OGDEN -- Patients who have surgery done with robotics typically have less blood loss, less post-operative pain, shorter hospital stays, lowered requirement for pain medication and a faster return to normal activities and work, an Ogden doctor says.
Intuitive Surgical Inc., the maker of the da Vinci robotic system, was used in nearly 400,000 surgeries across the country last year. Some of its uses include prostate surgery, hysterectomies, kidney removal, gallbladder removal and heart valve repair.
But the million-dollar system has come under scrutiny lately, and the U.S. Food and Drug Administration is looking into a spike of reported problems that include five deaths, a robotic hand slapping a patient on the operating table and a robotic hand grasping onto tissue and not letting go. Lawsuits filed by family members claim the surgeons who performed the procedures on their loved ones were insufficiently trained.
So is it time to go back to traditional laparoscopic and open surgeries?
Dr. Jeff Arrington, an Ogden obstetrician and gynecologist focusing on minimally invasive and laparoscopic women's surgery, said as far as he is aware, the most common issue surrounding lawsuits with robotics is surgeon error. In skilled hands, he believes robotic surgery is safer than abdominal open surgery.
"The main thing patients can do to make sure they are receiving the best care possible from a physician using robotic surgery is to know their experience," Arrington said.
"How long have they been doing the specific surgery by laparoscopy or robotics? Not just general robotic experience. How many of the specific type of surgery have they done?"
The da Vinci surgical robot is a computer-assisted robotic surgery platform that allows a trained surgeon to complete difficult laparoscopic procedures, Arrington said.
The actual surgery performed inside the patient is identical to a normal laparoscopic approach. With either, a long camera is inserted into the abdomen, usually through the belly button.
Two to three additional small incisions are made on the abdomen that allow instruments to be placed inside the abdomen. These instruments consist of scissors, cautery devices to control bleeding and different instruments to hold tissue.
With normal laparoscopy, these instruments are directly held by the surgeon and any assistants.
"In robotics, these instruments are attached to 'robotic' arms. The surgeon then sits at a console that is next to the patient bed and controls the 'robotic' arms," Arrington said.
"Under the surgeon's control, the instruments are used to complete the surgery. The robotics system allows articulation and full movement similar to the human wrist that traditional laparoscopic instruments do not have."
The risks include injury to body structures and organs surrounding the incision, bleeding and burns. Most complications, however, are dependent upon the skill and training of the surgeon.
In order to be allowed to use the robot for surgery, a new surgeon must attend classroom teaching as well as online training regarding the mechanics of the surgical robot, Arrington said.
The surgeon then completes hands-on active training with the robotic system and instruments in an animal lab.
The surgeon must then apply for robotic privileges at a hospital.
Most hospitals require surgeons to complete a number of "proctored" surgeries until the proctor deems they are proficient enough to operate on their own using the system.
The da Vinci costs $2,000 more than a conventional laparoscopic hysterectomy, according to the American College of Obstetricians and Gynecologists.
However, when the hospital stay and post-recovery work loss and treatment from traditional surgery are added into the mix, robotic surgery is the most cost efficient, physicians say.