surgeon here - 15 years - thinking about, but haven't received training to allow me to use the robot.
I consider myself a moderately advanced laparoscopic surgeon - I do lap cholecystectomies (gallbladder), laparoscopic hernias, adrenals, appendectomies, Nissen fundoplications, colons, biopsies.
I think there is a place for robotic surgery, but you have to maintain your skills to keep using it - at our hospital, robotically certified surgeons have to do at least 25 robotic cases per year to maintain certification - for my caseload, I don't think I have more than 10-15 cases that would warrant the robot so I would basically be taking 10-15 patients to the OR to do their case robotically in order to maintain my certification.
The advantage of the robot is that it is ridiculously easy to sew vs laparoscopically. To sew laparoscopically, you have a 2 foot long instrument holding the needle and trying to sew. For the robot, it follows the movement of your wrist and hand precisely. It really is amazing technology, but there is only specific, limited use in my opinion.
For example, for prostatectomies, it is awesome. In open prostatectomies, it's difficult to see the pudendal nerves and so they are sometimes sacrificed - no more erections! View is magnified and 3d in robotic. In addition, anastomosing the bladder back to the urethra happens under the pubic bone so only a limited number of sutures can be placed in the traditional way, whereas with the robot, it's a running circular stitch - less urinary leaks with the robot means less incontinence.
The biggest issue is that in our literature (general surgery) all of the research papers the last several years regarding the benefits of robotic surgery are funded by Intuitive Surgical, which leads to bias. It has it's place, but they are a company and are driven by profit - it behooves them to get a lot of surgeons trained so that we're all fighting for the robot, so the hospital feels they have to buy another!
My current status (as told to the rep) "Let's see if Dr. SoAndSo is still doing robotic surgery in 2 years...."
The only plus is that several other companies are going to be entering the market soon, so hopefully costs will go down bc now the robots are several million for one and the instruments are reusable (10 times), but cost $3k. Just look at ISRG......
"but haven't received training to allow me to use the robotbut haven't received training to allow me to use the robot"
What does such training consist of? Is it how to use the robot (like, these are the menus on the machine, and practice with these joysticks) or are the procedures different? I guess I'm asking, are robotic operations completely different from their manual counterparts, or are the 'just' the same except with the robot doing the moving for you?
I consider myself a moderately advanced laparoscopic surgeon - I do lap cholecystectomies (gallbladder), laparoscopic hernias, adrenals, appendectomies, Nissen fundoplications, colons, biopsies.
I think there is a place for robotic surgery, but you have to maintain your skills to keep using it - at our hospital, robotically certified surgeons have to do at least 25 robotic cases per year to maintain certification - for my caseload, I don't think I have more than 10-15 cases that would warrant the robot so I would basically be taking 10-15 patients to the OR to do their case robotically in order to maintain my certification.
The advantage of the robot is that it is ridiculously easy to sew vs laparoscopically. To sew laparoscopically, you have a 2 foot long instrument holding the needle and trying to sew. For the robot, it follows the movement of your wrist and hand precisely. It really is amazing technology, but there is only specific, limited use in my opinion.
For example, for prostatectomies, it is awesome. In open prostatectomies, it's difficult to see the pudendal nerves and so they are sometimes sacrificed - no more erections! View is magnified and 3d in robotic. In addition, anastomosing the bladder back to the urethra happens under the pubic bone so only a limited number of sutures can be placed in the traditional way, whereas with the robot, it's a running circular stitch - less urinary leaks with the robot means less incontinence.
The biggest issue is that in our literature (general surgery) all of the research papers the last several years regarding the benefits of robotic surgery are funded by Intuitive Surgical, which leads to bias. It has it's place, but they are a company and are driven by profit - it behooves them to get a lot of surgeons trained so that we're all fighting for the robot, so the hospital feels they have to buy another!
My current status (as told to the rep) "Let's see if Dr. SoAndSo is still doing robotic surgery in 2 years...."
The only plus is that several other companies are going to be entering the market soon, so hopefully costs will go down bc now the robots are several million for one and the instruments are reusable (10 times), but cost $3k. Just look at ISRG......
- surgeon