08 Nov Tools or Techniques – Which is More Important?
Lets look at the most highly advanced “tool” present in medicine for surgery today, the Davinci Robot. The “robot” is a $2 miillon dollar plus instrument that is very technically sophisticated, using some of the most advanced technology to allow the surgeon to actually sit in a console and perform surgery, without even touching the patient. The surgeon can actually have a cup of coffee while he or she is performing surgery!
As a patient, realize that marketing has become a very powerful tool to get you to “ask” for drugs, devices or tools that can be used for anything in medicine, from the treatment of weight loss to surgery. The Internet has allowed much greater access to this type of information, since almost any site that you go to is supported by marketing from drug or device manufacturers. What you need to understand about the robot is that despite all the marketing for the robot by a multibillion dollar company – Intuitive Surgical – the robot DOES NOT KNOW HOW TO PERFORM SURGERY. A surgeon who already has great techniques – which means that surgeon has experience and has already perfected certain techniques and “knows” how to perform surgery – will have a great result with or without the robot. Those surgeons with poor techniques – which means that surgeon does not perform surgery often, does not have great technique, and really may not know how to perform surgery well – will NOT have a great result with or without the robot. The robot will NOT make up for average or below average surgical skill. In fact, the robot is really pretty stupid when it comes to knowing WHAT to do – it takes instructions from the human behind the console. So although a robot may allow some surgeons to perform surgery EASIER, it will not replace the surgeon, and the results with robotic surgery are totally dependent on who is running the robot.
The bottom line: Really good surgeons who have mastered surgical techniques without the robot do NOT need robotics to perform surgery.
There are problems with robotics in GYN surgery. Unfortunately, most “surgeons” performing surgery are OBGYN’s, or “OBs”. Their focus is mainly Obstetrics, not surgery. As a result, most OBs have low surgical volume, and have not perfected techniques to allow for the best surgical outcomes. A robot will NOT replace these techniques. In fact robotic surgery may allow more OB’s to take on procedures that they otherwise would not have, often with results that are not optimal for the patient.
Robotics are very expensive. The cost is very high for purchase at $2 million dollars, and the use of disposable instruments further increases the cost. The time to complete robotic procedures is longer, meaning that the operative time costs increase. There are more incisions with robotic surgery, up to 6 in some cases, and the incisions are often through the muscle of the abdomen in very noticeable areas, increasing the risk of hernia and pain with poor cosmetics. The incisions are often larger. Complications with robotic surgery can be higher, with several studies showing much higher complications that with open or laparoscopic surgery. Patients undergoing robotic surgery are also under anesthesia longer, which has its own risks.
Surgeons with excellent techniques that have been mastered with time and experience will have the best outcomes. Dr. MacKoul for example does NOT use robotics, simply because he does not require that “tool”. He uses laparoscopic surgery, or minimally invasive surgery, using the advanced technique of “retroperitoneal dissection – RPD”. RPD increases the safety of the procedure, allows for almost any patient to undergo surgery effectively with superior outcomes, and avoids the hospital. RPD is revolutionary in its ability to perform hysterectomy, myomectomy (removal of fibroids only), or endometriosis with fewer number and size of incisions – often only two needed – with a much faster recovery and lower complications, as well as lower cost. For more information on Retroperitoneal Dissection and published results, see Number 5 in this series – Superior Techniques, Proven Results, and Publications.