Health, Prostate

The Da Vinci Robotic System: A Unique Niche?

As Dr. Samadi mentioned in his October 30, 2012 post, robotic surgery has many benefits over more traditional methods including less blood loss, a shorter hospital stay, and better functional outcomes which leads to a better post-surgery life. Additionally, enhanced dexterity and a 3D vision system allow the surgeon to perform procedures with impressive precision.

With all that said, one would think the robotic platform is a no-brainer. Right? Well, sort of. The cost of robotic surgery is justified…sometimes. We believe taking a broad view of the subject is a mistake. Too often robotic surgery is generalized, leaving no room for anything other than opinions of good vs. bad. For example, robot-assisted prostatectomy has displayed many improvements over traditional laparoscopy and open surgery. However, other procedures may see little improvement from incorporating the robotic technique. In such cases, the cost is most definitely not justified. However, for procedures in which fine movements and increased dexterity are more important, the answer to our original question is a resounding yes.

For this reason, the da Vinci robotic system has found a unique niche within urologic surgery as several different procedures require such precision within the abdominopelvic cavity. Our article, A Practicality Analysis Pertaining to Minimally-Invasive Urologic Surgery**, attempted to explore the ‘practicality’ of three different urologic surgery procedures (Radical Prostatectomy, Pyeloplasty, and Partial Nephrectomy) performed using either standard laparoscopy or robot-assisted laparoscopy. Using a pilot scoring research tool, we found each of the three procedures to be more practical when performed with robot-assistance. Our analysis displayed that although traditional laparoscopy is less expensive in most cases, the benefits of robot-assistance outweigh the difference. Further, our review of the literature displayed many other advantages that could separate robot-assisted surgery in the future. We plan to modify our research tool to give a better idea of how to weigh cost versus benefit. This piece is currently under peer review.

Ideas such as teleprescence surgery, in which a surgeon could perform from an off site location, could bring the economics closer to more traditional methods. Additionally, though the idea of automated surgery is certainly years away from becoming a reality, it seems robotic technology could lead the way toward such possibilities. However, that discussion is for another post.
So now that we’ve seen the evidence, why not just focus on developing robotic surgery to make it more affordable and accessible? Robotic surgery is no longer a novelty and nor should it continue to be discussed in such a way. Rather than continuing the endless discussion on whether the robotic platform is truly that much better, let’s move forward and see how more effort can be put towards collaboration between the the current supporters and detractors. Surely a combined effort will allow for incredible improvement over the coming years.
**Please see: http://www.urj.ucf.edu/vol6issue2/cavayero/index.php

Authors:

Chase Cavayero, DO(c) & Michael J. Rovito, PhD

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