Da Vinci Surgery

The da Vinci robotic surgical system uses the latest technologies to allow surgeons to operate with enhanced precision, while making only a few small incisions in the patient’s body.  The device features a surgical arm and a control and viewing console.  The surgeon sits at the viewing console, and uses joystick-like controls to move the instruments, which bend and rotate with a flexibility that is far beyond what the human wrist can accomplish, according to the manufacturers.

The makers of the high-tech system, Intuitive Surgical Inc., say that da Vinci surgery has a number of advantages over traditional surgery.  For example, surgery with the da Vinci robot purportedly leads to shorter hospital stays, reduced blood loss, less pain after surgery, a quicker recovery, and smaller risk of post-operative infection.  The device can also eliminate the deleterious effects of a surgeon’s hand tremors on instrument movements.

Da Vinci robotic surgery used to treat a number of conditions

Da Vinci surgery is indicated in a variety of procedures.

The da Vinci robotic surgical system is used for:

• Surgery through the patient’s rib cage on the cardiothoracic area
• Surgery through the mouth for benign or malignant tumors of the neck and head
• General procedures through the abdomen
• Colorectal surgery
• Urology surgery
• Gynecology surgery

The da Vinci robot is also used in operations to address throat cancer, lung cancer, bladder cancer, gynecological cancer, endometriosis, prostate cancer, and mitral valve prolapse, among other conditions.

The robotic system is completely controlled and operated by a physician. The surgeon sits at the console and views a magnified 3D image of the surgical site through the device’s Vision System.  As the surgeon moves the controls, the device interprets every wrist, hand and finger movement and directs the miniaturized instruments accordingly.  The surgeon navigates those instruments through small, dime-sized incisions in the surgery site.

Risks associated with da Vinci surgery

The use of robotic surgery has increased more that 400 percent in the United States between 2007 and 2011.  Not everyone is a good candidate for da Vinci surgery, however.  Patients who have blood clotting illnesses, easily bleed, are pregnant, or are severely obese should not have robotic surgery. 

Complications from da Vinci surgery can involve damage to tissues and organs, infections, severe burns, bleeding, and scarring.

In some cases, complications with robot-assisted surgery are caused by a surgeon’s lack of proper training on the system, as there is a learning curve with the new technology.  According to several news sources, some surgeons receive only a few days of training with the da Vinci robot before embarking on their first operation.  This lack of experience may increase the risk for complications.  Therefore, patients are advised to ask their surgeons how much training and experience they have with da Vinci robot procedures.

Between January 2000 and August 2012, thousands of adverse incidents involving da Vinci surgeries were submitted to the FDA.  According to a recent Johns Hopkins study, which was published in the Journal for Healthcare Quality, 174 injuries and 71 deaths related to da Vinci surgery have been reported.

Da Vinci surgical complications that have been reported to the FDA include:

• Surgical burns and punctured organs
• Tears and burns to blood vessels
• Heavy bleeding
• Cut ureters
• Infection
• Bowel Injuries

Furthermore, the Johns Hopkins study found that adverse events associated with da Vinci robotic surgery are “vastly underreported.”  Researchers were able to find examples of botched operations that were not reported to the FDA at all, even though medical device manufacturers and hospitals are required to report every device-related death and injury to the FDA within 30 days of learning about an incident.

The study’s authors concluded that because there is no clear picture of how many deaths and injuries can be attributed to the da Vinci system, there is no way to know whether the benefits outweigh the risks.

da Vinci robot-assisted hysterectomies

The da Vinci system is frequently used in hysterectomies, which are recommended in cases of endometriosis, heavy bleeding from the uterus, pelvic prolapse, fibroid tumors, or cancer.  A hysterectomy with the da Vinci system requires only small incisions, resulting in a quick recovery.  In a traditional surgery, the abdomen is open, leading to a six-week-long recovery.   Intuitive Surgical also claims that da Vinci hysterectomies are more effective than laparoscopic hysterectomies.

Recent studies and adverse event reports, however, indicate that the da Vinci robot may not offer as many benefits as initially believed.

Concerns are being raised about the safety and effectiveness of da Vinci surgery.  The American Congress on Obstetrics and Gynecology issued a statement in March urging women to exercise caution when choosing robotic surgery.  They wrote, “Robotic surgery is not the only or the best minimally invasive approach for hysterectomy.  Nor is it the most cost-efficient.  It is important to separate the marketing hype from the reality when considering the best surgical approach for hysterectomies.”

Prostate removal with the da Vinci system

In most cases, men who are diagnosed with cancer of the prostate undergo a radical prostatectomy, where the prostate gland is removed.  With da Vinci prostatectomy, however, surgeons operate though a few small incisions instead of one large incision.  This allows for a more targeted removal of the cancerous tissue.

Intuitive Surgical states that da Vinci prostate removal offers multiple benefits, including a quicker return of sexual function, a lower risk of infection of the surgery site, and a better likelihood that urinary continence will return.

But critics have questioned the advantages of da Vinci surgery in the removal of the prostate gland.  According to the New York Times, a 2009 study concluded that when patients underwent robotic surgery for prostate removal, they suffered higher rates of erectile dysfunction and incontinence than with traditional surgery.

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