Scalpels in Hand, Robots Take to the ER
TUESDAY, April 27 -- People facing surgery often imagine themselves under the care of a trained surgeon wielding a scalpel with a steady hand and a cool disposition.
But that picture is changing.
The surgeon will still be there, but the steady hand might very well not be human.
Robotic surgery is becoming a popular alternative to traditional surgical practices. For example, the number of prostate surgeries performed using robotic instruments increased from 9 percent in 2003 to 43 percent by 2007, according to a study published in late 2009 in the Journal of the American Medical Association.
For the surgery, thin tubes containing cameras and robot-controlled surgical instruments are inserted into the body through tiny incisions, and the procedure is performed internally. Proponents of the method say the technology allows for less-invasive surgery, which leads to a faster recovery.
"You used to have to make a pretty big incision in the pelvis to do prostate surgery," said Dr. W. Randolph Chitwood Jr., director of the East Carolina Heart Institute and chairman of cardiovascular and thoracic surgery at East Carolina University, who is also a pioneer in the use of robotic surgery. "With this technology, we can now access the internal organs through tiny incisions."
The technology is not flawless. The Journal of the American Medical Association study found that people who underwent minimally invasive robotic prostate surgery had an increased risk of incontinence, erectile dysfunction and other genitourinary complications.
Surgeons had hoped that the use of robotic instruments would protect the nerves surrounding the prostate by removing some of the shakiness that exists in even the best-trained hands, said Dr. Otis Brawley, chief medical officer of the American Cancer Society.
"It is decreasing the shaking, but it didn't decrease the amount of trauma to the nerves," he said.
However, patients also sustained less blood loss, had fewer complications overall and were more likely to heal faster and spend less time in the hospital, the study found.
But how does the average person know whether robotic surgery would be the right option? And if you decide to pursue robotic surgery, how can you make sure you're in the best hands possible?
First, research the team that would perform the surgery, said Chitwood, who regularly trains surgical teams on the use of robotic instruments.
Successful use of the new technology, he said, depends on whether the surgeons already are skilled at the procedure in question.
"This will not teach you how to repair heart valves," he said. "But if you take someone who's already performed the operation and already knows what they're doing, this can make the surgery less invasive. What we preach to people [is that] if you haven't done much microvalve surgery, it's not the time to come learn from us."
The entire team that will be involved in the surgery should be trained in the use of robotics, Chitwood said. Surgeons need to know how to use the equipment, and assistants and nurses need to know how to troubleshoot the technology. "You train them on the nuances of the device, and then you do team training so the scrub nurse and the assistant and the surgeon can work in synchronicity," he said.
Someone considering robotic surgery also should ask how often a surgeon performs the surgery because repetition builds skill with the equipment, Chitwood and Brawley said. A surgeon who has performed the procedure hundreds of times simply has more experience than someone who's performed it a dozen times, they said.
Also ask about the outcomes of earlier patients, and how those outcomes compare with those of people who had traditional surgery at the medical center in question. "My experience is that the better doctors are willing to discuss that," Brawley said.
He suggests that people facing the choice of robotic versus traditional surgery interview three or four surgeons who perform one or both forms of surgery -- and also try to talk to some of their patients.
"Interview these doctors and then make a gut decision about what's right for you," Brawley said.
But even if you've found the right team, that doesn't mean robotic surgery is the right choice for you.
"The story has been written time and time again that the new technology or medicine is superior to the old standard," Brawley said. "Sometimes it is not."
A number of risk factors should be taken into account before choosing robotic surgery over traditional surgical methods, including the prospective patient's age and overall health, Chitwood said. And anyone who has a risk factor that increases the chances of complications should seriously consider standard surgery, he advised.
"No one wants a big cut, but they'll take a big cut for safety and to have the procedure done properly," he said.
The U.S. National Library of Medicine has more on robotic surgery.
Posted: April 2010
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