Robotic Prostate Surgery
Posted by WhiteCoat on April 30, 2008
I came across an ad touting robotic prostate surgery the other day.
Apparently the surgeon sits at a console and controls a robot on the other side of the room. The arms of the robot control instruments that have been poked through the patient’s abdomen.
For the time being, the surgeon sits across the room.
In the future, I can foresee this type of setup being used to give a surgeon in India the ability to operate on someone in rural anywhere via an internet connection or a phone line.
Are the benefits of this robotic procedure currently worth the cost? These machines must be extremely expensive. If insurers won’t pay for cancer medications, how exactly do we expect that they are going to pay for some robot to be the extension of a surgeon’s hands?
If the next step in this process is remote access to specialists, I have this question: How are hospitals that are too isolated to have access to the specialist for the surgery going to deal with the post operative courses and complications?
The link to the site touting this new procedure is here.
I don’t know if I’d want some robotic probe up my rear end when the internet connection goes down or when the Medical Marijuana Advocates find out who I am and hack into the connection during my surgery.
Although now that I think about it, this could be great fodder for a future John Grisham novel.
April 30, 2008 at 9:32 am
Call me immature but I’m not sure the shape of the machine was the best design choice, reminds me of a rear end.
Funny. Guess we’re both immature because I’m right there with you on that one.
April 30, 2008 at 9:49 am
I agree with Audreyln, this is a poor choice for a design…
April 30, 2008 at 12:04 pm
According to surgeons I have worked with, there is no real benefit other than the bragging rights for the hospital and the accompanying help in sales pitches to unaffiliated surgeons.
April 30, 2008 at 1:46 pm
WhiteCoat, is your rant against robotic surgery per se, robotic surgery on prostates, or doing robotic surgery over the internet or other type of wide-area network (say, across a hospital campus via network)?
I wouldn’t say that I’m “against” anything. Just raising issues of practicality.
Research in robotic surgery is great, but when we don’t have the resources to care for millions of patients, what good is it going to do to purchase a multimillion dollar machine in order to do the same things that a surgeon can do? Couldn’t the money be better spent controlling the blood pressure of hundreds of patients who couldn’t otherwise afford health care?
Similarly, if the resources aren’t there to have the surgeon, who is going to manage the postoperative course and/or complications?
If we are doing truly “remote” surgery, how is it that we can afford to put a multimillion dollar machine in a remote location but we can’t afford to have a surgeon there?
Doesn’t make sense to me.
April 30, 2008 at 2:36 pm
Don’t see that there is practical application of robotics. If a small hospital has insufficient demand for a surgeon, I doubt they will have the demand necessary to buy the robotic device. The use of the device has to pay for the purchase after all.
The surgery is only a part of the global care of the patient. Prior to surgery, there has to be a meeting that establishes the need for surgery and the development of a relationship between the operator and the operated upon. Finally, the after care of the patient is still required.
Bah, robotic surgery is a humbug, says I.
April 30, 2008 at 3:22 pm
Hmm I sense fear about job security (outsourcing all those expensive surgeons to India!). Robotic surgery has many advantages - one is the operations on remote facilities (think north pole, oil drilling station, or a combat area and no access to surgeon at all or the specialists). Right now it may not be ready for all that but it has to be worked on and advanced - so not a bad start I’d say.
It’s great if you can do the surgeries at remote locations, but I think that there’s just more to it than that. I need to see how remote surgery would work in real life.
So people just lay on the table under the arms of the machine and the machine scrubs the abdomen, administers anesthesia, and pokes its arms through the skin?
What then happens if the remote surgeon nicks an artery or perforates the bowel and no one is around to manage the complications? Do they call a robot code? Some medic robot controlled by an ER physician in a big city comes rolling down the hall with an intubation setup?
When millions of Americans have no access to basic health care, I think we need to rearrange our priorities in terms of where we put our funding resources. Some Sci-Fi experiment versus millions of immunizations to children and primary care services for the poor. Hmmmm. Tough choice.
April 30, 2008 at 6:16 pm
Interesting post. Loved the India line!
Didn’t see the shape but can now. You make some valid points.
You might be interested in checking this blog out although Dr Savatta hasn’t updated in a while.
http://roboticsurgeon.blogspot.com/
April 30, 2008 at 6:42 pm
Odd that you wrote about this today. Right before I read your blog i was reading this article while in class.
http://www.usatoday.com/news/health/2008-04-29-robot-surgery_N.htm?loc=interstitialskip
Keep up the good work on the blog… this is my first comment but have been a reader for a while now
Thanks for the update and the encouragement. Helps keep me going.
Interesting in that the complication and infection rate is less according to this article. Maybe there is some promise for robotics after all.
April 30, 2008 at 8:04 pm
Oh, Christ. If it comes to the USA, it will be co-opted by the IRS, and tax time will get even more interesting. Or Hollywood will modify it to put in saline implants, inject botox and put in hair plugs.
April 30, 2008 at 10:48 pm
Then, you will see robot surgery convenient machines scattered through-out malls. Slide your credit card! Face lifts and rhinoplasty’s are 50% off with purchases of $299 or more, sale ends 08/31/2020.
Regardless, The article was a very interesting read despite the stated concerns.
By the way, this is the first time I’ve commented but a long time reader of your blog. Great work! Love the scattered humor along with the seriousness of real issues that are impacting medicine.
Your robot surgery machine scenario would make a great cartoon. Too bad I can’t draw …
Thanks for the encouragement!
May 1, 2008 at 1:33 am
My place of employment recently became the proud owner of 2 DaVinci machines. Oooohhh…we’re soooo cool. All the other kids in town are going to be so jealous that we have a new toy.
Thing is though, they’re running the things like mad.
It’s just frustrating to see them blow money on this while our remodel has been held up for a long time 30+ year old facilities is not so great mind you)and they still haven’t opened a new OR in years, like promised. I think the DaVinci rep s our area is just that good…
May 1, 2008 at 8:47 am
The hospital I work in (RN) has a Davinci robot. It was slow to catch on for the first couple of months, but now it’s being used quite a bit. I work on a med-surg floor, and we have seen numerous prostatectomies done with the robot. The “robot” patients do far better post-op than the TURP or radicals. The robotics almost all leave within 24 hours, and (from what I have heard) they have far better outcomes as far as continence and (ahem) functionality.
May 1, 2008 at 1:13 pm
I would like to see some scientific studies rather than just anecdotal evidence that patients do better with a robot. I question whether we can afford this or need it when so many patients cannot pay for their healthcare as it is. Please check out my blog at mdoncall.blogspot.com Would you consider linking it?
May 3, 2008 at 6:59 pm
The resemblance between the machine and the buttocks is only because everybody knows that sticking your head between the cheeks is the best way to visualize the prostate.
May 5, 2008 at 6:49 pm
I think it’s interesting that the focus is on outsourcing surgery, as when I read the initial part of your blog I was thinking that the robot could be used to allow patients from remote areas of the world to get surgeries without having to be shipped to the U.S. or to be shipped to large urban centers.
The idea of having the patient stay in an area that is comfortable to them, where their family can be around can be optimal for the healing process. I’m wondering what the intent of the physicians were when developing these robotics.
May 14, 2008 at 1:01 pm
Hi there,
I had robotic surgery to remove a tumor on my heart (nestled in my aortic arch) when I was 25.
They did a biopsy and all was benign.
Thinking back to the visits before the surgery, the doctor seemed so excited about the upcoming event.
I feel that maybe I was rushed into surgery without time to think of other options just so he could try out his new toy.
On the other hand, the recovery time was only a couple of weeks, and for a heart surgery not to be open chest, the recovery time, days in the hospital and rehab might have made up for that.
Plus I only have 3 tiny scars on the side of my ribcage, as opposed to the huge chest long fracture line my uncle has from them cracking open his chest…
and i was only in the hospital 3 days, whereas my uncle was in there for almost 2 weeks…
I think that while it is a huge cost initially, it can definately help with recovery time, and perhaps even through distance professionals can help people who would normally not have to be helped.
Still though, it is so new, and so many doctors are itching for a chance to try it live, they may loose sight of the actual patient.
thanks for the article!
May 16, 2008 at 11:32 pm
Thank you for good information~~*
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Bye