Patient satisfaction surveys confirm patient acceptance and endorsement of robotic surgery with a more rapid return to normal daily activities.
Last, we agree that there is no substitute for experience. As the first and most active robotic system in Wisconsin, Aurora Health Care surgeons have performed more than 4,700 robotic operations.
This letter was signed by Aurora Health Care physicians Peter Johnson, medical director, gynecological oncology; Leslie Man, OB/GYN; Daniel O'Hair, cardiothoracic surgeon; Aaron Sulman, urologist; Mark Waples, urologist and kidney surgeon; and Alex Zacharias, urologist.
Thomas E. Ahlering, M.D.
Dr. Thomas Ahlering,
was trained in traditional open surgery, but in the past few years has turned himself into one of the world's leading urologists specializing in robot-assisted laparoscopic surgery.
"You have to get used to a new perspective," he said. From the viewpoint of the robot's camera inside the patient, the prostate, bladder, nerves and rectum can appear as part of the ceiling, walls and floor of a chamber.
Unlike traditional surgery, "you're not at arm's length, but right down in the thick of it. With laparoscopic surgery, you have to learn to operate on TV in a cavernous space," Ahlering said.
As a surgeon at UCI Medical Center in Orange and a professor at the UCI School of Medicine, he's an innovator who has refined the techniques of robotic surgery and trains other doctors to operate in the same way. He and other expert surgeons also consult with Intuitive Surgical of Sunnyvale, the manufacturer of the Da Vinci robot, on how to improve the device itself.
"He's a true pioneer in advancing techniques to make operations better for patients," said Ryan Rhodes, senior director of worldwide marketing at Intuitive. Ahlering's achievements include finding ways to remove as much cancerous tissue as possible while avoiding unnecessary damage to nerves that regulate erection and urination, Rhodes said.
Impotence and incontinence are common side-effects after prostate surgery, and Ahlering isn't satisfied with what he has achieved so far.
"Most men do get dry," he said, "but I'd like to shorten the time it takes to achieve that. For a man who would have taken three months, it should take only one month." That's possible with the Da Vinci robot, he said, because it allows more precise surgery. Three robotic arms and a camera, inserted into the abdomen through small incisions, are controlled by the surgeon, who sits at a console near the operating table. The camera provides a close-up view. The robotic arms, with scalpels and forceps at their tips, move at the doctor's command and are steadier than the hands of the best surgeon, Ahlering said.........Continue reading
RAHULDEV BHALLA MD
Dr. Rahuldev Bhalla, MD, Wednesday, May 7, 2008
is director of robotic surgery at Stony Brook University Medical Center in New York brings a unique perspective to rolling out a robotic surgery program. Bhalla not only directs the robotic surgery program at Stony Brook beginning in August of last year, but also started another program at a state university across the river in New Jersey, between 2004 and 2007.
“The roll-out here was a lot more smooth not only because I knew what to expect, but because both the dean and the CEO here are very into having this robotic program succeed. At the other hospital there was not as much support,” said Bhalla.
“It is imperative that the hospital has a vision or a plan,” said Bhalla. “ We’re the only tertiary care center in Suffolk County, serving most of Long Island. We’re going to be able to deliver health care at 2010 levels. In addition our urology program is one of the top fifty in the whole country,” he said.
But even when environmental circumstances are right for a new roll-out, the institution has to figure out how the program will fit in with the rest of the hospital. “It takes operating room time, money to buy the machine it, and resource support. You initially have to be able to take a big hit financially,” said Bhalla, who noted that the total costs for starting up with a Da Vinci ‘S’, such as Stony Brook has, runs between $2.2 and $2.5 million, inclusive of all services, instruments and related costs. “But we’re doing the community a service by having this here,” he said.
Bhalla stated that he is getting a lot of work out of his institution’s Da Vinci, with 80% of the institution’s urology cases being done robotically. Thirteen urologists practice at Stony Brook, Bhalla said. Qualified physicians are mandatory, he added. “You definitely need someone who’s skilled
Nevetheless, opportunities abound in robotic surgery, even outside the treatment context. Stony Brook, for example, has a large robotics program on the university side as well, developing robotics for lung cancer. Bhalla himself is involved with research to add tactile feedback to the Da Vinci system’s other advantages. Article from Medical Robotics Magazine
Dr. Harlan M. Krumholz
Krumholz: Which doctors measure up? In the U.S. health care system, patients have no way of knowing
Dr. Harlan M. Krumholz Special to the Washington Post. Wednesday, June 03, 2009.
A patient turned to me for advice recently after being diagnosed with early stage prostate cancer. A hard-charging Vietnam veteran who exercised every day, he had prided himself on his excellent health, and the news scared him. He had undergone several rounds of biopsies in response to an abnormal blood test. Finally, he got the same unhappy diagnosis that about 200,000 men get each year.
After considering treatment options, he chose to have surgery to remove his prostate. I'm a cardiologist, not a urologist, but we happened to have met at the gym, so he asked me where he should have the surgery performed and whom I would pick to do it. I wasn't sure. It's a tricky surgery with many possible complications. The prostate is the size of a walnut and nestled in a difficult location at the base of the pelvis near some important nerves. Almost everyone survives the surgery, but afterward, patients may be incontinent or impotent, problems that get most men's attention.
This patient had nowhere to turn to figure out which doctors and hospitals had the best results and the lowest risk of these complications. His dilemma is the same one that virtually every patient — and the entire health care system — is facing: How can you measure quality in an area in which your life may be at stake?
Need a new hip? A hernia repair? You're out of luck if you want to look at a doctor's track record or an institution's success rates. Results vary by surgeon and by hospital; you just have no way of knowing which one is best. And often, neither do they.
For most patients, the decision of where to seek care comes down to a recommendation based on hearsay. Good reputation plays a role, but unfortunately studies show that just because you have a famous name doesn't mean that you're good.
Even doctors don't know what to do. I broke my collarbone in a bicycle accident a few years ago and had no good way of selecting a surgeon. I picked someone based on advice from colleagues, but neither they nor I had any way of knowing what his past results for this operation — or any operation — had been.....Continue reading
Experts Praise Robotic Surgery By : Allison Gandey
March 21, 2007 -- While some surgeons remain skeptical of the advantages of joystick-operated robots in the operating room, many specialists are applauding the change and suggest automation cuts recovery time and helps men undergoing radical prostatectomy regain bladder control and sexual function. "If you can save somebody 3 months of diaper time, that's important," said Timothy Wilson, MD, director of the prostate cancer program at City of Hope Cancer Center, in Duarte, California. Presenting at the National Comprehensive Cancer Network (NCCN) 12th Annual Conference in Hollywood, Florida, Dr. Wilson pointed out that patients' 2 top postoperative worries are incontinence and impotence......continue reading
Timothy Wilson M.D
Timothy Wilson M.D.
is a nationally renowned urologic oncology surgeon, with expertise in prostate cancer, bladder cancer, testis cancer, kidney cancer, and urinary reconstruction. Dr. Wilson is highly experienced with the use of minimally invasive, laparoscopic and robotic-assisted procedures in the treatment of urologic malignancies. As such, Dr. Wilson is a recognized world expert in robotic-assisted laparoscopic prostatectomy being one of the top five surgeons worldwide performing this type of surgery. He is committed to compassionate, aggressive and complete urologic cancer care, and the research necessary to find the best possible treatments.
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Robotic Surgery: A Current Perspective By : Anthony R. Lanfranco, BAS; Andres E. Castellanos, MD; Jaydev P. Desai, PhD; William C. Meyers, MD Published: 01/13/2004
Robotic surgery is a new and exciting emerging technology that is taking the surgical profession by storm. Up to this point, however, the race to acquire and incorporate this emerging technology has primarily been driven by the market. In addition, surgical robots have become the entry fee for centers wanting to be known for excellence in minimally invasive surgery despite the current lack of practical applications. Therefore, robotic devices seem to have more of a marketing role than a practical role. Whether or not robotic devices will grow into a more practical role remains to be seen.
Our goal in writing this review is to provide an objective evaluation of this technology and to touch on some of the subjects that manufacturers of robots do not readily disclose. In this article we discuss the development and evolution of robotic surgery, review current robotic systems, review the current data, discuss the current role of robotics in surgery, and finally we discuss the possible roles of robotic surgery in the future. It is our hope that by the end of this article the reader will be able to make a more informed decision about robotic surgery before "chasing the market." To read complete article Click here
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