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| Archive : Winter 2007 |
PAGING DR. DA VINCI:
Scissors? Check. // Forceps? Check. // Cameras? Check. // The newest doctor can remove prostates, repair heart valves and reattach tissues. And it’s not even human.
Meet:
The Robot Surgeon [page 3]
 By Charles Slack // Additional reporting by Andrea Appleton
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It would be easier to spring for a $1.5 million robot if you knew for sure it represented a clear step forward. Yet while FDA trials have concluded that the da Vinci is safe and effective for a growing number of surgical applications, so far there is little data addressing whether, in fact, robotic surgery is superior to open or laparoscopic procedures. In 2003, one study by a team at Vattikuti Urology Institute at Detroit’s Henry Ford Hospital found that 100 patients undergoing robotic prostatectomy lost less blood than 100 who had open surgery and 50 who got nonrobotic laparoscopic procedures. And hospital stays after robotic surgery were shorter—1.2 days on average vs. 3.5 for open surgery and 1.3 for laparoscopic.
But the study touched only briefly on complications of prostatectomy such as incontinence and impotence, and it didn’t address whether da Vinci patients had a lower incidence of such problems. In another study at Henry Ford, 97% of 154 patients who had robotic prostatectomies reported the return of sexual function, a result surgeons attribute largely to the da Vinci’s magnified view and precise motions. Yet, while an October 2006 paper in the British Journal of Urology called such studies promising, it noted that “clearly, data from so few patients need to be treated with caution, and outcomes from one specialist centre might not always be achievable elsewhere.”
It’s also too early to know whether the da Vinci offers improvements in long-term patient outcomes. For patients with prostate cancer, open radical prostatectomy is considered the gold standard, much more widely available than laparoscopic prostatectomy and offering the best chance of patient survival over five to 10 years. How does the da Vinci compare? There are no studies to answer that question. “A rigorous scientific process needs to be gone through before one can figure out whether a certain technology is better than another, and that hasn’t been done,” says W. Scott McDougal, chief of urology at the Massachusetts General Hospital (MGH) and Walter S. Kerr Jr. Professor of Urology at the Harvard Medical School.
At many hospitals, much of the pressure to consider a da Vinci purchase comes from a staff worried about falling behind the technological curve. But in 1997, doctors at Brigham and Women’s Hospital in Boston did more than just lobby for the da Vinci. Hoping to participate in clinical trials for heart valve procedures, cardiac surgeons at the hospital established a “robot fund” to help pay for the machine. Donors, primarily former patients, gave about 20% of what was then a $1.2 million purchase price, and the hospital picked up the rest of the cost.
“We were very interested in this as a technique for minimally invasive valve surgery,” says Lawrence Cohn, former chief of cardiac surgery at Brigham and Women’s. Cohn, who has performed some 2,000 mitral valve repairs, is a leading specialist in the procedure, in which surgeons correct narrowing or leakage of the valve that controls the flow of blood into the heart’s left side. “If you could do an operation of the same quality, with much less trauma, that’s great for the patient,” he says.
But after performing just five successful repairs with the help of the robot, Cohn decided against using a da Vinci. “The operations went very well,” Cohn recalls. “But using the robot required a pretty large logistical team, and it took twice as long to do a repair as when I did it in the usual way.” Cohn concedes that, had they continued to hone their skills on the machine, they would have gotten more efficient. Still, he missed the feel of holding instruments in his hands and working directly on the valve. “It’s a great machine,” Cohn says. “The visualization it provides is incredible. But the complexity of valve pathology didn’t lend itself to consistent repair by the robot.” Nevertheless, the machine won’t sit unused: The hospital recently hired a urologist trained in robotic surgery to employ da Vinci for prostatectomies. |
Next page | Pages: 1 2 3 4
Photographs by Max Aguilera-Hellweg |
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