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The State of Robotic Surgery

kdawson posted more than 4 years ago | from the cut-on-dotted-line dept.

Robotics 72

kkleiner writes "Robotic surgery is experiencing explosive growth in America's operating rooms, and the unquestioned industry leader in this field is the DaVinci robot, made by Intuitive Surgical. Only 14% of prostate surgeries in the US last year took place not using the DaVinci. Installations have grown from 210 systems seven years ago to 1,395 today. Although typically used for smaller surgeries like prostate removal and hysterectomies, the system was recently used for a kidney transplant, and more complicated procedures are expected in the future. The DaVinci is really just the first wave of robotic surgery as technology continues to push clumsy human hands out of the operating room." The article mentions some of the downsides, or perhaps the growing pains, of DaVinci robotic surgery: "According to a large study of Medicare patients, robotic prostate surgery led to fewer in-hospital complications, but had worse results for impotence and incontinence ..." Another company makes a simulator to train surgeons on the DaVinci. Embedded in the article is a 2009 TED talk on DaVinci by a surgeon.

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FROSTY AFRICAN PISS!! (-1, Troll)

Anonymous Coward | more than 4 years ago | (#31505280)

What does it say on the inside of a nigger's lips? INFLATE TO 30 PSI

Incontinence or Death (0)

Anonymous Coward | more than 4 years ago | (#31505292)

robotic prostate surgery led to fewer in-hospital complications, but had worse results for impotence and incontinence

Would you rather be dead or incontinent? I'll take the diapers. Impotent? I'll have to think about it.

Re:Incontinence or Death (2, Interesting)

Anonymous Coward | more than 4 years ago | (#31505308)

Having had my Prostate removed the choice is neither with conventional surgery. That tells me this surgery is not as good as non robotic surgery like I had. I don't have problems with leaking or impotence. Given the choice I would go for non robotic surgery.

Re:Incontinence or Death (1, Funny)

BadAnalogyGuy (945258) | more than 4 years ago | (#31505320)

Just a guess, but do you perchance use a Mac?

Re:Incontinence or Death (1)

Sulphur (1548251) | more than 4 years ago | (#31506722)

Opening Windows on the prostate and elsewhere.

--

The doctor who, with deft and unerring hand has often excised the prostate gland, has reaped the harvest he has sown. He's having trouble with his own. Francis Leo Golden in For Doctors Only.

Re:Incontinence or Death (0)

Anonymous Coward | more than 4 years ago | (#31505374)

Contrary to Slashdot readers' beliefs, technology will never totally expel humans from every sphere of life. There will always be situations where the humans are the "mission critical component" and then some.

Re:Incontinence or Death (1)

gmhowell (26755) | more than 4 years ago | (#31505410)

They better have things figured out if they're bringing a scalpel anywhere near my own personal 'mission critical component".

Re:Incontinence or Death (1)

MichaelSmith (789609) | more than 4 years ago | (#31505416)

They better have things figured out if they're bringing a scalpel anywhere near my own personal 'mission critical component".

Its funny. We have two of almost everything else...

Re:Incontinence or Death (4, Funny)

gmhowell (26755) | more than 4 years ago | (#31505424)

If we had two, I'd never get any typing done.

Re:Incontinence or Death (1)

countertrolling (1585477) | more than 4 years ago | (#31505482)

Popsicle stick... between your teeth... I've heard..

Re:Incontinence or Death (1)

K. S. Kyosuke (729550) | more than 4 years ago | (#31505784)

We do. There are people happily living after hemispherectomy. GP must be a gigolo, not an engineer.

Re:Incontinence or Death (2, Insightful)

OhHellWithIt (756826) | more than 4 years ago | (#31509726)

Would you rather be dead or incontinent? I'll take the diapers. Impotent? I'll have to think about it.

For me, the notion of diapers in my fifties was far worse than impotence. As another prostate cancer patient observed, you've got a lot better chance getting a woman into bed if you have bladder control. Luckily, the odds are better for continence than potency, and the former comes back much faster. (But neither one comes back soon enough!)

FWIW, I considered both open and Da Vinci surgery, and I chose the open surgery after lots of reading and discussion, but mainly because I felt like the Da Vinci surgeon was trying to sell me on his method, while the traditional surgeon didn't seem to even be selling surgery; he freely explained reasons that I might want to consider radiation. In one of my meetings with my surgeon, I asked him which he would choose if he were in my situation, and he said "Open, without question!" He said the feel of the tissue was more useful than seeing it. He also said that more Da Vinci patients report dissatisfaction about recovery than open surgery patients, mainly, he believed, because their expectations for Da Vinci were too high. He is learning to use the Da Vinci robot only because more people are demanding it.

The bottom line, though, is that if you are in the situation of needing a prostatectomy, you don't want to look at the statistics of method A vs. method B. You want to look at the statistics of the individual surgeons you are considering and go with the one you are completely confident with. There are no guarantees of full recovery, no matter whom you choose, and when you're recovering, you do not want to be asking "What if?" It's a moot question, anyway: there is only what is.

Top Grade Acai (-1, Troll)

namirosei (1769070) | more than 4 years ago | (#31505304)

I am planning on writing this as a casual teen/young adult sci-fi read. I will start writing this weekend. Top Grade acai

Well... (0)

Anonymous Coward | more than 4 years ago | (#31505306)

I haven't read the summary. But, given the title, I'd say...

They're taking our jobs!

Re:Well... (2, Funny)

gmhowell (26755) | more than 4 years ago | (#31505414)

They took err jerbs!!!

I was thinking Nevada. (0)

Anonymous Coward | more than 4 years ago | (#31505310)

Where else could you pay to put an actual Da Vinci in your rectum? Vegas, baby.

almost there, with some improvements (0)

Anonymous Coward | more than 4 years ago | (#31505318)

while the impotence and incontinence may seem a minor inconvenience to our silicon brethren, I'm a little fond of the constitional and occasional shag, that's some bleeding edge there

Re:almost there, with some improvements (1)

techno-vampire (666512) | more than 4 years ago | (#31505546)

that's some bleeding edge there

As a slashdotter, you should be in favor of bleeding edge technology.

Re:almost there, with some improvements (1)

MrNaz (730548) | more than 4 years ago | (#31505604)

Furthermore, as a Slashdotter, impotence should be a non-issue.

Re:almost there, with some improvements (1)

K. S. Kyosuke (729550) | more than 4 years ago | (#31505798)

I am, as long as the "bleeding" in "bleeding edge technology" does not come from a mistakenly hit artery.

Cost benefit? (2, Interesting)

S1ngularity (1635987) | more than 4 years ago | (#31505372)

And what effect this sort of technological uptake have on health cost containment?

Re:Cost benefit? (1, Interesting)

gmhowell (26755) | more than 4 years ago | (#31505418)

It will cost the insurance companies less (shorter hospital stay) so therefore, it's all benefit to them. Expect to see this tech continue to expand, even at the cost of customers' leaky, flaccid weiners.

Really difficult surgery (4, Interesting)

MichaelSmith (789609) | more than 4 years ago | (#31505408)

It would be interesting if robots like the DaVinci could in future operate on a smaller scale and in trickier parts of the body. Some cancers (for example) are inoperable because of their location in the body. Maybe a robot could cut out most of the tumor in these cases and leave chemotherapy or radiotherapy devices behind the clean up the rest.

Re:Really difficult surgery (4, Informative)

nanoakron (234907) | more than 4 years ago | (#31506958)

As a qualified surgeon (albeit junior), I'd like to offer my $0.02 if I may.

To be honest, there aren't many parts of the body that are inaccessible to modern surgery. Closed boxes such as the thorax or skull are a couple, but in these cases the main problem is not physical access but the fact that the cancers themselves are often aggressive and deeply embedded. Brain tumours (particularly GBM) are notorious for sending out stray single-celled metastases before the main tumour even shows itself. Small-cell lung carcinoma is another. Basically, by the time the cancer has revealed itself, it's all but too late to do anything about, and no amount of cutting out the primary will remove distant microscopic spread, even with the best tools for the job.

Fortunately, these 'black book' cancers are the rare ones. Common cancers such as bowel, breast and prostate tend to be slower growing and based in parts of the body that are relatively easy to access.

The main use of robotic surgery is not so much to improve physical access, or to 'remove more', but to reduce surgical trauma, and thereby speed patient recovery and reduce peri-operative complications.

And interestingly, we all know surgery for early or localised tumours is the best chance for 'cure', but did you know that radiotherapy actually cures almost the same proportion of cancers? Together they account for nearly 90% of all cancer cures, but where does all the money go? Chemo - because it's sexy. Well, I guess we're also trying to replicate Erlich's 'magic bullet' theory which applied in the early days of antibiotics but unfortunately it's still a way off.

-Nano.

Re:Really difficult surgery (1)

blakelarson (1486631) | more than 4 years ago | (#31509036)

There's a new "look" for robotic surgery that uses intraoperative imaging (ultrasound, MRI, CT, fluoro), as the "eyes" as opposed to cameras, which merely duplicate the function of the eyes. It will be especially useful for percutaneous operations, but the possibilities go beyond that...

Re:Really difficult surgery (3, Informative)

quantumghost (1052586) | more than 4 years ago | (#31511026)

Actaully, being a surgeon who has used the robot, you stand a greater chance of injury.

To set the record staight, the robot is a tool looking for a problem. The robot is no better than a skilled laparoscopic surgeon, and in fact suffers from a "fatal flaw". I'll explain: the most common procedure for the robot is for prostatectomy which involved going deep into the pelvis to remove a walnut sized gland at the base of the penis and below the bladder. To do this using standard laparoscopic instruments is hard beause you would have to stand where the pt's head is to have the proper angle. The robot can operate "upside down" and removes this restriction.

The draw back to the robot is that it does not provide "haptic feedback" or force-feedback....a skilled surgeon relies on his sense of touch as much as his sense of sight. I've removed a pt's colon doing 80% of the surgery not needing to see what I was doing and just going by touch which was more revealing than my sight for those parts of the procedure(hand assisted laparoscopic colectomy). If I can't feel the tumor in the bowel because the robot doesn't provide a sense of touch, guess what - the robot will not provide any advantage.

The true falacy is that the human surgeon is a butcher and that the precision of the robot will be superior. In truth, the surgeon relies on the body's ability to heal to accomplish the miracle of the cure. I cut, but I rely on the body's ability to mend. There are precious few procedures out there that requrie such precise touch...and trust me I've sewn a 1mm vein to a 2mm artery during a bypass operation using my own hand, and with a suture that would break if you sneezed on it (another reason to use a surgical mask!). This case would not be possible with the current generation of robots.

Now, don't get me wrong, there may be some advances in the furture where the robot-assisted surgeon can out perform me, but for at least the next 5-10 years, the robot will be relegate the corner of one of our ORs and used 2-3 times a week for the RALP (robot assisted lapr prostatectomies).

As an aside, the tele-surgery concept may be a valid use in the future, but A) you need 100% up-time on your link B) you still need a semi-qualified individual at the pt's beside to 1) set up the robot, 2) put the ports in so the robot can slip the intruments in to the pt. And in reality, you need someone on stand-by to take over if the case can not be completed and you are stuck at a critical juncition.

Re:Really difficult surgery (1)

MichaelSmith (789609) | more than 4 years ago | (#31516102)

Software analogy:

I am a C programmer with 25 years experience in real time systems. If a client needs a database to track their pencils then I am the best person to come to because I understand all the implications: race conditions, middle ware, infrastructure; you name it, I know it.

But the fact is that they client will pay some guy half what I earn to knock their database up in MS Access. It will fall over from time to time but do a reasonable job.

So can I get cheap but acceptable surgery with a robot?

Re:Really difficult surgery (1)

quantumghost (1052586) | more than 4 years ago | (#31518628)

Software analogy:

I am a C programmer with 25 years experience in real time systems. If a client needs a database to track their pencils then I am the best person to come to because I understand all the implications: race conditions, middle ware, infrastructure; you name it, I know it.

But the fact is that they client will pay some guy half what I earn to knock their database up in MS Access. It will fall over from time to time but do a reasonable job.

So can I get cheap but acceptable surgery with a robot?

Well...no. First the robot costs more to use...the instruments are of limited use - they only function X times before the lock out - that way the company can keep making money after the robot is sold. Those intruments also cost a lot more than standard lap instruments (and don;t last as long).

Second, as was noted in another post, this isn't really an automaton. It is still _very dependent_ upon the skill and judgement of a trained, experienced surgeon. A teenager may be able to operate it, but won't have a clue what to do. Surgery residency is at least 5 years of 80 hrs/week (used to be 100-120+ hrs/wk) (fellowship adds 1-3 years of additional training). So from that alone, I have well over to 30,000 hrs of expereince and training in the OR and managing my patients pre- and post-operatively and I'm still a young surgeon.

In addition, as I noted, the robot adds a layer of complexity (requiring more training to master) than a normal laparoscopic surgery, even though the procedures are often very similar, the un-natural-ness of controlling the robot and the slim margin of error (you can't swing an instrument wildly while it is inside a body) have all consipred to limit the use of the "robots".

Third, a lot of the cost of surgery is in the pre and post operative period. The OR itself in often just a portion of the total bill. I've had cases where a weeks worth of antibiotics cost 2-3 times the reimburstment of the surgery itself....

To conclude, let me take your anaolgy one step further...the first time the database blows up.: someone dies. How would that look on the bottom line? Surgery (and medical care in general) is not somewhere you want to find the lowest bidder. -- QG

Surgical Automats (1)

Degro (989442) | more than 4 years ago | (#31505412)

So how long until there's completely unmanned surgical automats? That would be pretty scary and at the same time pretty cool, in a dark cyberpunk future kind of way...

What was the rate of complications? (4, Insightful)

im_thatoneguy (819432) | more than 4 years ago | (#31505426)

I wonder what the actual numbers were of complications.

If it reduced deaths from 2 to 1 per 1,000 and only increased the rate of incontinance from 1 per hundred to 2 per hundred then that seems like a good trade off. But two unrelated statistics without the details are difficult to compare.

If you had a procedure that killed 70% of the people and could reduce it to 10% but only increased the chance of side effects by 1% then it's a no-brainer.

Nosferatu (-1, Offtopic)

moteyalpha (1228680) | more than 4 years ago | (#31505432)

A member of my family has been doing this type of work for several decades. I have been studying genetics and developing a mitochondrial operating system. It is merely a concept which I think is workable. It would transform the organism in such a way that it could function as several trillion parallel process control computers. It takes a long time to bring a concept as complex as this from idea to implementation. I have been working on it for seven years now and expect that it will be a reality eventually if nothing else seems a better approach.
I do wonder what it means though. At first it seemed a really neat idea and the methods are not much more difficult than maintaining an open source OS. It does seem that if every cell contains the necessary data to evoke the organism, it would be no different than a liquid terminator or vampire in its result.
There are organisms which regenerate themselves from their parts. Members of Planariidae, for one. As it becomes more feasible it occurs to me that it is very odd in its consequence. I had a bad feeling when I first cloned an organism, as if I should not be allowed to do such a thing.
DARPA is considering experiments with genetically engineered soldiers merged with nano technology and electronic extensions. To paraphrase a common meme at slashdot , on the Internet, technology advances you.

Re:Nosferatu (1)

the biologist (1659443) | more than 4 years ago | (#31505474)

Is there a website or something where someone might be able to read more of this?

Re:Nosferatu (2, Interesting)

moteyalpha (1228680) | more than 4 years ago | (#31505554)

I see I have been labeled off topic. I find that amusing, considering my relationship to the person in the video. I plan to have a WebGL interface to the operating system later this year. I suppose I got marked off topic , just for the Nosferatu label. I am sure that when it is done, Google will know. Google seems to know about everything. You seem to have a reasonable knowledge of the field from your posts. It is certainly an area that will yeild many new technologies. The ability to convert a skin cell to an omnipotent stem cell is one. The interesting thing is that contained in the genetic code is the instruction for that transform and once found is just a string of bases. It is very much like writing the code for life.

Growing pains? (1, Funny)

Anonymous Coward | more than 4 years ago | (#31505442)

According to a large study of Medicare patients, robotic prostate surgery led to fewer in-hospital complications, but had worse results for impotence

Talking about growing pains

Shouldn't that be CUTTING pains? (1)

wisebabo (638845) | more than 4 years ago | (#31505544)

(ducks)

It's Cool. (2, Interesting)

stuffman64 (208233) | more than 4 years ago | (#31505484)

I for one welcome our robotic overlords... I mean, helpers!

Last month I got to play with one of the Da Vinci units at a car show (why it was there is anyone's guess). I am amazed at how intuitive it was to use- even though I was just putting tiny rubber bands on small rubbery cone-thingies, the 3D display and 1:1 motion mapping really made it feel like an extension of my body. Even though the unit doesn't use force feedback, it almost seemed like it did (just my brain, I guess). The most amazing part? My 7-year-old niece had absolutely no problem using it, and now she wants to become a doctor.

Cool stuff.

Re:It's Cool. (1)

Jedi Alec (258881) | more than 4 years ago | (#31506390)

My 7-year-old niece had absolutely no problem using it, and now she wants to become a doctor.

Why not become a roboticist instead? All the fancy toys and none of this nasty bloody stuff. Less lawsuits too, from what I hear.

Re:It's Cool. (2, Informative)

radtea (464814) | more than 4 years ago | (#31506628)

1:1 motion mapping really made it feel like an extension of my body.

Now if we only had a word [wikipedia.org] to distinguish a system such as you describe from a robot...

Re:It's Cool. (1)

VeNoM0619 (1058216) | more than 4 years ago | (#31658512)

Last month I got to play with one of the Da Vinci units at a car show (why it was there is anyone's guess). ... My 7-year-old niece had absolutely no problem using it, and now she wants to become a doctor.

Getting kids interested of course.

A little over the top... (1)

qpawn (1507885) | more than 4 years ago | (#31505506)

These robot doctors are very professional, except for their entrance into the operating room:
http://www.youtube.com/watch?v=JqlawTD_9B0 [youtube.com]

Don't be a testing ground for these machines (0)

Anonymous Coward | more than 4 years ago | (#31505510)

Being nerds I know you guys all love testing out brand new tech, but the one thing these robots have taught me working in a major metro hospital is that you don't want to be a beta tester. It takes years for surgeons to 'perfect' a surgery, and if you put them in front of a machine it will take years to figure out the kinks. Always go for the tried and true tested way. New machines are dangerous while they are new and their users are inexperienced.

Unanswered question (1)

93 Escort Wagon (326346) | more than 4 years ago | (#31505514)

Only 14% of prostate surgeries in the US last year took place not using the DaVinci.

Okay, so DaVinci is by far the market leader - but of that minority 14%, how many are using Medibot?

Re:Unanswered question (1)

demonlapin (527802) | more than 4 years ago | (#31506360)

Frankly, I find that number very hard to believe. Maybe 14% of prostate surgeries in hospitals with a DaVinci took place without one, but there are less than 1400 machines nationwide according to TFA. That's less than one per 200 000 people.

If anything, they perhaps meant they have 86% of the market for radical prostatectomies. Most prostate surgery is done via the urethra because it's done for benign prostatic hypertrophy that impedes urine flow, not for cancer.

Re:Unanswered question (2, Insightful)

radtea (464814) | more than 4 years ago | (#31506662)

Okay, so DaVinci is by far the market leader

And we know with a far higher degree of certainty than any of the bogus stats in the article that that means they have mediocre technology but great marketing.

Being "market leader" in a cutting edge (as it were) field is in my experience almost always an indication that the tech is poor to middling but the company is brilliant at marketing. I'm not just talking about Microsoft here, although they are a prominent example of the phenomenon. In the areas I've worked in professionally (which includes image-guided surgery) the best technology has never been close to the market leader.

Personally, I don't want a surgeon using a machine from the market leader on me until the technology is mature, which doesn't happen for decades.

Should put one on the ISS (or Antarctica) (2, Interesting)

wisebabo (638845) | more than 4 years ago | (#31505524)

The best use for this would be to put one on the ISS (or other "nearby" manned spacecraft where speed of light time-lag is not too long).

That way, you'll have an emergency "surgeon" available in case of a medical emergency. Nowhere near as good as a real live doc but better than nothing.

I understand a few years ago, a female scientist had to be evacuated from the Antarctic base in the dead of the ANTARCTIC(!) winter because she had breast cancer. This could have prevented that (and eliminated the risk to the rescue crew. I think they had to keep the plane's engines on so that the skids wouldn't freeze to the ice).

Now what was the name of that "emergency medical program" on Star Trek?

Re:Should put one on the ISS (or Antarctica) (2, Informative)

careysub (976506) | more than 4 years ago | (#31506890)

The best use for this would be to put one on the ISS (or other "nearby" manned spacecraft where speed of light time-lag is not too long).

That way, you'll have an emergency "surgeon" available in case of a medical emergency. Nowhere near as good as a real live doc but better than nothing.

OTOH, in low Earth orbit you can bring the patient back to Earth very quickly (an emergency reentry vehicle is always available on the ISS) so the space surgery unit isn't needed. It might be useful on a lunar base, but the 2.5 second time lag would make using it tricky.

For extended space missions (e.g. a trip to Mars) I believe NASA intends to send two astronaut-surgeons (out of crew of 8 or so), so that one can operate on the other if needed.

I understand a few years ago, a female scientist had to be evacuated from the Antarctic base in the dead of the ANTARCTIC(!) winter because she had breast cancer. This could have prevented that (and eliminated the risk to the rescue crew. I think they had to keep the plane's engines on so that the skids wouldn't freeze to the ice).

Yes, she WAS the base doctor and thus could not operate on herself. Sending two surgeons to Antarctica, as in the NASA Mars plan, could have spared this rescue mission (they could have dropped any needed supplies without the hazard of landing). This is possibly a cheaper solution than a million dollar machine (the two surgeons would have other research duties and so are not just additional costs. Keeping the engines running was necessary for the engine's sake. They would not have been able to restart them in the cold.

BTW - the doctor in question, Dr Jerri Nielson Fitzgerald, died from a recurrence of her cancer last year (ten years after the rescue): http://www.abc.net.au/news/stories/2009/06/25/2608384.htm [abc.net.au]

Re:Should put one on the ISS (or Antarctica) (1, Informative)

Anonymous Coward | more than 4 years ago | (#31508570)

This idea is always floated around, and it is fantastic in theory, but it fails to take into account that you still need at least some surgical ability onsite to use a DaVinci. Ports have to be placed, some of the work is still done as traditional lap, and one always needs to be ready to perform emergency conversion to an open surgery. All of these things still require human hands trained in surgery. A tech or nurse could theoretically do it, but I'd much rather a surgeon do the work.

The more interesting use of robotics in surgery is in rural areas. Suppose you have a general surgeon, but need to perform a more complicated procedure that requires the expertise of a sub-specialty. In that instance, the general surgeon can do the setup and allow the specialty surgeon to control the robot. This extends the specialty surgeons range and decreases the need to have onsite surgeons in every specialty for rural areas.

These devices are not robots. (5, Informative)

jcr (53032) | more than 4 years ago | (#31505528)

They're remote manipulation systems, also known as "waldoes". Robots operate under the control of a stored program, not the direction of a human operator.

-jcr

Re:These devices are not robots. (5, Interesting)

janek78 (861508) | more than 4 years ago | (#31505684)

That's a valid point. Also, every technology - and medicine is no different in this - has it's phase of enthusiastic adoption, eventual disappointment when it's found out it's not as good as previously hoped, and then a phase of rational use in indications where it makes sense. I remember the time when surgeons would do 6-hour laparoscopies because it was IN. Later they realized that a 2-hour open surgery is actually better for the patient and laparoscopies were limited to cases where they make sense.

I am a doctor in a university hospital and I recently went out to have beer with a friend of mine from the urology department. He's the chief "robot operator" for our hospital and he hates the machine with a vengence. No only are the operations several times more expensive (and longer), but to get the money they paid for the machine back, the hospital forces him to use the robot even on cases that would be much better done hands-on. Patients with more complications and longer hospital stay are no exceptions. To me this still seems like a technology we are yet to learn to use properly. Use it for remote operations where the surgeon is not physically available, use it in indications where it makes sense, but don't believe in all-saving robotic future of surgery. It's not here yet. The adoption cycle of many older technologies should serve as a warning.

Re:These devices are not robots. (2, Insightful)

radtea (464814) | more than 4 years ago | (#31506694)

the hospital forces him to use the robot even on cases that would be much better done hands-on

No one is "forcing" him to do anything. He just doesn't have the guts to do the right thing and say no to his bureaucratic overlords. He is willing to do harm--in his own estimation--to other innocent human beings who have put their deepest trust in him, for the sake of his own comfort and security.

Your friend is a coward, and the most appalling thing is that you apparently see nothing wrong with that.

When people say, "For evil to triumph it is merely necessary for good people to do nothing", this is exactly the kind of behaviour they mean.

Re:These devices are not robots. (1)

Caue (909322) | more than 4 years ago | (#31507764)

Resistance to new techs + distorted sence of justice = medieval nightmare.

You obviously don't have a boss, a family to support, house payments, etc. Even more obvious is that hospital "overlords" are in the harming people business and doctors are the executioners. please.

Re:These devices are not robots. (2, Insightful)

janek78 (861508) | more than 4 years ago | (#31511496)

While I see you point, I have to disagree. In your extreme logic noone can ever be forced to do anything. Because when it comes to it, you can always refuse (and die).

My friend is a very skilled surgeon - which may be one of the reasons why he feels that hands-on would be better in many cases. And he's not "doing nothing". He's an out-spoken critic and opponent of overuse of the technology and he's actually trying fairly hard to overturn the hospital's decision. Admittedly, not to the point of losig his job.

I applaud your life if you really have the clear consciousness to call people who make compromises cowards.

Re:These devices are not robots. (0)

Anonymous Coward | more than 4 years ago | (#31507150)

" To me this still seems like a technology we are yet to learn to use properly."

No, this is a technology that your pencil-pushing administrators have yet to learn to use properly. The docs know what to do.

Re:These devices are not robots. (0)

Anonymous Coward | more than 4 years ago | (#31507554)

What he(she) said. As an orthopedic surgeon, we're still trying to figure out which situations are or are not suitable for robotic / computer guided surgery. At this time, there's still nothing out there that really provides a benefit for our surgeries - the added cost and setup time have not been shown to provide any benefit for the patient. That's not to say that someday a robot might not help replace my knee, but it's not happening any time soon. So far as the DaVinci, I'm at a well known academic center with a well known urology department, and the word on the street is that most of the experienced urologists really are finding that a few years into adoption of this robot, they prefer the manual approach instead, and think it's better for their patient. /not a luddite

Re:These devices are not robots. (1)

jcr (53032) | more than 4 years ago | (#31516884)

I remember the time when surgeons would do 6-hour laparoscopies because it was IN. Later they realized that a 2-hour open surgery is actually better for the patient and laparoscopies were limited to cases where they make sense.

I can see why people would assume that the laparoscopic approach would be better (small incision, etc, etc.) I take it that being under general anesthesia for the shortest time possible outweighs other advantages that laparoscopy would offer?

Does it seem to you that it would be fruitful to work on making laparascopic surger less time-consuming?

-jcr

Re:These devices are not robots. (1)

Hurricane78 (562437) | more than 4 years ago | (#31506004)

Exactly what I wanted to say. Nowadays the mob of idiots describe every remote-controlled machine as a robot.
I wonder if they would call my door opener a “roboter”... since it’s obviously remotely controlled.

Re:These devices are not robots. (2, Insightful)

javilon (99157) | more than 4 years ago | (#31506368)

They're remote manipulation systems

What we need is companies like Da Vinci making lots of money and evolving the technology into real robots.

The first phase in the evolution path is likely to be first adding tactile sensors, then chemical sensors, and relying all that information to the doctor, processing it before presentation so the doctor can use all that information in an easy way.

Second phase would be to add more autonomy to the tool, so it makes "decisions" like identifying tissues and for example warning before cutting through nerves or scaling the surgeon movements depending on the area and tissue type it is working at that point, as to make it safer.

Third phase would be to add more autonomy and let some of the tools to be moved by the computer in coordination of the surgeon actions, so for example the computer could take care of draining blood without the surgeon intervention. In order to do that, the computer needs to be able to tell one tissue type from another, and understand the organization of the body area it is working in.

Then some stereotypical parts of the operation could be carried on completely automated.

Finally, eventually the full operation would be carried by the computer.

I would really like computers take over. Even if they are worst than actual surgeons. There are two advantages.

The first one is price. A lot of operations are not carried because of economic reasons. People in that situation would prefer even a "bad" robotic surgeon than nothing.

The second would be consistency. There would be no variability between one robot and the next. Now the outcome of your operation depends so much on what surgeon performs it and if he has a good day.

Just like laparoscopic surgery maybe? (2, Interesting)

mednerd (1384749) | more than 4 years ago | (#31505652)

when laparoscopic surgery came in there were all these studies done that showed one thing or another. for example, a laparoscopic cholecystectomy (removal of the gallbladder) is a very common operation. apparently there are studies done that show 10% of the time you will have damage to the common bile duct (which would be bad). any general surgeon worth his salt these days will tell you that 10% chance is more like 0.5% or better.

my point is, maybe people just need to get better at using these things? it's not like playing a computer game, the surgery is still very complicated.

of course I'm no expert but hey, this is /. isn't it?

Do you need robots for this (1)

j_sp_r (656354) | more than 4 years ago | (#31505654)

After spending some weeks in the hospital as observer and talking to various surgeons about these robots I was basically told that a prostate surgery using DaVinci takes about as much time as with Minimal invasive surgery, but costs a lot more (instruments can be used 10 times (DRM) on the DaVinci and are really expensive ($2000+ I think)). You also have absolutely no feedback ( I got to play with one for 30 seconds before I got crazy about the 50Hz 3D screen and I broke stitching wires with it by pulling them apart).

The coolest operation with the DaVinci I hear about was an Aorta replacement. Save splitting your breast plate.

Re:Do you need robots for this (0)

Anonymous Coward | more than 4 years ago | (#31506122)

Yep, it does take as much time as minimally invasive surgery, because it a minimally invasive surgery. Anything laparoscopic is minimally invasive. However, I've yet to meet a surgeon who's wrist rotates 360 degrees, so there are some advantages. :) It's not so much an issue of DRM as you state, but an issue of re-processing. A lot of medical companies and surgeons are against it(Yes, administration loves it), but if it wasn't a 10 use item, it would be a one use item and would probably cost the same. BTW, the hospital you observed needs to negotiate a better contract, I believe our DaVinci items are only $1000. Also, do you mean an Aortic valve replacement, or possibly a graft, but not an aortic replacement? I'm not sure how you would replace an aorta/ Prostatectomies, lap choles, lap nissens, CAGBs, some gyn procedures that escape me, and I believe lap band surgery are done at the hospital where I used to work. I missed my chance to play with it in the pig lab, bummer :(

Re:Do you need robots for this (1)

demonlapin (527802) | more than 4 years ago | (#31506396)

Choles and Nissens? Really? You take a 15-20 minute, three-port procedure and do it with a non-feedback mega-port device? Why?

The state of robotic surgery (3, Funny)

commodoresloat (172735) | more than 4 years ago | (#31505882)

Robotic surgery is actually pretty straightforward. You just pop off a few screws and open the front panel on the robot's torso, and then you can get at the insides pretty easily.

Re:The state of robotic surgery (1)

randyleepublic (1286320) | more than 4 years ago | (#31518976)

Don't forget to take a picture right after you get the front panel off. Really helps later when you're trying to remember which wire goes where.

IANAL math (2, Insightful)

ibsteve2u (1184603) | more than 4 years ago | (#31506688)

fewer in-hospital complications
minus
worse results for impotence and incontinence
plus
210 systems seven years ago to 1,395 today
equals
It is a lot harder to sue for impotence and incontinence than it is for in-hospital complications

Sounds likely, but IANAL.

Re:IANAL math (1)

Carnildo (712617) | more than 4 years ago | (#31515600)

"In-hospital complications" are things like life-threatening infections, uncontrollable internal bleeding, and the occasional dead patient. I don't know about you, but given the choice between wearing a diaper and wearing a body bag, I know which I'd pick.

Top Grade Acai Extreme (-1, Offtopic)

haesry (1769306) | more than 4 years ago | (#31506758)

The active ingredient of the product gently cleanses every single corner without any difficulty. It bleaches and repairs your teeth and gums to make you smile healthier and brighter. Top Grade Acai Extreme [articlesbase.com]

The skill of the person using the tool (2, Insightful)

mikefocke (64233) | more than 4 years ago | (#31506788)

really matters. No matter if you are using a so called robotic tool or an X-ray generating tool, the Doctor you choose and his or her experience and success rate will determine the outcome far more than the type of treatment you choose.

When you talk to a doctor, ask him how many of the procedures he did last year and what his success rate was. I had the choice of a Doctor who answered "3 and I don't know" and a Doctor who answered "several a day and people with your 'scores" have had a success rate of x and a complications rate of y". Show me the Doctor who measures the success of the way he does a procedure and tries to improve and I'll show you the increased success active learning brings.

Plug ProstRcision into your search engine.

Robotic prostate surgery? (1)

idontgno (624372) | more than 4 years ago | (#31507842)

Sorry, there's NO way I'm letting a robot with scalpels anywhere near that portion of my anatomy. I prefer not to be one integer underflow exception away from singing soprano.

Before having prostate surgery (3, Informative)

Budenny (888916) | more than 4 years ago | (#31508866)

Before prostate surgery for you or someone you know, whether robotic or human, check it out very carefully. I did on behalf of someone else, and came to the conclusion that the optimal treatment is intermittent hormone blockage. The technique is, you have total hormonal block for about 9 to 15 months - until PSA falls to zero. Then you go off the blockade.

The rationale is that prostate cancer grows in the presence of testosterone. When testosterone is removed, it dies. It then, in the total absence of testosterone, becomes hormone refractory, that is, it grows in the absence of hormone. You then restore the hormone, and it reverses again.

That at least was my own conclusion, and what I will try if need be. I concluded that local treatments have almost universal side effects of impotence and incontinence, which I think are underreported. And that the dangerous forms of the cancer are probably inoperable locally anyway.

If over some age, don't know quite what, perhaps 80, I concluded there is no point in surgery. We will almost all of us die with prostate cancer. Very few of us will die of it. Over 80, local treatment is probably almost never a good idea.

And do not forget that the biopsy procedure is not risk free, particularly for older men. It can induce total urinary blockage. This then leads to permanent catheterization, which will inevitably result in blockages, followed by hospital visits in the middle of the night, followed by MRSA infections. This happened in a case I knew well. The result was real misery for quite a few years, followed eventually by death from the complications of repeated MRSA infections.

As I said sadly at the time, the tragedy is, he was one of the few men of his age in the country who when biopsied did not test positive. But even if it had, surgery was impossible given his heart health. It wasted the rest of a life, for no good reason.

Before having prostate surgery: part 2 (0)

Anonymous Coward | more than 4 years ago | (#31509534)

http://www.nytimes.com/2010/03/10/opinion/10Ablin.html

Read that article if you're considering having a PSA test. The key assertion, that there are tremendous number of false postives and that for each man saved by PSA + Prostate surgery, 47 men are needlessly harmed frequently resulting in incontinence and erectile disfunction.

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