The reduction of human touch is one of the arguments against the advent of robotic surgery - and a recent story out of Denver provides fodder for those who feel attempting minimally invasive surgery by operating a series of joysticks is fraught with risk for the patient. A related concern stems from alleged pressure felt by hospitals to use, as much as possible, a system that costs the hospital in excess of $1 million to acquire.
Such concerns lay at the foundation of issues surrounding the professional conduct of a doctor who provides surgical services for Porter Adventist Hospital located in Denver, Colorado. As reported by The Denver Post (4/11/13), Dr. Warren Kortz has been charged with 14 counts of unprofessional conduct by the Colorado Medical Board following several reports of botched surgical procedures involving robotic surgery failure.
The issue has caught the attention of the US Food and Drug Administration (FDA), which is investigating by way of surgeon interviews in an attempt to get a handle on the issues surrounding this newer and somewhat controversial form of surgery.
Prior allegations of insufficient training and unsupervised surgical procedures too soon after training have cast a pall on what is described on the da Vinci Prostatectomy website as growing in popularity amongst men seeking better cancer control, a faster return of erectile function and a better chance for return of urinary continence. Robot-assisted surgery is also touted as a safer option than standard-care, open surgery. Da Vinci robot surgery is often used, but is not exclusive to, procedures involving the prostate.
The charges against Kortz, and other surgeons having experienced difficulty with alleged da Vinci robot failure, lends an air of suspicion that robot-assisted surgery is not as safe as the marketing suggests.
According to The Denver Post, Kortz was found to have used the da Vinci robot for harvesting live kidneys from donors when use of robot-assisted surgery for such complex procedures was not the standard for care. In one case, the harvesting of a kidney destined for the donor’s ailing brother had to be aborted when the donor’s aorta was injured while inserting a pathway device using the robot. The surgeon had no choice but to abandon the robot-assisted procedure and immediately convert to an open surgical procedure in order to stop the bleeding and save the life of the donor. The kidney removal had to be aborted, leaving the donor’s ailing brother to languish on the waiting list for an additional six months.
But that wasn’t the end of it. A sponge was left inside the patient and the patient was improperly padded on the surgical platform, leading to nerve damage. The patient eventually went into post-operative respiratory distress. She has launched a da Vinci Robot lawsuit alleging negligence on the part of the surgeon.
“I’d really like to see that this never happens again,” said Shanti Lechuga, the plaintiff in the malpractice case and the donor attempting to help save the life of her brother. “It never should have,” she told The Denver Post.
Another case involved an 86-year-old patient with metastatic cancer. The da Vinci robot surgical system was used. During the procedure, the patient’s aorta was injured. When the surgeon converted to an emergency open surgical procedure, the aorta was torn a second time when the robotic arm moved in error. The patient suffered kidney failure following the operation and did not survive.
A third patient suffered an aortic injury by way of a scalpel held by the robot, causing injury. The patient immediately lost blood pressure and had to be resuscitated.
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In the meantime, it has been reported that hospitals, having spent in excess of $1 million to acquire the massive robotic system, are under pressure to deploy the da Vinci robot system as much as possible, even when it may not be the best option for the patient.
Lechuga told The Denver Post she was told soon after the operation that hers was the only such complication. Having since seen the state’s charges against her surgeon using the da Vinci robot, she said “it blew my mind there were so many [complications] before me, and so many who had aorta injuries, too.”