Many hospitals, and surgeons, are touting the benefits of their latest piece of technology–the DaVinci Robotic Surgery System. This new piece of high technology allows the surgeon to sit at a video game-like console to perform many types of surgery. Instead of performing minimally invasive surgery using now time-tested techniques of laparoscopic surgery, surgeons are opting for the DaVinci system. The claimed benefits are that the procedure is less invasive, has fewer complications, less pain and promises a quicker return to normal activities–all the same benefits derived from laparoscopic techniques compared to “traditional” techniques. However, it is becoming clear that patients may be experiencing a myriad of complications as a result of the DaVinci Robotic Surgery system.
So how do the three surgery types differ? In traditional “open” surgery the surgeon makes an incision and actually places his hands and instruments directly into the patient. The benefits are that the surgeon has a normal view and can manipulate organs and structures directly with his hands. The surgeon has tactile and other sensory feedback. Most surgeons are taught that when they encounter complications using any other type of procedure, they can and should convert to an “open” procedure for the remainder of the surgery. In fact, almost every consent form for either laparoscopic or robotic surgery will include permission to convert to an open procedure if needed.
The gold-standard for many surgical procedure in the last twenty years has been laparoscopy. In laparoscopy, the surgeon makes several small incisions and uses these incisions to insert a camera and instruments into the patient to perform the procedure. The surgeon directly manipulates the instruments but views what is going on in the patient on a video monitor. Almost every surgeon practicing today was either directly trained in laparoscopy or has been performing laparoscopy for many years. The benefits of laparoscopy are less pain and a quicker return to normal activities.
And now there is the DaVinci Robotic Surgery System, which takes laparoscopy to a whole new level. The same types of small incisions are made in order to insert a camera and instruments. However, once the instruments are placed, the surgeon does not hold them in his or her hands. Rather, the instruments are attached to a robotic surgery platform and the surgeon sits at a video console and manipulates the instruments using video game-like controllers. The alleged benefit of this system is that it allows the surgeon to make much more precise and controlled maneuvers, such that a 1/2 inch movement of the controller may equate to a 1mm movement of the instrument in the patient. The concept sounds wonderful. However, in practice, problems appear to have arisen.
DaVinci Robotic Surgery systems have been used for abdominal surgeries such as gallbladder remove, for gynecological procedures such as hysterectomies and for other procedures such as prostatectomies. They are even being used for endoscopic procedures.
However, patients have experienced complications such as bladder and bowel perforations, injuries to the ureter and rectum, and burns and other complications. One suspected problem is that the DaVinci system utilizes an electronic scalpel, called a cautery, to make cuts. The makers of the DaVinci system, Intuitive Surgery, Inc., a California company, used a monopolar system rather than a bi-polar system to ground the electrical current. It appears that this less expensive system allows the current used to make cuts to jump to places unintended by the surgeon, sometimes far remote from the spot where the surgery is occurring.
Complications such as bowel and bladder perforations and other injuries can be life-threatening. Serious injuries or death can occur if these complications are not promptly recognized and treated.
If you or a loved one have been injured during a DaVinci Robotic Surgery, please contact T