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Intuitive Surgical (ISRG) on Watch Following Negative Piece on Robots vs. Laparoscopic Surgery in Removing Ovaries, Ovarian Cysts
October 8, 2014
Intuitive Surgical (Nasdaq: ISRG) is on watch Wednesday following a negative piece in the WSJ late Tuesday. Highlighted in the upcoming issue of Obstetrics & Gynecology, Jason D. Wright, chief of gynecologic oncology at Columbia, questioned the usage of robotics in removing removing ovaries and ovarian cysts.
While supporters of robotic surgery note that robots use smaller incisions, allow less blood loss, provide for lower pain and postoperative pain medication, the researchers say that regular laparoscopic surgery has similar benefits without having to invest in the new technology, training, and maintenance.
Intuitive makes the da Vinci Surgical System. The company said, following review of the study, the some surgeons choose to use the da Vinci because it can lead to fewer complications and shorter hospital stays. The company also said the technology is often used on patients “with more complex disease and higher risk factors, which the latest study didn't take into account..........read more
Robotic Surgery To Remove Ovaries More Costly, Complications
October 8, 2014
We’ve heard it before — the robots are coming to save the day. But for certain medical procedures, that day may not be as close as you’d think.
A study published Tuesday in the journal Obstetrics & Gynecology suggests that robot-assisted surgeries to remove ovaries or ovarian cysts were more expensive and had more complications than traditional minimally invasive surgeries.Removing ovaries and cysts with the help of a robot cost about $2,500 and $3,300 more, respectively, than laparoscopic or “keyhole” surgeries. That can add upward of 80 percent to the cost of a surgery.
What’s more, women whose surgeries had been performed with the help of a robot were slightly more likely to have complications such as a bladder injury, bowel obstruction or excessive bleeding.
The study “really questions the utility of using robotic-assisted surgery,” says Dr. Jason Wright, the chief of gynecologic oncology at Columbia University and the lead author. ”More studies need to be done” he said, “before it’s accepted as the standard of care.
”The data didn’t offer any clue as to why the complications arose. But in the past two months, there have been reports of software glitches, battery malfunctions, and difficulties in seeing through the robotic system’s lens, according to the U.S. Food and Drug Administration’s Manufacturer and User Facility Device Experience database, which documents issues with medical devices. In some cases, these problems occurred after the patient had been put under anesthesia. Last year, the Associated Press reported ”freak incidents” during which robots wouldn’t let go of tissue or accidentally hit patients on the operating table.
Wright’s study looked at nearly 90,000 women 18 years and older who’d gone under the knife between 2009 and 2012 to have ovaries or cysts removed, and compared the cost and safety of robotic surgeries to those which used laparoscopic methods........continue reading
The Surgical Robot for Hernias: Converts and Holdouts
Two years ago, in a General Surgery News interview about the surgical robot’s role in hernia repair, laparoscopic surgeon Karl LeBlanc, MD, answered unequivocally: “Inappropriate.
”Today, despite no new evidence to the contrary, he has changed his mind. “I’ve had to eat my words on that particular topic,” he said.
Dr. LeBlanc, a hernia surgeon at the Surgeons Group of Baton Rouge, in Louisiana, and clinical professor of surgery at the Louisiana State University School of Medicine, New Orleans, said he began to reconsider his opposition to the robot earlier this year after anecdotal reports that patients experienced less chronic pain after robotic ventral hernia repair. Proponents of this approach say patients are less likely to have chronic pain because surgeons can perform the repair without use of transfascial sutures or mesh fixation.
“The thing that drew me to it is perhaps there may be some value in the robot over a traditional laparoscopic ventral hernia repair because you can sew the mesh in,” Dr. LeBlanc said.
“You can do most of the dissection robotically and then you can sew the mesh in. It eliminates the need for transfascial sutures. It also eliminates the need for mesh-fixation devices.
”After attending several presentations on robotic hernia surgery, Dr. LeBlanc began to train on the robot that his hospital had purchased several years earlier. By late this summer, he completed more than 15 robotic hernia repairs (both ventral and inguinal) and plans to do more. The robotic procedures require more time, although Dr. LeBlanc expects procedure length will drop as he gains more experience......read more
Intuitive Surgical Single-Site Needle Driver Cleared by FDA
October 1, 2014
Intuitive Surgical, Inc. (NASDAQ: ISRG) revealed that it has received U.S. Food and Drug Administration (FDA) clearance for Single-Site Wristed Needle Driver for use in single-incision surgery with the company’s da Vinci Si robotic surgical System.
The clearance allows use of another instrument under Single-Site suite for minimally invasive removal of the uterus (hysterectomy), the ovaries, and fallopian tubes for benign conditions, as well as removal of the gallbladder.
Single-Site Instrumentation leads to scar-less surgeries through a single-incision. It gives the benefits of robotic and computer assistance to surgeons.
The 5 mm Single-Site Wristed Needle Driver was also developed to facilitate suturing after removal of the uterus. It can lead to movement of up to 45 degrees of the instrument tip in all directions for precise needle positioning. These apart, it also features serrated jaws to facilitate needle handling.
The FDA clearance allows sale of the Single-Site Wristed Needle Driver in the U.S. Intuitive Surgical will now seek regulatory approvals for selling the product across the world.....read more
Artist's rendering of the NeuroBlate fibre-optic probe inserted in the brain delivering the laser-directed heat to a tumour.
Robotic laser surgery approved for brain tumours at Vancouver General Hospital
October 1, 2014
New technique could be ‘life-extending and life-saving,’ surgeon says
A neurosurgeon at Vancouver General Hospital will be the first in Canada to use new robotic laser heat technology to destroy brain tumours or other abnormal growths inside the skull.
Dr. Brian Toyota said he expects the first case using the technology, called NeuroBlate, will take place next month. It is considered a less invasive approach than craniotomy surgery, in which a piece of skull bone is removed to access the tumour and then replaced after the tumour is surgically cut out.
“This represents another option (besides surgery and radiation) for patients. It’s especially good for tumours I can’t get to with my hands. It has the potential to be both life-extending and life-saving,” Toyota said in an interview.
Using the NeuroBlate system, Toyota will burr a small hole in the skull, insert a laser probe, then step on a foot pedal to deliver heat that essentially fries the tumour to destroy it, while sparing surrounding brain matter.
The hole in the skull will be made in an operating room where the patient’s head has been immobilized in a frame; the patient will then be transferred to an MRI suite so that Toyota can see, in real time, precisely where to place the thermotherapy probe that heats up to 57 degrees Celsius. The guided imagery also allows Toyota to see the area heating up.
The technology (formerly called AutoLITT) has now garnered Health Canada clearance.....read more
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