More robotic surgery overkill (with video proof)

Symptomatic sialoliths, or salivary duct stones, are relatively uncommon, occurring at a rate of 27 to 59 cases per year per million population. Most can easily be treated with hydration, local heat, “milking” the duct, and sialogogues [things that increase secretion of saliva] such as lemon drops.

When stones require intervention for removal, many choices are available such as lithotripsy, wire basket retrieval via fluoroscopic- or endoscopic-guidance or operative stone removal through the mouth.

Surgery is remarkably successful. One study from 2001 found that utilizing operative trans-oral surgery, over 90% of patients were rendered asymptomatic with few complications including a < 1% rate of lingual nerve injury. Another study showed that this surgery was curative 85% of the time.

Here’s a case report in the journal Laryngoscope that describes extracting a large sialolith using the da Vinci robot. It has an accompanying video [found under the “Supporting Information" tab] which shows the robot in action along with a regular [non-robotic] forceps and suction. Human fingers are seen placing a stent into the duct. The duct is then sutured closed using the robot again.

Since the standard surgery is done via the mouth, there is no scar. Standard surgery is  nearly always successful and has a low complication rate.

It’s difficult to appreciate just how the robot makes this simple surgery better.

Similarly, a hospital in Iowa live tweeted its first robotic cholecystectomy. They didn’t live stream the video of the surgery [that takes guts] but posted a heavily edited video on its website. [Update 9/27/12: the link has been removed by the hospital.]

A new link features a 1 minute video on the benefits of single incision robotic cholecystectomy with a claim by a surgeon that there are fewer hernias using this technique. This has not been supported by the literature which has suggests that the opposite is true.

The surgery took about 50 minutes, not counting the docking time for the robot. Two surgeons were engaged for the entire procedure. Surgery for a small gallbladder like this with no inflammation should have taken 30-35 minutes and could have been done by a surgeon assisted by a physician assistant, a scrub tech or a nurse.

Again, it’s hard to see how this is progress, since standard laparoscopic surgery is so routine now.