Da Vinci Surgery

A product of Intuitive Surgical, the da Vinci robot surgical system is a high-tech telesurgical device that has been FDA approved for a range of minimally invasive procedures. The system uses advanced technology that allows surgeons to get closer to the surgical site and work on a smaller scale than conventional surgery. The $1.5 million robot consists of two main components: a control console and a surgical arm unit with three or four arms, depending on the particular model.

Using da Vinci surgery, surgeons gain seven degrees of motion that extend beyond the limits of the human hand. According to Intuitive Surgical, advantages of daVinci robotic surgery include shorter hospitalization, less blood loss, reduced post-operative pain, faster recovery, minimal scarring and a lower risk of infection. To date, the da Vinci system has been used in some 1.5 million surgical procedures.

Da Vinci surgery is utilized in numerous surgical specialties including:

• Colorectal
• Urology
• Gynecology
• Cardiothoracic performed through the rib cage
• Head & neck procedures performed through the mouth (for malignant and benign tumors)
• General surgery performed through the abdomen

Common da Vinci surgery procedures

The FDA cleared the da Vinci surgical robot for use in general laparoscopic procedures, gynecologic procedures, otolaryngology procedures limited to tumors classified as T1 and T2, thoracoscopic procedures, and thoracoscopically-assisted cardiotomy operations.

Da Vinci robotic surgery is approved for the following procedures:

• Hysterectomy, sacrocolpopexy and myomectomy
• Gallbladder removal
• Radical prostatectomy, pyeloplasty, ureteral reimplantation, cystectomy, nephrectomy
• Cholecystectomy, Nissen fundoplication, Heller myotomy, gastric bypass, donor nephrectomy, adrenalectomy, splenectomy, bowel resection and other colorectal procedures
• Oropharyngeal, laryngeal and hypopharyngeal resections; floor of mouth and oral cavity resections
• Internal mammary artery mobilization and cardiac tissue ablation
• Mitral valve repair, endoscopic atrial septal defect closure
• Mammary to left anterior descending coronary artery anastomosis for cardiac revascularization with adjunctive mediastinotomy

The da Vinci surgical system has been used to treat conditions such as:

• Bladder cancer
• Prostate cancer
• Throat cancer
• Thyroid cancer
• Colorectal cancer
• Lung cancer
• Kidney cancer
• Coronary artery disease
• Endometriosis
• Gynecologic cancer
• Heavy uterine bleeding
• Kidney disorders
• Mitral valve prolapse
• Obesity
• Uterine fibroids
• Uterine prolapse

Risks and contraindications for daVinci surgery

Patients with blood clotting disorders, those who bleed easily, are morbidly obese, or pregnant are not good candidates for da Vinci surgery. Potential complications with robotic surgery include damage to organs and tissues, infection, bleeding and internal scarring that can lead to chronic pain and dysfunction.

Patients are encouraged to speak with their physicians about their surgical experience and training with the da Vinci system, since there is a demonstrated learning curve with new surgical technologies. Some surgeons receive as little as a few days training on the da Vinci system, increasing the odds of serious complications.

The following daVinci surgical complications have been listed in adverse event reports submitted to the FDA:

• Punctured organs and surgical burns
• Burns and tears to blood vessels
• Cut ureters
• Excessive bleeding
• Bowel injuries
• Infection

Bloomberg News reports that at least 70 deaths have been associated with da Vinci surgery over the past four years, and the state-of-the-art system has been the subject of increasing number of da Vinci robot lawsuits as some injured patients claim the device is defectively designed.

How the da Vinci system works

Although the da Vinci system is labeled a “robot,” the device is 100 percent controlled and operated by a physician. From a seated position, the surgeon views a magnified 3D image of the surgical site through the Vision System. Using the da Vinci EndoWrist instruments, the surgeon maneuvers the controls while the device responds in real time, translating every wrist, hand and finger manipulation into precise movements of miniaturized instruments. The patient side cart features an array of specialized instruments, which the surgeon uses through small incisions, no more than 1 to 2 centimeters in length.

Intuitive Surgical claims that daVinci robotic surgery enhances visualization, magnification, and maneuverability, which translates into surgical precision and increased patient safety.

Da Vinci hysterectomy

One of the most common applications of the da Vinci surgical system is for hysterectomies – a procedure indicated for treating heavy uterine bleeding, fibroid tumors, endometriosis, pelvic prolapse or cancer. A robot-assisted hysterectomy is less invasive when compared to traditional open procedures through the abdomen that usually entail a 4 to 6 week post-operative recovery. A da Vinci hysterectomy is purportedly more effective than conventional laparoscopic hysterectomies, as well. Using tiny incisions, surgeons can operate with greater dexterity and accuracy, minimizing the recovery period and lowering the risk of potential complications.

However, post-marketing data and adverse event reports have shown the opposite in some cases, raising concerns over the safety and efficacy of da Vinci robotic surgery. James Breeden, President of the American Congress of Obstetricians and Gynecologists said there hasn’t been good evidence “that robotic hysterectomy is even as good as, let alone better than, far less costly minimally invasive alternatives.”

Da Vinci prostate removal

In the United States, an estimated one in six men will be diagnosed with prostate cancer during their lifetime. A radical prostatectomy – or removal of the prostate gland – is the treatment of choice for most cases of prostate cancer. A da Vinci prostatectomy allows surgeons to operate through a few tiny incisions rather than one large incision, and allows more precise removal of cancerous tissue.

Intuitive Surgical says that da Vinci prostate removal offers multiple benefits including a faster return of sexual function, lower risk of wound infection, and a better chance for return of urinary continence. During the procedure, the prostate is removed through one of the incisions after being detached from the body. After the tissue is removed, the area is cleansed with a sterile solution, a catheter is inserted and the incisions are closed.

Critics of da Vinci surgery have questioned the device’s advantages when it comes to prostate removal. A New York Times article reports “a 2009 study showed that while patients had shorter hospital stays and fewer surgical complications like blood loss when they underwent this kind of robotic surgery, they later experienced more … incontinence and erectile dysfunction,” and that similar complications are occurring with other robot-assisted cancer surgeries.