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Blogs by David W. Page
Should I Ask For Robotic Surgery? 6/5/2012 10:40:20 AM
Robots are swiftly becoming part of our lives. In surgery the use of robotics has surged but isn't a clear-cut trend to improvement in care. Sure it's easy to list the advantages of using a robot - for the surgeon: stable field, tremor filter, 3-D view with 10X maagnification, improved dexterity, improved ergonomics (less strain and fatigue), and shorter learrning curves. In controlled studies, it works well if used by a truly esperienced surgeon. And that's the rub. There is little connection between what our few studies have suggested is enough cases to assure competence - usually between thirty and fifty cases under supervision - and what the people selling the robots are saying is enough training. The folks selling the machines suggest that every surgeon's learning curve is different. And the hospitals that buy the expensive machines want their surgeons using it pronto (Google robotic surgery malpractie cases).
Here we go again - if you've read any of my other blogs you know that you have to ask how many robotic cases your surgeon has done. And, you have to ask what scientific studies support the use of the robot for your particular type of operation. The practice of surgery is a little fuzzy in places currently. For example in one study robotic removal of the thyroid gland (in the neck) was compared to 'conventional endoscopic' thyroid gland removal. There is no conventional endoscopic thyroid technique! They are all experimental. So the study compares an unacceptable operation to another even less accepted operation for the thyroid gland. In fact - this is where it gets truly crazy -there are about twenty ways to remove the thyoid gland! Yet, for most surgeons the most safe operation is with a neck incision.
Final craziness about less invasive surgery (which by the way is the best way to go for many common surgical problems). Breast surgeons are putting their incisions in the armpit to hide the scar while thyroid surgeons are putting their incisions on the breast (yes folks) to avoid a neck incision. For one of the common diseases - gallstones - the robotic approach is more expensive and provides no benefit over standard laparoscopic gallbladder removal.
REMEMBER: Sexy usually isn't safe in the operating room.
