da Vinci Robotic Surgery
The da Vinci surgical robot helps doctors perform complex, minimally invasive surgeries like hysterectomies and prostate operations. But some patients suffer serious complications that require additional procedures, some of which can be fatal.
Developed and marketed by Intuitive Surgical, the da Vinci Surgical System gained approval by the U.S. Food and Drug Administration (FDA) in 2000. California-based manufacturer Intuitive created the multi-armed robot to assist surgeons with more precise, minimally invasive surgery through small incisions that don’t require doctors to open the abdomen.
One of my readers commented asking if I’d ever heard about “Unplug the Robot”? I replied I hadn’t. She wrote about how the da Vinci robot she had for her hysterectomy ruined her life and other women’s lives as well.
Some of these stories are terribly tragic.
The consequence is that little is known of the real disadvantages of the equipment [the da Vinci robot], and the injuries and deaths it may cause, even as robotic surgery is widely marketed to consumers. ~ Dr. Diana Zuckerman.
Personally, I haven’t heard a single terrible story of any patient I have known or treated regarding the da Vinci method which is not to say there aren’t tragedies happening left and right of which I’m not aware of. The da Vinci robot can be used for many other surgeries and not simply hysterectomy. While I don’t work directly with da Vinci or its company Intuitive Surgical, my blog is not about promoting the use of da Vinci itself, but rather to chronicle my experience with hysterectomy … I would have created this blog regardless of the method (and outcome) I had.
In the beginning, I was planning on having my hysterectomy the laparoscopically assisted vaginal method (no robot involved) believing there was less scarring and was easier for the surgeon. My case was actually booked that way for a few days until I had an in-depth discussion with my GYN surgeon while also reading quite a bit about the da Vinci method.
The da Vinci is not, strictly speaking, a robot. It is a surgical tool and interface for that tool. Robots perform a pre-programmed sequence of steps that may or may not be conditional on input (think the IRobot vacuum). The surgery performed with it is only as good as the surgeon. A poor surgeon or poorly trained surgeon will not use it optimally. ~ random commenter
I had a lot of trust in my surgeon … and still do. He’s been a physician for a very long time … in fact, he graduated high school the year I was born! He has received many accolades on his performance and patient satisfaction throughout his years of practice. I can tell by many things about his personality that his “job” of being an Ob/Gyn was a career and calling. Luckily, my hysterectomy performed with the da Vinci robot laparoscopically assisted went off without a hitch.
Sometimes when surgeries don’t go as expected there are numerous reasons for these problems like:
- The baseline of the patient’s basic health. If you start out with a patient who has lung or heart problems there are simply greater risks involved in healing and effects of anesthesia and recovery from surgery.
- Age can also play a role in a patient’s recovery — in general, the young and the elderly are at higher risks because the young have smaller bodies (typically) and aren’t fully developed like an adult, and the elderly can often have less lung reserve capacity, decreased ability to heal as quickly, less physical mobility and flexibility to name just a few challenges with this group.
- The patient’s psychological baseline and readiness for surgery is a huge component in successful recovery. Sometimes surgeries are emergencies and the patient cannot take the time to adequately prepare emotionally for surgery. Some people struggle with anxiety and depression among other mental health and chemical imbalance disorders that can sometimes place them at a disadvantage with healthy coping mechanisms in terms of recovery.
- The experience of the surgeon really is one of the key components to successful surgeries, but not all patients are the exact same in anatomy and health status, so that the surgeon has to draw on experience making the best decision at the time when a surgery goes awry. There is a lot to be said for training and the number of that type of surgery he/she has performed.
- Patients bodies are many times similar in general, but can often be unique. If a patient is a person of size (POS), there are going to be much greater challenges to performing many surgeries and the anesthesia risk increases as well (think short neck and/or sleep apnea). When a POS has extra body tissue it is not often muscle, but rather fat and adipose tissue simply doesn’t heal as well as non-fatty tissue because it lacks the vasculature to deliver nutrients via the blood to assist in the healing process. Special surgical (and scanning) tables are often required for patients weighing over 350 lbs. (~ 160 kG). It is more difficult to physically reach into a patient that has a greater visceral depth while specialized equipment is needed to keep the area open for the surgeon to have an adequate working field.
- Another factor in having a successful outcome for a surgery is the team in the operating room, the recovery room and even the area where the patient will recuperate — AKA the nursing floor. The more experienced the team, the more outcomes they have seen and worked with. A newer nurse may know something is amiss after surgery, but an experienced nurse may know what that problem is more quickly related to having more time-in-grade experience. Whether the nurse is newly graduated or has dozens of years of experience is immaterial if he/she lacks care. Care and attention should be the primary components of caring for all patients.
- Malfunctioning or lack of the proper surgical equipment can lead to disastrous results. However, in my experience, hospitals in the U.S. go through rigorous preparations to ensure their operating rooms are up-to-date with proper equipment working and available prior to the surgery. There are many regulatory agencies that mandate this such as OSHA and JCAHO. Surgeons will leave hospitals and work elsewhere if the equipment they want and need is either not available or not functioning to their standards.
I cannot speak to the individual cases of da Vinci Hysterectomies gone awry because there can be several and differing reasons why these operations ended up as either surgical misadventures and/or maladies for the female patients involved. One has to be careful when making assumptions that a particular surgery is “all good” or “all bad”. The cliched saying is that medicine is both an art and a science.
I recommend anyone contemplating a non-emergent surgery to get a second (or third) opinion and do as much possible research on the surgeon including his/her experience with any robotic equipment, the hospital where the surgery will be performed along with the technique of surgery recommended — and this advice is not merely for the laparoscopically assisted da Vinci hysterectomy, but ALL other major surgeries as well! Another recommendation I’d like to make is to explore ALL other options — especially non-surgical weighing the pros and cons, risks and advantages of each. Surgery doesn’t always have to be the answer.
There are horror stories about robotic surgeries gone awry found in the pages of thousands of lawsuits. But experts interviewed by Healthline lay the blame for these negative outcomes at the surgeons’ feet, not at the robot’s. Whenever a new technique enters the operating room, some doctors make mistakes with it. They are, after all, only human.
‘When [laparoscopic surgery] was introduced, there was a spike in patient complications. That was because, in general, the surgical field was getting trained; there were errors, there were mistakes. Now fast-forward, this is just kind of par for course when it comes to introducing a disruptor. You’re going to run into these issues,’ said the ECRI Institute’s Schabowsky.
The key is for patients to minimize their chances of being one of the mistakes by ensuring their surgeons have ample experience with any device they plan to use in the OR. That information can be hard to get, the experts agreed — only cardiac surgeons currently make such records available to the public.
But consumers aren’t doing their part, either. ~ Cameron Scott
from HealthLine (Feb 2015)
There are women out there who have researched their surgery, were in good health, trusted their surgeon and still had complications from their hysterectomy … my heart goes out to all of these women! It’s possible I could have been one of them and this blog would be written with a completely different perspective. Fortunately most elective surgeries do turn out well with most people being greatly satisfied they chose to have the surgery to include the robotic method. It’s an extremely unfortunate circumstance of life all surgeries cannot go 100% well without any problems … living life and having surgeries involve risk. Merely being alive is risky … but it beats the alternative.