Robotic Surgery Controversies

Intuitive Surgical may be trying to cover up more adverse events involving the da Vinci System. In March 2009, a robotic surgery patient experienced injuries post-operation. Because the patient’s wounds went unreported by the hospital to a database by the Food and Drug Administration, she filed a lawsuit. During the da Vinci’s decade in operation, thousands of mishaps occurred. [1] While patients went unharmed in most cases, there were 174 injuries and 71 deaths reported due to the da Vinci according to a study by The Journal for Health Care Quality. [1] As for unreported incidents, researchers at Johns Hopkins found instances of unreported botched robot surgeries, and they believe that adverse events could be vastly underreported. [1]

The robotic da Vinci System is aggressively marketed by its creator, Intuitive Surgical, in an attempt to mask the system’s risks. Intuitive has pressured doctors and hospitals to implement the da Vinci even when the physicians are not adequately experienced in the name of new technology. [1] Perhaps this is the reason why there are so many adverse events. Even though robotic surgery is marketed as a safe and effective method, little is known about its dangers.

A tragic example of Intuitive Surgical’s aggressive tactics is the case of patient Fred E. Taylor. [2] The active 67-year-old retiree underwent robotic surgery for a prostatectomy. His five-hour surgery went on for more than 13 hours and caused him multiple complications, including a stroke, which led to his death a year later. The reasons for this? Internal company emails from Intuitive Surgical reveal that they pressured hospitals to increase the number of robot surgeries and lower the surgeon training standards to boost company credentials. [2] In 2002, Intuitive’s 70-question training exam was replaced by a 10-question online quiz. The company would also try to persuade surgeons into performing robotic surgery on patients when the traditional method was planned.

Robotic surgery tries to save lives, but at what cost?

Sources:

[1] Rabin, R. C. (2013, September). New Concerns on Robotic Surgeries. New York Times. Retrieved from http://well.blogs.nytimes.com/2013/09/09/new-concerns-on-robotic-surgeries/?_r=0

[2] Rabin, R. C. (2013 March). Salesmen in the Surgical Suite. Retrieved from http://www.nytimes.com/2013/03/26/health/salesmen-in-the-surgical-suite.html

Robotic Surgery Infographic

Here is an infographic I made on http://easel.ly/ detailing the benefits of robotic surgery to both the patient and surgeon.

Adverse Robot Surgery Events

Like any machine, the da Vinci Surgical System may malfunction. Intuitive Surgical reports that the most common problem with the da Vinci involves instrument cable breaks. [1] When a cable breaks, the robot’s equipment is rendered non-functional, but it can be replaced quickly. Another problem that can occur is when the da Vinci’s multiple arms hit against each other like sword fighting. [1] However, these issues are not as severe as what is archived in the Food and Drug Administration’s “adverse event” database.

According to the database, an arm jumped and stabbed a patient’s artery during a hysterectomy, although the surgeon was able to regain control. [1] Another incident involved one of the robot’s instruments not articulating correctly, and the surgery had to be converted to the open technique, which is traditional surgery with a large incision. A patient had been hit in the face with one of the system’s robotic arms, and that surgery had to be converted to open procedure as well. [1]

Submissions to the FDA database are only based on what has been voluntarily reported. [1]

The main disadvantage to robotic surgery is the lack of tactile feel. Because surgeons are operating using robotic limbs, they can’t feel the texture of their patients’ organs and lose the sensory feedback upon which they rely. This may cause surgeons to accidentally injure patients. [2]

Some physicians believe that the da Vinci is no better than a human. “There's never been a study showing clinical superiority,” says Dr. Marty Makary, a surgeon at the Johns Hopkins University School of Medicine in Baltimore. [3] Chief medical adviser to Intuitive Surgical, Dr. Myriam Curet, states, “I'm not anti-robot, but for most of the operations where robotic surgery is used, there's no benefit to the patient. More technology doesn't necessarily mean better quality healthcare.” [2]

Sources:

[1] Greenberg, H. (2013, March). “What Happens When the Surgical Robot Malfunctions?” Retrieved from http://www.cnbc.com/id/100565260

[2] Glass, N., & Knight, M. (2013, August 5). Would you have surgery at the hands of a robot? CNN. Retrieved from http://www.cnn.com/2013/08/02/tech/da-vinci-robot-surgery/index.html

[3] Dance, A. (2011, October 17). Robotic surgery grows, but so do questions. Los Angeles Times. Retrieved from http://articles.latimes.com/2011/oct/17/health/la-he-robotic-surgery-20111017