Robotic Surgery – a Closer Look
Would you allow a robotic surgeon to conduct your operation? That’s the question many people are asking themselves after the UK investigated the death of a recent patient.
Shocking details from the United Kingdom recently emerged about the dangers of robotic surgery. An inquest was held in November of 2018 to investigate the death of Stephen Pettitt, 69 who died from complications in the first robotic surgery in the UK to treat mitral valve disease.
The procedure was conducted by Sukumaran Nair in tandem with the Da Vinci robotic surgery device.
The coroner who conducted the autopsy concluded that Pettitt’s death was due to “direct consequence of the operation and its complications” and warned that there “remains a risk of further deaths” from robotic surgery in the UK due to lack of training.
Nair had no one-on-one training with the Da Vinci device prior to Pettitt’s fatal operation in 2015.
The death of Pettitt in 2015 has prompted the United Kingdom to halt all robotic surgeries and the inquest has generated new concerns in the US, as well.
Robots – Wave of the Future in Medicine?
The Da Vinci surgery system employs tiny incisions in the human body to insert a 3D camera and some small surgical instruments. The surgeon controls the robotic apparatus with a console that has pedals for his/her hands and feet. Using these pedals, the surgeon remotely operates the robotic arm. The robot doesn’t make any moves or actions independently.
The FDA approved the Da Vinci robotic surgery system back in 2000 and since then, more than 2,900 systems have been installed in the United States. According to iData Research, over 693,000 robotic-assisted procedures were performed in 2017 in the United States.
Statistical data on the injuries and fatalities from robotic surgery are a bit dated and come from a study that covered robotic surgeries between the years 2000 and 2013.
The study entitled Adverse Events in Robotic Surgery found that there were 144 deaths, 1,391 injuries, and 8,061 counts of device malfunctions. Those numbers might seem shocking at first glance but considering the sheer volume of robotic surgeries the procedures are within accepted safety margins. That’s little comfort though to someone who is waiting to go under the knife.
A separate study that focused on the effectiveness of robotic-assisted surgery on patients who suffered from bladder cancer found that the procedure was just as safe as surgeries conducted by non-robot-assisted surgeons.
Yet, the study was far from comprehensive because it only covered one organ – the bladder.
One of the main concerns surrounding robotic surgery is the lack of hands on feedback. During the procedure, the surgeon isn’t touching the body at all. Dipen J. Parekh, M.D., chair of urology and director of robotic surgery at the University of Miami Miller School of Medicine is mindful of this fact and notes – “When you do robotic surgery you don’t feel anything,” Parekh said.
“It’s more by visual cues. If you’re doing open surgery you have the organs in your hands, you can feel them, and you assess and do these surgeries accordingly.”
Guy Counseling conducted further inquires into this topic in hopes of getting a professional opinion about the safety of the procedure and the specific training a doctor needs to use it.
Dragan Golijanin, MD, is a director of the Minimally Invasive Urology Institute and director of Genitourinary Oncology at The Miriam Hospital and is especially versed in robotic surgery.
When asked about the safety of the procedure, Golijanin commented that “Extensive training and expertise in using that tool is critical to successful robotic surgery. Research clearly shows hospitals and surgeons that perform a high volume of robotic surgeries have improved outcomes and less complications.”
When considering the case from the United Kingdom, statistical data and Dr. Golijanin’s remarks together, proper training and practice are key elements to a successful robotic surgery.
If you are thinking of having a robot-assisted surgery, be sure to choose a facility and surgeon that is well-versed in the procedure.