Robotic surgery has grown dramatically, increasing more than 400 percent in the United States between 2007 and 2011. The leading company in this field is Intuitive Surgical, Inc. which markets the da Vinci robotic surgery system. About 1,400 da Vinci systems, which cost $1.5 million to $2.5 million, have been purchased by hospitals, according to Intuitive’s investor reports.
Robotic surgical devices allow a surgeon at a console to operate remote-controlled robotic arms, which may facilitate the performance of laparoscopic procedures. Laparoscopic surgery, in turn, is associated with shorter hospital stays than open surgery, as well as with less postoperative pain and scarring and lower risks of infection and need for blood transfusion. These robotic systems enhance dexterity in several ways. Instruments with increased degrees of freedom greatly enhance the surgeon’s ability to manipulate instruments and thus the tissues. These systems are designed so that the surgeons’ tremor can be compensated for through appropriate hardware and software filters. In addition, these systems can scale movements so that large movements of the control grips can be transformed into micromotions inside the patient. With the surgeon sitting at a remote, ergonomically designed workstation, current systems also eliminate the need for surgeons to twist and turn in awkward positions to move the instruments and visualize the monitor.
However, as is often the case with new medical technologies, robotic surgery as it is currently used has some distinct downsides. Robot operations haven’t been proven in randomized trials to offer significant health benefits compared to standard, less-invasive surgery and multiple studies show they can cost thousands of dollars more. There have been widely publicized horror stories, including patients who have bled out after a robotic instrument inadvertently nicked a blood vessel or those who have been injured in other ways, such as accidental punctures, tears or burns. There has been a sharp increase in the injury and death rate from robotic surgery to about 50 reports per 100,000 procedures last year from only 13.3 in 2004. The rise of such “adverse events” during various robotic procedures has led to new government scrutiny.
Given the enthusiasm for this new technology, it is unlikely that demand will diminish any time soon. Doctors say robotics is catching on not just because of its merits—there’s a “wow” factor at work. There is an arms race by hospitals eager to attract new patients and get a competitive edge. As training improves and protocols become established, the instance of serious problems should decline.
If you are considering a surgery involving robots, it is a good idea to proceed cautiously and consult with your physician about the risks and benefits.