The Da Vinci robot was developed by the manufacturer Intuitive Surgical. It was FDA-approved for use in soft-tissue surgeries. These include: cholecystectomy, hysterectomy, prostatectomy, and many other open and laparoscopic surgeries. The Da Vinci robot must be operated by a trained surgeon. The device has many arms and tools, and a camera that gives the surgeon a 3D, high definition view of the area being worked on. When used ideally, the Da Vinci robot provides many benefits to both doctors and patients.
Benefits of the Da Vinci Robot
Benefits of Da Vinci assisted surgery include:
- Less blood loss
- Faster patient recovery process
- Minimally invasive
- Magnified view of area being operated on
- Decreased chance of infection
- Need for fewer surgical assistants
- Reduced risk of errors caused by hand tremors
- Surgery is performed sitting down, reducing surgeon fatigue
Da Vinci Robot Features
The Da Vinci robot is comprised of four main elements. The first is the vision system, a remote camera and imaging equipment that allows the surgeon to the see inside the patient’s body during laparoscopy, or take a closer look at the incision during open surgery. The system operates by sending about a thousand frames per second through a video processor that eliminates background noise. A foot pedal allows the surgeon to switch views.
The second element is the patient side cart, which is the set of arms that directly contact the patient during surgery. This includes two or three arms that doctors can attach different instruments to, depending on what is needed. Additionally, an endoscope arm allows the camera to reach the area of interest. In 2003, Intuitive Surgery added the third arm at an added cost for new installations and an upgrade for existing machines. This gives surgeons an extra arm for complex surgeries and eliminates the need for an operating room nurse.
The third is the surgeon console, from which the operation is remotely controlled. This is a few feet away from the operating table. Surgeons tilt their head forward to view the 3D imagery, and connect their hands to the main interface to control the arms of the Da Vinci robot.
The fourth element of the Da Vinci robot is the detachable instruments. These can perform functions such as suturing, cutting, and clamping. The arms and instruments have movement advantages over human hands and arms, being able to pivot completely and maneuver into smaller areas.
The Da Vinci robot has the ability to filter out hand tremors, and can sense when it is about to bump into another instrument. Carbon dioxide is often pumped into the patient’s cavity during a laparoscopic surgery. This allows the doctor can see more clearly and there is more room to navigate the robotic arms. The carbon dioxide is easily absorbed by the patient’s body and exhaled.
Da Vinci Robot Complications
There has been a recent spike in the number of issues reported to the FDA from surgeries in which the Da Vinci robot was used. Since January 2012, there have been five deaths reported and as many as 500 incidents. Most of these incidents stemmed from a lack of training before use, but some have occurred because of malfunctions on the part of the machine.
It is yet unclear whether the spike is a result of increased use, a recent change that Intuitive Surgical made in the way that incident reporting is done, or an actual increase in incidents. The FDA has begun a systematic review of articles and studies associated with the Da Vinci robot. The FDA is also currently conducting surveys with surgeons that have worked directly with the machine to find out more about the reason behind the increase in incident reports.
Da Vinci Robot Controversy
There is a concern that hospitals may be promoting use of the Da Vinci robot in order to garner new patients. This in turn helps to cover the high cost of the robot. Each new Da Vinci robot costs about $1.8 million. There is much debate about whether the perceived benefits of using the system outweigh the possibility of incidents.
Recent Incidents during Da Vinci assisted surgery:
- A robotic arm hit a patient in the face during a hysterectomy
- A robotic arm wouldn’t let go of tissue grasped during a surgery
- Patient’s colon was allegedly perforated during a prostatectomy
- Patient died during a hysterectomy when a blood vessel was nicked
- Patient died after spleen surgery