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Robotic Surgery: More Problematic Than Helpful?

23 Sep

Robotic surgery is cool. Even the name is cool. Can’t you just see Robby the Robot standing beside the operating table performing some miraculous feat? Great visual. Actually it is ofte done employing the da Vinci Surgical System.

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Real robotic surgery doesn’t work that way. Ih fact it’s basically the so-called minimally invasive surgery except that the surgeon is removed from the patient. In minimally invasive surgery small openings are made and cannulas (hollow metal tubes) are inserted into the patient. Instruments are passed through these tubes and the surgery is performed, usually with the guidance of a fiber-optic scope. The beauty of the situation is that the incisions are smaller and therefore recovery is much faster.

The da Vinci Surgical System

The da Vinci Surgical System

Robotic surgery is performed more or less the same way. The difference is, rather than the surgeon standing next to the patient, he is often on the other side of the room sitting in a console operating handles, which in turn move the instruments. He is able to watch everything on the screen, again using fiber-optic imaging techniques.

This technique has always been problematic for me. Much of surgery has to do with tactile feedback. What the surgeon’s fingers feel as they touch and move the organs and as they repair injuries or remove certain tissues and organs is a critical part of any surgical procedure. It’s all in the fingertips. Minimally invasive surgery removed some of this tactile feedback but still the surgeon had some “feel” through the instruments he worked with. Robotic surgery is another step removed from that.

Lately there has been some concern over the safety of robotic surgery, often for these very reasons. The surgeon needs all the feedback he can receive during delicate surgical procedures and the system seems to remove many of them. It’s not that robotic surgery isn’t useful or that it doesn’t have its place, it’s just that everything comes with a downside. But increasingly we are seeing problems with this cool technique. Sometimes the old ways are still best.

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My second Dub Walker thriller, HOT LIGHTS, COLD STEEL, deals with robotic surgery. Far advanced from where we are now, but robotic surgery nonetheless.

 
11 Comments

Posted by on September 23, 2013 in Medical Issues

 

11 responses to “Robotic Surgery: More Problematic Than Helpful?

  1. Carol Wong

    September 23, 2013 at 12:03 pm

    I had robotic surgery, a hysterectomy with prolapse repair. My doctor told me that it would be safer because I have a lot of diverticulous. Was that a good reason?

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    • D.P. Lyle, MD

      September 23, 2013 at 5:37 pm

      I can’t comment on your situation but know that robotic surgery is an accepted technique that many surgeons like and use with great success. There are, as with all things medicine, problems. Nothing is ever perfect.

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  2. Brenda

    September 23, 2013 at 3:17 pm

    Your comments are most interesting. I can also, unfortunately, picture a robotic going nonstop like the Toyotas sometimes do thus killing.

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    • D.P. Lyle, MD

      September 23, 2013 at 5:35 pm

      You should read HOT LIGHTS, COLD STEEL. What happens there is even worse.

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  3. Cheryl B. Dale

    September 24, 2013 at 5:10 am

    Scary. Of course, being ill is scary, too. Guess we have to look at the facts and make our choice and hope for the best.

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  4. tom combs

    September 24, 2013 at 6:32 pm

    I’ve had the same concerns/questions regarding the loss of tactile feedback and visualization.
    I’m an ER doc and have no hands-on experience with robotics. I was involved in a hospital wide physician documentation initiative and noted one striking fact in our hospital. Radical prostatectomies performed via the DaVinci robotic had significantly less total blood loss. I can’t comment on the overall effectiveness of traditional versus robotic surgery but I was impressed by the consistent blood loss difference.

    Currently reading James lee Burke’s “Light of the World” (totally brilliant). I have ‘Hot lights. Cold Steel next on my “to be read” stack!

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    • D.P. Lyle, MD

      September 24, 2013 at 6:47 pm

      Light of the World is indeed great—and I hope you like Hot Lights, Cold Steel.

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  5. Frank Karl

    September 26, 2013 at 7:52 am

    I had robotic (deVinci) surgery. The worse, by far, the worse mistake I ever made. I use to wake up in the morning and before I opened my eyes I would pray it was all the bad dream. But deep down inside I knew it wasn’t. I had to have surgery to repair the problems, I still have daily pain from the repair job and it’s much more preferable to the results of robotic surgery.

    There may be a place for it, but I’d recommend you jump off the examination table and and run naked into the street before you let anyone perform robotic surgery on you.

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  6. Wil A. Emerson

    September 28, 2013 at 5:58 pm

    I’m an ‘old’ nurse, with past experience in transplant surgery and when a friend asked what I thought about robotic surgery, my reply was as fast as lightening. “Go for it if you’re stranded on an island, in the Artic, in remote Siberia where no expert can reach you.” What I witnessed many times over was the compassionate care and skillful hands of surgeons who felt the warmth of the human body, the life within. They saved lives because of that special contact. Why must we resort to ‘steel and titanium..the mechanical’ when we have the best, the most talented skillful ‘machine’ the world has ever known? My friend: she opted for new technology—I think got a strong sales job from the younger, eager surgeon—ended up with a sorry outcome, infections and subsequent surg. to repair the colon problems. Granted it happens with human intervention but at least you know the why and wherefore of it. Save the robotics to fix our cars, let man take care of it’s own problems.

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    • Jonathan Quist

      October 8, 2013 at 10:35 pm

      Interesting… When I saw the link mentioning robotic surgery, a humorous image of Robbie standing in the center of an operating theatre popped into my head.

      I’ve been reading for decades about robotic extensions of humans with tactile feedback built in. Don’t surgical robots provide some sort of feedback? It would still be different from hands-on surgery, and therefore a new skill to be learned and developed by the surgeon, but I can’t imagine signing off on a waiver for a technique that didn’t provide this instant feedback to the surgeon.

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      • D.P. Lyle, MD

        October 8, 2013 at 10:53 pm

        Yes that is being worked on but duplicating the human fingertip is far down the road. Much of surgery involves texture, pressure, slickness, impression and rebound, consistency, elasticity, mobility, pulsations, and on and on. A lot goes on at the end of the surgeon’s fingers and much of that is lost with robotics. To me, many of these problems were predictable and inevitable. Doesn’t mean it isn’t good in many situations just that as the envelope is pushed, the body will push back—and that is what we are seeing.

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