Ready for Robots in the OR?

Since the advent of minimally invasive surgery, when everything else is equal, the procedure of choice should be minimally invasive over the "open" method. The caveat is knowing when "everything else" is truly equal, especially, the surgeons experience.

The question then would be, with respect to radical prostatectomy:

Does robot assisted minimally invasive surgery have any advantage over the standard laparoscopic minimally invasive surgery?

The peer reviewed evidence based studies have shown the following results;

1. No difference in complication rates from the two minimally invasive surgeries.

2. No difference in treatment outcomes of cancer recurrence or cure rates.

Once again the surgeons experience is the discriminator. The standard laparoscopic minimally invasive surgery has a steep learning curve and a surgeon must have performed over 80 cases before he approaches the skill level of a surgeon performing the robot assisted procedure by their second or third case. So with an experienced surgeon and a patient that has minimal or no medical problems then the choice between the two merely boils down to patient convenience or preference.

The final questions to be asked by an organization that is considering robotic surgery is;

1. Does the Robotic procedures on a cost-benefit analysis for both tangibles and intangibles(ie. the publics opinion of who is the best) make economic sense?

2. Is there future "value-added" benefits by incorporating the new technology?

For both questions the answer is a resounding.... YES..

First and foremost is the issue of Extinction....the number of experienced surgeons able to perform non-robotic minimally invasive surgery is constantly dwindling, and will approach zero, sooner than most people realize.

Second, ...a trained non-surgical physician or "a properly trained" mid-level, can be at a remote site in "real-time consultation" with "the specialist surgeon" and ultimately attain comparable robotic surgery results,...Great for organizations that have "long tails" i.e. military medicine, Docs-without-borders" and other crisis management medical-surgical teams.

I agree on your statement of "everything else" being equal, it is only the craftmanships of the surgeon that will make the difference! By the way most "robotic surgery procedures" are "laparoscopic in nature". Beside the fact that the surgeon can be remotely located, far from the actual procedure, the main difference is the removal or minimization of any shakes or tremors inherent to the surgeon. Any natural risks associated in a laparoscopic procedure, whether done by a robot or by a human, are still present especially the accidental burning / damaging of organs around /near the main surgical site, which is inherent to the laparoscopic procedure!