A Guiding Hand
Robots are showing up in ever more surgical suites. But they're better suited for some operations than others
For patients, robotic surgery promises many of the same benefits as other minimally invasive surgical techniques: shorter hospital stays, quicker recovery times, and reduced blood loss. But for certain procedures, robotically assisted surgery is proving to be even better for patients than laparascopic surgery, which can be hampered by its long, inflexible chopsticklike instruments. With the robot's agility and precision, a surgeon can perform reconstructions that involve complicated suturing, like attaching the urethra to the bladder after the prostate gland has been removed. And it allows them to access small or hard-to-reach areas without damaging delicate networks of nerves or blood vessels.
John Lynch spent just one night in the hospital following his robotic prostatectomy at New York-Presbyterian Hospital/Weill Cornell Medical Center in June. Although he felt some discomfort afterward, by the second day he was taking nothing stronger than ibuprofen to manage the pain. His catheter was removed a little more than a week after surgery, and he had no difficulty with either incontinence or impotence. A month after his procedure, he still felt an occasional twinge from the surgery, but the six small scars on his abdomen, each less than an inch long, were his only reminder. "I wasn't thinking it would take me a year to recover, but this is even better than I expected," says Lynch.
A study published in the British Journal of Urology in 2003 found that robotic surgery to remove the prostate was superior to both laparoscopic and traditional open surgery in every clinical measure, from time spent in the hospital to complication rates to cancer removal. As promising as robotic surgery is, however, even many of its supporters caution that, except for prostatectomies, the jury is still out on whether a robot offers a clear clinical advantage over other surgical methods for many procedures. "It's been demonstrated as a safe and effective device for general surgery, but it may not improve patient outcomes in every case," says W. Scott Melvin, chief of the division of general and gastrointestinal surgery and director of the Center for Minimally Invasive Surgery at Ohio State University-Columbus, one of several training centers that surgeons visit to learn how to use the da Vinci Surgical System, manufactured by Sunnyvale, Calif.-based Intuitive Surgical. It is the only robot approved for use in the United States.
So why are hospitals large and small, more than 300 across the United States, investing up to $1.5 million for a surgical robot whose clinical superiority has yet to be conclusively demonstrated? Attracting top talent is one reason, especially in urology, where graduating students have often trained on robots and are eager to use them. Surgeons also say they like robots because they make some operations much easier, and they believe that results in better patient outcomes, even if they don't yet have much hard data to prove it.
But perhaps just as important, having a robot sends a signal that a hospital is cutting edge, and that can be good for business. "Being able to provide the robotic as well as nonrobotic technology demonstrates a commitment to having the most advanced techniques available," says J.P. Gallagher, senior vice president for Evanston Northwestern Healthcare in Evanston, Ill., which recently purchased a da Vinci system. Some are more blunt. "It's a marketing tool," says Hanmin Lee, associate professor of surgery, pediatrics, OB-GYN and reproductive science at the University of California-San Francisco. "For most uses, I'm not sure the robot adds a lot except to say, 'Look, I'm using a robot.'"
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