Surgeon’s View: What to Consider Before Minimally Invasive Robotic Surgery

October 4, 2013, 3:30PM. By Gordon Gibb

Park Ridge, ILMuch has been made about the impact robotic surgery has had on the medical profession, and subsequent impact to patients. Reports of operating room injuries related to the use of the da Vinci surgical robot have fostered headlines and triggered debate over traditional surgery v. a robot-assisted procedure with surgeons operating from a highly sophisticated work station.

While there are polarizing opinions on both sides of the debate, obstetrician and gynecologist surgeon Brian Locker maintains his support of the concept.

“I have had some people say they don’t want da Vinci robotic surgery because of the stories they have heard on TV about complications and recall of the instruments,” Dr. Locker, of the Midwest Center for Women’s Healthcare in Park Ridge, Illinois, told LawyersandSettlements.com. “But I don’t believe there is any evidence to show that da Vinci robotic surgery is any more dangerous than laparoscopic surgery.”

There have been problems nonetheless. Several former da Vinci patients or their families have filed a da Vinci lawsuit over alleged injuries. And in May of this year, the manufacturer of the sophisticated da Vinci robot, Intuitive Surgical, issued an alert over an issue with surgical scissors that could become susceptible to minute cracks. The result could foster “a pathway for electrosurgical energy to leak to the tissue during use and potentially cause thermal injury,” according to the statement by Intuitive.

But Dr. Locker remains bullish about the da Vinci system and its benefits - in this case, speaking about hysterectomy surgery. “You get a much better view than you would if you were doing the hysterectomy as an open abdominal surgery, where you are three, or four feet away from the incision,” he says. “Your vision is improved with the robot. You see a high-definition, 3-dimensional image. I think doing the hysterectomy with the robot is in fact easier - that is why we call it enabling technology.”

It should be noted that hundreds of thousands of surgical procedures have been successfully performed using the da Vinci surgical robot - and with more hospitals acquiring the $2.2 million device, there will be increased pressure to use them. Advocates of the da Vinci robot laud its increased capacity for precision while further promoting “keyhole surgery” that proves less invasive than traditional methods and rapidly speeds healing. Patients are discharged sooner, reducing bed pressures on hospitals.

However, former da Vinci patients alleging da Vinci robot injury, reference the potential for problems outside of the surgeon’s field of vision. Accidental arcing of electrical energy from surgical instruments, as referenced by Intuitive Surgical in the spring, has allegedly negatively impacted patients.

There have been questions as to the real or perceived benefits by way of improved surgical outcomes v. the increased cost. Da Vinci surgical procedures are usually more expensive than traditional surgery.

And critics of the system reference the lack of a national credential system or standardized training - leaving it to individual hospitals to sort out. Dr. Locker noted to LawyersandSettlements.com that the da Vinci robot, as sophisticated as it is, remains essentially a tool that does what it is told - but will not improve the ability of a surgeon not already keenly skilled in the arena of laparoscopic surgery.

What role the da Vinci robot itself plays in an alleged injury to a patient v. the potential for a qualified laparoscopic surgeon poorly trained on the system to undertake a procedure without sufficient experience with it, will undoubtedly be answered through the discovery process associated with any da Vinci litigation.

However, Dr. Locker advocates for transparency in medicine, and notes that any patient concerned about the potential for da Vinci robot failure and the use of new technology such as that promoted through the da Vinci system, should be encouraged to ask thorough questions prior to their procedure.

“If you’re asking me if a patient should ask the surgeon how many robotic surgeries they’ve done and what their complication rate is,” Dr. Locker said in comments to LawyersandSettlements.com, “then the answer is yes, they should ask.”