tag:blogger.com,1999:blog-4968787219619380438.post1904866649602322787..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Is robotic surgery the “laser” of the 21st century?Skeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger57125tag:blogger.com,1999:blog-4968787219619380438.post-6658681206637082772013-05-29T16:30:47.855-04:002013-05-29T16:30:47.855-04:00Anon, thanks for your comments. It is an interesti...Anon, thanks for your comments. It is an interesting debate.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-43842129536516106312013-05-29T15:40:21.496-04:002013-05-29T15:40:21.496-04:00Well "The Robotic Proponents" are one cr...Well "The Robotic Proponents" are one crew of people, and the highly distinguished and renowned Urological Surgeons of MSK a totally different set of people.There are matters in Urological science, in which I differ from the highly respected scholars and Urological surgeons you find at MSK, but that is another issue. MSK has once again gained in esteem and added to their internationally excellent reputation by the described decision to discontinue the trial. World Urology needs more of that kind of high morals and unbiased evaluations. We aren´t monkeys in a circus running around to the grab as many bananas as possible in the shortest time...at least not all of us! Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-38356731571690346852013-05-28T17:55:14.246-04:002013-05-28T17:55:14.246-04:00Thanks for the link. I had read about the paper. T...Thanks for the link. I had read about the paper. The robotic proponents have dismissed it as a bad study. They say the MSK urologists were not experienced enough and many other objections.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-84272082940592259262013-05-28T16:43:08.245-04:002013-05-28T16:43:08.245-04:00Memorial Sloan-Kettering closes a randomized prosp...Memorial Sloan-Kettering closes a randomized prospective trial after interim analysis. No difference between Robotic cystectomy with Ileal conduit versus Open with the same urinary diversion.<br /><br />http://www.aua2013.org/webcasts/webcasts.cfm?id=PLIIM-6_Laudone<br /><br />My conclusion (and many with me), the new "technique" failed to show any significant differences.No improved outcomes.It is a paradigm in the medical world: a new method should offer significant improvements before being introduced. If no differences, the standard "old" method should not be abandoned. End of storyAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-1679531146364970592013-05-26T13:47:15.629-04:002013-05-26T13:47:15.629-04:00I had seen that report when it was first published...I had seen that report when it was first published. As you may have heard, Intuitive won its first lawsuit. A patient's family in Washington State alleged that a surgeon was not properly trained to do a robotic prostatectomy. See story here http://www.bloomberg.com/news/2013-05-23/intuitive-wins-trial-defeats-negligent-training-claims.html.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-12107635332229238172013-05-26T13:37:39.455-04:002013-05-26T13:37:39.455-04:00Please Google "the Citron report on robotic s...Please Google "the Citron report on robotic surgery" and every intelligent reader will find that a MAJOR backlash for this overhyped gimmick is in the coming...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-80845200526716038312013-05-09T21:13:18.003-04:002013-05-09T21:13:18.003-04:00Anon, thank you for your thoughtful and interestin...Anon, thank you for your thoughtful and interesting comments. A lot has happened in the year and a half since I wrote this post. <br /><br />It sounds like you are being very responsible and careful with the robot. That's good. <br /><br />Your anecdote about the robot making single-site cholecystectomy easier is not supported by any literature to date. The jury is still out on whether robotic cholecystectomy is an improvement on standard laparoscopic cholecystectomy.<br /><br />I am not the only one questioning whether the supposed better cosmetic result of the larger single incision which is also more hernia prone is worth it to avoid two or three 5 mm incisions which are nearly invisible 6 months later.<br /><br />And the average elective lap chole usually does not require 3-D vision and increased cost for the equipment.<br />Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-39513637855701653702013-05-09T20:15:18.820-04:002013-05-09T20:15:18.820-04:00I think there is a ton of misinformation here. I ...I think there is a ton of misinformation here. I am a board certified general surgeon with 16 yrs experience and use the robot on a regular basis. I have been in the same practice location my whole career. The Da Vinci robot should be viewed as another tool in the surgeon's toolbox. It should not be viewed as something that should always be used, nor should it be viewed as something that should never be used. Anyone who believes either of these two opposite extremes has an agenda.<br /><br />I use it selectively. I frequently do single site cholecystectomy, and yes patients absolutely do have better cosmetic outcomes. The robot makes this much easier. The 3-D camera alone makes use of the robot worthwhile in difficult dissections. To say otherwise only shows ignorance.<br /><br />The key with the robot, as with all medical devices, is to make sure you use it appropriately. The robot does not cause injuries. It only does what the surgeon tells it. A bad surgeon will be a bad robotic surgeon. <br /><br />My prediction is the robot will be around forever. It is silly to think we sit at the apex of technical development in surgery. It will not go away, but it will probably get better. Surgeons who do not learn how to use the robot effectively will one day be as outdated as surgeons 25 yrs ago who refused to learn laparoscopy.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-82508750842301835062013-04-01T13:02:26.401-04:002013-04-01T13:02:26.401-04:00I haven't seen those commercials. Where are th...I haven't seen those commercials. Where are they running and what do they say?Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-48770329960502881452013-04-01T12:56:42.743-04:002013-04-01T12:56:42.743-04:00I've noticed the bad robot surgery commercials...I've noticed the bad robot surgery commercials playing a lot recentlyBad Robot Surgeryhttp://www.davincisurgery-lawsuit.com/bad-robot-surgery/noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-79994861908702519302013-02-14T12:37:59.114-05:002013-02-14T12:37:59.114-05:00Thanks for telling us your story.
I'm not sur...Thanks for telling us your story.<br /><br />I'm not sure how taking "magic pills" speeds healing of nerve endings.<br /><br />I would say you are most fortunate to have had such a great result. I hope you continue to enjoy good health.<br /><br />Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-61217140838971424332013-02-13T23:39:36.030-05:002013-02-13T23:39:36.030-05:00OK....here goes. I was diagnosed with one site (o...OK....here goes. I was diagnosed with one site (out of 12) in the spring of 2007. Figured I would have PC....dad had it and two male cousins, one on maternal and the other paternal also had PC. One was a renowned surgeon and wanted my dad to have surgery....Dad opted for radiation. LC got him...but I always wondered if the LC was triggered by the radiation. Turns out, my cuz, the MD went for hormone.<br /><br />My Gleason score was low....the Doc said it would have been PRE-Cancerous 3 months earlier.<br /><br />I had LOT of time to think and to evaluate. I am a professional with an Engineering degree and have had to make a LOT of decisions about equipment, people, scrap vs repair, etc in my career.<br />I listened to the MD that did the biopsy. A little younger than me. He said that he would have the DaVinci and finally said which one of their two certified surgeons he would prefer.<br /><br />The surgery was a piece of cake. I was up..but later on, I had some issues. GASTRO, not DaVinci related. My system would not get regular again....so I had water diarehea....back to the hospital. Once I got my system back in sync, I progressed quickly.<br /><br />My surgeon was a genius....probably played video games through Med School. My "manhood" responded quickly and my wife told me to slow down because our sex life was normal after 6 weeks. I had the magic pills, but only took them 5 or 6 times per month. I took them to speed healing of the nerve endings.<br /><br />That has been 5-1/2 years ago. Everything is still in tip-top working order....and I am now almost 68. I gained a little weight and my BP almost required meds. I went on a Wellness Program and improved my diet and exercised. Lost almost 20% of my weight and two pants sizes. Interesting, my libido went into overdrive....picked up a little weight while I got my AFib under control. Then as I started losing weight, it has come back....my WIFE is happy, except when I am really charged up for extened periods of time....she calls me Slick in honor of our former Prez who had quite a sexual appetite.<br />I have recently seen all the commercials about BAD ROBOT SURGERY. Not EVERY surgery is as successful as mine. However, based on all the horrors of scapel surgery and the complications, the Robotic is the ONLY way to go. I know several men that have had the DaVinci and they all rave about it. Each had different surgeons in different parts of the state and different practices.<br /><br />SO, if the surgeon is qualified, then the Robotic is the only game for me. If I had to do it over again, SAME deal....Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-3709888588352009222013-01-11T17:51:37.961-05:002013-01-11T17:51:37.961-05:00The only national organization that I am aware of ...The only national organization that I am aware of is the AAGL (formerly the American. Association of Gynecologic Laparoscopists). I hear they are about to issue a position statement saying robotic hysterectomy is not worth the expense.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-52948538676395244972013-01-11T16:59:36.405-05:002013-01-11T16:59:36.405-05:00Is anyone aware if the American College of Surgeon...Is anyone aware if the American College of Surgeons or any surgical specialty societies have made policy statements regarding the use of the Da Vinci robot? Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-91115909972633602142013-01-10T09:49:34.818-05:002013-01-10T09:49:34.818-05:00The increasing problems for the maiming Robotic gi...The increasing problems for the maiming Robotic gimmick and the company producing it, is also commented upon in Foxbusiness recently:<br /><br />Quote:<br /><br />"I have shared favorable views on Intuitive Surgical (ISRG) in the past, but I am cautious on this name now due to slowing prostate removals and concerns regarding growth in other areas. The company has attracted several lawsuits alleging quality issues".<br /><br /><br />http://www.foxbusiness.com/investing/2013/01/09/medical-device-companies-could-look-healthier-in-2013/<br /><br />...and the upcoming lawsuits have drawn attention in two recent articles in San Francisco Chronicle:<br /><br />http://www.sfgate.com/business/prweb/article/Da-Vinci-Surgery-Robot-Lawsuits-Now-Being-4120879.php<br /><br />Quote:<br /><br />"Da Vinci Surgery Robot lawsuits are now being investigated by Bernstein Liebhard LLP. Victims of serious injuries that occurred during robotic surgery procedures that utilized the Da Vinci Surgical System may be entitled to compensation"<br /><br />Further;<br /><br />http://www.sfgate.com/business/prweb/article/Da-Vinci-Surgery-Robot-Lawsuits-Mount-as-4162171.php<br /><br />Quote:<br /><br />"Da Vinci Surgery Robot lawsuits continue to be filed by plaintiffs around the country who allege use of the machine in hysterectomies and other procedures led to serious injuries, including surgical burns and tissue damage, Bernstein Liebhard LLP reports. According to a report issued by Citron Research on December 19, 2012, Intuitive Surgical, the manufacturer of the Da Vinci robot, has been named in nine such claims, including three that involved hysterectomies. Two of the lawsuits detailed by the Citron report are wrongful death claims".<br /><br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-43683532674067137482013-01-10T08:42:24.749-05:002013-01-10T08:42:24.749-05:00Thanks. If you click on the link, you will discove...Thanks. If you click on the link, you will discover that the CEO of the company that makes the robot sold $50 million of its stock last month. Also, it mentions that a lot of lawsuits against the company have been file filed.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-24644871071709257932013-01-10T08:16:00.099-05:002013-01-10T08:16:00.099-05:00Dark clouds on the horizon?
http://www.consumerin...Dark clouds on the horizon?<br /><br />http://www.consumerinjurylawyers.com/intuitive-surgical-stock-price-expected-to-fall-as-da-vinci-surgery-robot-lawsuits-riseAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-31349746422601784952013-01-07T16:50:11.394-05:002013-01-07T16:50:11.394-05:00And further a comment to Ari: Great to hear that y...And further a comment to Ari: Great to hear that your uncle is doing well, but you should also know that more and more data being accumulated these ten last years point at Watchful Waiting instead of surgery, as a viable option in many patients.A substantial amount of patients who do not require surgery, still are sent to surgery. The huge capital investment in Robot Surgery has to "pay off" - regardless if the indications are sound and solid or not. It should be noted that the "Robotniks" are those who most aggressively try to promote Prostate Cancer Screening, a very unsolide and dull tool for detecting "significant cancer". The Robot investment has to pay off! Note that the U.S. Preventive Services Task Force, just recently has recommended AGAINST prostate cancer screening.<br />http://www.uspreventiveservicestaskforce.org/prostatecancerscreening.htm<br />And guess what group is most upset over that....Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-85068788327992572902013-01-06T20:55:18.711-05:002013-01-06T20:55:18.711-05:00Ari, I am glad your uncle is doing well. However, ...Ari, I am glad your uncle is doing well. However, I hope you understand that he might have fared just as well with surgery that di not involve the use of a robot.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-54456940361812855442013-01-06T12:04:59.826-05:002013-01-06T12:04:59.826-05:00My uncle had robotic surgery for lesions and tumor...My uncle had robotic surgery for lesions and tumors from prostate cancer. We were all anxious about it but the recovery time was minimal and his cancer has been in remission for months. Better training and improved technologies could make this a winner in the future.Arihttp://www.hudsonrobotics.com/products/noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-8507549798053091012012-12-21T14:42:05.232-05:002012-12-21T14:42:05.232-05:00I guess the robot could be used in space and contr...I guess the robot could be used in space and controlled from earth. Just hope that the datalink doesn't fail during the case or that a problem doesn't arise and conversion to open is not necessary.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-15445526544939554192012-12-21T14:23:10.570-05:002012-12-21T14:23:10.570-05:00The only real place that a robot for surgery is ab...The only real place that a robot for surgery is absolutely needed is probably in the spaceship that will take the astronauts to Mars.<br />I suspect an open belly in zero gravity makes for one hell of a mess.<br />However, blood in the belly under insufflation I am told comes together into little balls.<br />Seriously, it likely would be needed there (unless the astronauts get prophylactic appys and choles-which I hear is a plan now.)RuggerMDnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-6875129760870466952012-12-15T11:26:14.552-05:002012-12-15T11:26:14.552-05:00Artiger, yes, even the RRC is talking about going ...Artiger, yes, even the RRC is talking about going to competency based training instead of say you need 10 colectomies and 30 GBs etc to graduate from residency.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-30320251421690705912012-12-15T10:54:48.953-05:002012-12-15T10:54:48.953-05:00And Scalpel, how much difference is there really b...And Scalpel, how much difference is there really between 199 and 201? It's like board certification, just something that says you've jumped through enough hoops to make someone else happy. artigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-9085213506251404682012-12-15T06:38:46.210-05:002012-12-15T06:38:46.210-05:00Good comments, all. The link to the Lean blog is w...Good comments, all. The link to the Lean blog is worth reading. It brings up the interesting point of "the learning curve." Some surgeons say it takes anywhere from 200-750 cases to become proficient with the robot. Who's volunteering to be cases 1 to 199?Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.com