Are da Vinci surgical complications the fault of the robot?

The daVinci surgical robot is a multi-million dollar device that more hospitals are using for urologic and gynecological surgery.

I wrote previously on the topic, saying that robotic surgery is, in part, driven by patient demand.

The Wall Street Journal had a scathing piece on the robot a few weeks ago, exposing the relatively high complication rates at a small New Hampshire hospital.

The issue comes down the training, or lack thereof, at these small hospitals:

At Wentworth-Douglass, however, the robot has been used in several surgeries where injuries occurred. One patient operated on days after the hockey game was so badly injured that she required four more procedures to repair the damage. In earlier robotic surgeries, two patients suffered lacerated bladders.

There’s no evidence to suggest the injuries at Wentworth-Douglass were caused by technical malfunctions. Surgeons who use the da Vinci regularly say the robot is technologically sound and an asset in the hands of well-trained doctors. But they caution that it requires considerable practice.

Paul Levy, CEO at Boston’s Beth Israel Deaconess Hospital, was forced to buy one for his institution, saying that he had to keep up with the “medical arms race.” Smaller hospitals are under similar pressure, despite little data showing that the robot provides better patient care.

But are the complications really the fault of the robot, or the fact that hospitals are rushing to perform robot-assisted procedures?

In a response to the WSJ piece, a patient writes that some surgeons are indeed cognizant of the experience needed to operate the robot safely:

Before surgery I met with numerous doctors in some of the best institutions near Virginia. I chose UVA and Dr. Steers because he had done well over 500 (he stopped counting) of these operations with success. He has a number of young, talented surgeons on his team, but until they get the right experience they will not operate using the da Vinci.

Not all technologically modern medical marvels provide the best care. Especially in these cases, it’s imperative that patients inquire about the surgeon’s experience with the device before proceeding with a da Vinci robot assisted operation.

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  • Joe

    Once we can sue robots we have truly made it as a society.

    • Steffan Lozinak

      .heh :).

      Sue the robots for not performing as programmed and the trees for not growing back quickly enough… The oil for continuing to spill. haha

  • Rob H

    I would take issue with your statement that the WSJ article was “exposing the relatively high complication rates at a small New Hampshire hospital.”

    The article actually just highlights specific (and sensational sounding) instances of complications insinuating that they were a result of inexperienced surgeons using the robot. Nowhere do they actually talk about specific complication rates, how these compare with the complication rates for non-robotic procedures and that these same complications are fairly routine in non-robotic procedures.

    The article raises some reasonable questions but was hardly fair in it’s characterizations.

    • Rob H

      Sorry, just wanted to clarify my original point. The article didn’t “expose high complication rates” because we don’t have any indication whether their complication rates are high in the first place. All we know is that there were instances of complications. Perhaps their rates are high but the WSJ author made no attempt to support such a claim by either demonstrating that their complication rates were higher than typical or even by claiming that the complications mentioned were rare in a comparable non-robotic procedure. He certainly insinuated both, but provided no basis for such a claim.

  • Doc99

    When did the robot become self-aware?

  • Vox Rusticus

    How can a complication of a surgery done with the aid of a da Vinci robot be any different than complications from a laser refractive surgery, done by a “robotic” scanning excimer laser, which uses a sophisticated computer program to direct and control the laser procedure.

    I don’t see where this is really new territory as concerns liability. The robot didn’t consult with the patient and recommend surgery, did it?

  • r watkins

    Does anyone know if Medicare pays more for a procedure done with the robot than for the same procedure done manually?

  • Rob H

    Medicare pays the same for robotic as for a comparable laparoscopic surgery. I’m not sure if that is the same as for traditional open surgery.

    • r watkins

      Thanks. I assume that means both the professional and facility payments remain the same.
      I’m trying to understand the big push for every hospital to have a robot. Is it just the publicity brings in enough additional cases that the cost is covered, or is it docs threatening to take their procedures elswhere if the hospital doesn’t have one? (but if payment is that same, does that make sense?)

  • C Lindsay

    The WSJ article does mention that on at least one patient BOTH ureters were cut. You can’t put a complication “rate” on that particular injury since it is exceedingly rare (est. for hysterectomy ~ 1/10,000). Furthermore, hospitals don’t normally divulge their procedure related complication rates unless forced to.

    • Rob H

      The complication rate includes all variety of complications, including rare ones. 500+ people caught on fire last year in operating rooms around the US. These are rare but are still lumped in with other complications when trying to determine whether complication rates are high or low for a procedure, hospital or surgeon. My point was that the WSJ author seems to have drawn his conclusion without the benefit of this information and in fact doesn’t even appear to have tried to compare robotic vs non robotic or even the record of these same sugeons in their pre-robotic cases. Accidentally cutting unintended adjacent structures is a common complication with all sorts of surgery. Senator John Murtha was recently killed by just such an accident recently during a non-robotic laparoscopic gall bladder surgery. Can or should we draw any conclusions about complications rates in non-robotic lapaorscopic surgery from this incident? I don’t think so.