da Vinci Robotic Prostatectomy

Da Vinci robotic prostatectomy remains a popular option for surgeons treating patients with enlarged or cancerous prostates. “The da Vinci prostatectomy is innovative technology that offers extraordinary benefits to patients and revolutionizes the treatment for prostate cancer,” says Dr. Alistair Campbell, a urologist at John Flynn Hospital in Queensland, Australia. He adds that it is “the least invasive surgical approach” to prostate cancer.

The first robot-assisted prostatectomy was performed in 2000. It was pitched as a way to decrease post-operative pain, shorten hospital stays and lessen the amount of blood loss. Manufacturer Intuitive Surgical estimates that the da Vinci robot is used in 4 out of 5 prostate removal surgeries today. Yet, some critics question the safety of this new technology.

How da Vinci robotic prostatectomy works

Prostatectomy is the surgical removal of all or part of the prostate gland for men with enlarged or cancerous prostates. Traditionally, a surgeon would make an eight to 10-inch vertical incision below the belly button and down the abdomen. Most surgeries were being done laparoscopically, where a thin, lighted tube and surgical tools are inserted through small incisions in the abdomen. The surgeon looks at a 2-D monitor to see a simulated view of the organs. However, with da Vinci surgery, a robotic prostatectomy provides high-definition 3-D images for better accuracy and surgeons direct three or four robotic arms equipped with surgical tools in real-time.    

Pros of daVinci prostate surgery

The makers of the da Vinci robots say their technology gives surgeons better visibility and improved control during prostate surgeries. They say other benefits include:

• Less pain
• Less bleeding
• Less scarring
• Lower risk of infection
• Shorter hospital stay
• Quicker return to urinary continence and sexual function 

Cons of daVinci prostate surgery

On the other hand, robot-assisted surgery takes twice as long as traditional surgery (about 3.5 hours, reports the NY Times) and adds another $2,000 onto the price-tag.

Furthermore, a daVinci prostate surgery carries risks of:

• Bladder tears
• Burns to internal organs
• Punctured blood vessels
• Cut ureters
• Excessive bleeding
• Impotence
• Incontinence
• Unknown long-term effectiveness
• Potentially fatal complications

Is a da Vinci robotic prostatectomy worth the risk?

Patients with impending prostatectomies want to know: Is the da Vinci robot surgery worth seeking? First, there is a question as to whether or not the robot surgery provides better outcomes. A study published in The Journal of the American Medical Association found that robot-assisted surgery may lead to shorter hospital stays, lower transfusion rates and fewer surgical complications, but it also carried greater long-term risks of incontinence and impotence.

The New York Times reports that it’s unknown whether the additional cost of the da Vinci robotic surgery is balanced by the lower costs associated with a shorter hospital stay and fewer complications. It is also unclear whether robot-assisted prostate surgery gives better, worse or equivalent long-term cancer control than traditional methods.

A review by New York University scientists found that “Aside from reducing the amount of blood loss, current data suggest that the most significant outcomes (cure, continence, and potency) are no better with Laparoscopic Radical Prostatectomy or Robot-Assisted Laparoscopic Radical Prostatectomy than with conventional Open Radical Prostatectomy.”

Secondly, there are questions of safety. A recent report issued by the FDA and Department of Health and Human Services said the company did not establish clear protocols for cleaning the tools during surgery, which “led to tears or holes in protective tip covers” – that, in turn, led to patient injuries like electrical burns and other robotic surgery complications.

Lastly, it’s important to remember that “newer” does not always necessarily mean “better.” Patients are leading the charge for more robot-assisted surgeries, according to the NY Times. However, at the end of the day, a good robot cannot compensate for a poorly-trained surgeon. It takes 200 to 300 robot-assisted surgeries to be considered “proficient,” says Dr. Ashutosh K. Tewari of New York, who has performed 3,200 robotic operations. 

DaVinci prostate surgery lawsuits

Intuitive Surgical is facing at least 26 lawsuits from patients who were injured during da Vinci robot surgery, according to the New Jersey Star-Ledger. Plaintiffs report punctured blood vessels, organs, arteries and bowel injuries, as well as infections.

One of the da Vinci robot lawsuits has received a verdict so far. Iln the case of 67-year-old Fred Taylor, a five-hour prostatectomy turned into a 13-hour ordeal. Mr. Taylor subsequently died of kidney and lung damage, sepsis and a stroke four years after his robotic surgery. His family sought damages, but a Washington jury voted 10-2 in favor of Intuitive Surgical, stating that surgeon inexperience, obesity and a previous hernia operation were the factors that ultimately led to his demise.

Even so, lawyers are pushing ahead with new cases. One of these recent filings includes a New York man whose colon was perforated during a da Vinci robot prostatectomy. The success of a daVinci prostate surgery lawsuit eventually comes down to proving that Intuitive Surgical was negligent in manufacturing and marketing, while also ruling out other medical conditions that could have led to a patient’s injuries