New “da Vinci” Robot: Is “da Vinci” Robotic Surgery A Revolution Or A Rip-Off? (PART 1)

Editor’s Note: Cameron Scott of HealthlineNews wrote on the Is“da Vinci” Robotic Surgery A Revolution Or A Rip-Off? In this 2 Part Series we check evidence alongside Mr Scott in the US and beyond.

da Vinci robot at Southmead Hospital, UK

By Cameron Scott

A robotic surgeon with tiny lights, tiny cameras, and steady hands sounds like a miracle of technology. But what do the results show?

Even before laparoscopic surgery took off around 1990, several companies, backed by U.S. defense grants, were at work on robotic surgical systems.

Laparoscopic surgery has proven to be a significant medical advance, turning major surgeries that kept patients in the hospital for several days and left big scars behind into fairly minor procedures. As robotic surgical systems moved through research and testing, many doctors hoped the new technology would double down on those advances.

The companies building surgical robots were certainly optimistic. In product names like Zeus, Aesop, and da Vinci, one can hear great humanitarian aspirations.

Zeus and Aesop were slain by da Vinci, whose Silicon Valley manufacturer, Intuitive Surgical, bought the company that made them and scrapped the projects. But many of those hopes still hang on da Vinci, which was first approved for clinical use by the Food and Drug Administration in 2000.

The da Vinci surgical system continues to be the shiny new toy that hospitals and private surgical practices boast about on billboards and websites. The system doesn’t resemble a robot so much as a video game: The surgeon sits comfortably behind a screen and looks at a magnified view of the surgical site while operating the machine’s robotic arms.

The robotic arms can ostensibly get into hard-to-reach places, promising patients less bleeding, faster recovery, less chance of damage to important nerves, and smaller scars than traditional surgeries.

Da Vinci’s price tag partly explains why buyers might want to brag: A single robot costs about US$2 million. Some of the attachments that go on the arms are disposable, and their sole manufacturer is Intuitive. Robotic surgery generally costs as much as US$3,500 more than a comparable laparoscopic operation.

So is this the brave new world of medicine or an expensive boondoggle?

NHS, UK: New 'da Vinci' Robot Allows Patients To Leave Hospital Just Two Days After Major Surgery

• New robot is being used by NHS experts in the fight against lung cancer 
• Cyborg removes tumours with less impact on patient than keyhole surgery
• Da Vinci robot allows patients to leave hospital within 2 days of operations

By Anthea Gerrie for The Mail On Sunday

A four-armed ‘cyborg surgeon’ first developed to treat prostate disease is now being used by NHS experts in the fight against lung cancer.

The innovation has allowed patients to leave hospital within two days of surgery, suffering only minimal post-operative pain.

Cardiothoracic consultant Sasha Stamenkovic says the da Vinci robot now used by his NHS trust for the majority of lung cancer operations removes tumours with less impact on the patient than other forms of keyhole surgery.

The da Vinci is activated by a doctor who operates a camera and a surgeon who

Named after the Renaissance artist

and inventor (pictured) who foresaw the

coming of robots, the da Vinci gives surgeons

a high-definition view of a patient’s organs in 3D

manipulates the robot’s arms from a console using a joystick and foot pedals. The hydraulic limbs move as she or he does, effectively creating a ‘cyborg’ melding of human and machine.

The machine locates and removes tumours without pressing on patients’ ribs as it reaches and grabs the tumour. This pressing is the major cause of operative pain in traditional laparoscopic, or keyhole, lung surgery.

‘This is a huge advance in lung-cancer treatment with a clear advantage for patients,’ says Mr Stamenkovic, whose team has performed 30 lung operations using the robot in the past year and will present its findings to the world congress of cardiothoracic surgeons in September.

He says the Newcastle Hospital Trust, which has two of the machines, bought for about £1.2million each two years ago, is also using them to operate on prostate, gynaecological, liver, ENT and colorectal cancer patients.

Named after the Renaissance artist and inventor who foresaw the coming of robots, the da Vinci gives surgeons a high-definition view of a patient’s organs in 3D via a screen inside the control console.

During the past two years, it has become a favoured option in the UK for removing prostate tumours, which are difficult to excise using traditional keyhole surgery.

In all, NHS trusts have invested more than £60million in 52 of the surgical robots, whose articulated joints can turn corners inside patient’s bodies, giving them a huge advantage over traditional devices.

But while many are also being used for gynaecological surgery, the robot has potential uses that most trusts have not yet investigated, according to Erica Schaefer of Intuitive Surgical, da Vinci’s California manufacturer, which has sold 3,317 of the robots worldwide to date.

Use in Britain is spreading, however, as more surgeons learn how to operate the robot. It has proven hugely popular with patients in the US, where two-thirds of all da Vincis are located.

One surgeon who trained in robotic surgery with the Newcastle team is now operating on lung-cancer patients in Middlesbrough, and a pilot programme is being started in London in September by the Guy’s and St Thomas’ Trust.

Consultant thoracic surgeon Tom Routledge, head of robotic lung surgery there, said: ‘Traditional keyhole surgery is like operating with chopsticks, whereas the robot’s arms have elbows and wrists, with all the articulation that implies.

‘We were encouraged enough to convince our managers to allow us access to the robots, which have up to now only been used for prostate and kidney-cancer surgery in our Trust and will be a more expensive way for us to operate on lung patients.’ Patients who are medically eligible will be asked if they would prefer robotic or traditional keyhole surgery, and Mr Routledge said: ‘Whether we do manage to demonstrate benefits to patients with this system remains an open question.’

da Vinci gives surgeons a high-definition view of a patient’s organs in 3D via a screen inside the control console

Sylvia Barnes, 78, one of the first patients in Britain to have a lung tumour removed by the da Vinci, admits she fell for the novelty of having a robot do the surgery.

Her lung cancer was diagnosed last year by a scan after she complained to her GP of feeling ‘very low’ and iron pills failed to work. ‘They told me a tumour an inch wide had been found which they wanted to take out with part of my lung.

‘At my age, I didn’t want to face such a big operation.’

However, when presented with the prospect of the da Vinci, she was persuaded to think again.

‘It was the fact there would be just four dots on my back where the pincers would go in, and a three-inch scar under my arm to pull out what they were taking instead of a cut from front to back. The idea of the robot appealed to my weird sense of humour,’ Mrs Barnes says.

Six days after having the operation at Newcastle’s Freeman Hospital in April, she went home ‘with a hop, skip and a jump’ and within three weeks was once again walking her grandson to school.

The robotic surgery treatment will not be available to all lung- cancer patients as only tumours seven centimetres in diameter or less can be extracted by the machine’s arms through the space between the ribs, explains Mr Stamenkovic. He says there could be difficulties operating with the robot on obese patients with a body mass index over 35.

However, the majority of patients with lung tumours would be eligible, and Mr Stamenkovic says the Newcastle team expects to perform at least 50 more robotic lung operations in the coming year.

The Trust is now offering training to surgeons from other parts of the country.
Original articles published in HealthlineNews and Mail On Sunday