da Vinci usage numbers: success and failure

As the da Vinci conquers much of the US, even smaller hospitals are investing into the technology, being pushed by market forces often lacking the rational arguments.
A study published in the Journal of Urology found that a hospital needs to do at least 520 surgeries a year with the robot to bring its costs in line with traditional surgery. Smaller hospitals can barely meet that.
"Also, some surgeons with extensive robotic experience say it takes at least 200 surgeries to become proficient at the da Vinci and reduce the risks of surgical complications. That's difficult for surgeons at smaller hospitals to achieve."
More recently, in a 170-bed hospital (Wentworth-Douglass Hospital in Dover, NE) investigations began to clarify on the responsibility of many surgical complication during robotic procedures.
"One patient operated was so badly injured that she required four more procedures to repair the damage. In earlier robotic surgeries, two patients suffered lacerated bladders. In another case, an inexperienced surgeon cut both ureters, supervised by another novice at the procedure. There's no evidence to suggest the injuries at Wentworth-Douglass were caused by technical malfunctions. Noreen Biehl, a spokeswoman for Wentworth, says the hospital's da Vinci complication rates are below the rates published in two recent gynecological studies. As a small regional hospital, Wentworth-Douglass has used the da Vinci about 300 times in four years." This number may give an answer to the emerging issues. At Wentworth-Douglass, surgeons began doing da Vinci procedures unsupervised after four cases, while others simply refused to use the robot with such low number of training sessions. The two day training offered by Intuitive is definitely not enough to make someone a master of the robot, but Aleks Cukic, Intuitive Surgical's vice president of strategy says the robot's learning curve "varies from procedure to procedure and from surgeon to surgeon." He adds: "There's no number of surgeries required to master the device."
Now a woman whose ureters were accidentally cut with the da Vinci robot last year filed a lawsuit against Wentworth-Douglass Hospital, and a law firm is seeking more patients harmed.

A retired Air Force colonel from the Dayton, Ohio area has filed a lawsuit against the Cleveland Clinic, alleging that a botched prostate surgery at the hospital has left him impotent and incontinent.

In 2009, a 42-year-old man died following robotic surgery at Boca Raton, Fla., hospital. An attorney for the man's family said the urologist who operated on him had never before performed the procedure he was attempting with the robot, according to the report.

Some surgeons have also been complaining about the increased price and modest technical innovation that arrived with the newer da Vinci-Si model. Other centers founded wide training programs to overcome the difficulties:

"With surgeons highly experienced in robotic surgery, the Hartford Hospital in Connecticut is showing surgeons across the country the precise, minimally-invasive procedures that often spell less trauma, blood loss and hospital time for the patients through innovative use of new technology.

The hospital’s TANDBERG video teleconferencing (VTC) solutions are being used to provide high-definition (HD) video of ongoing robotic surgical procedures that doctors at the hospital, and across the country, can watch and learn from.

In a recent report from the local NBC affiliate in Connecticut, Dr. Steven Shichman from Hartford Hospital discusses the benefits of the procedure, and how this learning vehicle would not be possible without the recent VTC technology advancements like HD."

"Doctors at Orlando Health's Winnie Palmer Hospital and Florida Hospital's Celebration Health, say measures have been taken at their hospitals to ensure patient safety and successful . "We're developing strict guidelines for these types of surgeries," said Dr. Jessica Vaught, a gynecologic surgeon who leads Winnie Palmer's robotic surgical training program."

In the meantime, Intuitive Surgical is celebrating steady growth, its last quarter (2010Q1) total revenue was $329 million, up 58% over the last year. Gary Guthart, CEO said in July: "...We continue to be and we have made some investments going forward that we think take advantage of some of the unique attributes of robotic surgery. Dual Council [ph] is one of them. Dual Council is being adopted well for use in training. And we’ve talked about surgical simulation as being another one."

Source: The Wall Street Journal, MIT Technology Review, TANDBERG blog, Physorg.com, MEDCITYnews, Fosters, photo: AP


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