Introduction
“The Da Vinci System is a sophisticated robotic platform designed to expand the surgeon’s capabilities – and for the first time – offer a minimally invasive option for major surgery.” (“Da Vinci Surgery,” 2010) Intuitive Surgical, the manufacturers of The Da Vinci Surgical System, have hailed it as a breakthrough in surgical technology “allowing surgeons offer a minimally invasive option for complex surgical procedures.” Approved by the Food and Drug Administration in 2000 Da Vinci was developed to spread minimally invasive surgery (MIS) to more complex procedures rather than the typical ones. Clearly, the benefits of such technology can be immense allowing for “better” surgery however there are legal issues such as training requirements, among other issues are social concerns of a new type of equipment being used and finally security concerns. Overall though, Da Vinci has been used successfully many times since its inception and will probably continue to do so in the future reducing inefficiencies and improving clinical outcome.
Potential Benefits
The Da Vinci System has several features which make it more clinically superior than tradiational surgery or laparoscopy, surgery with small incisions.
Intuitive Surgical, manufacturer of the Da Vinci Surgical System detail its benefits:
The da Vinci Surgical System is the only commercially available technology that can provide the surgeon with the precision, dexterity and control of traditional open surgery, while only requiring 1-2 cm incisions. (“Da Vinci Surgery: Da Vinci Surgical System Features” para 1) Da Vinci Surgical System consists of an ergonomically designed surgeon's console, a patient cart with four interactive robotic arms, a high-performance vision System and patented EndoWrist instruments. (“Da Vinci Surgery: Da Vinci Surgical System Features” para 2)At the da Vinci console, your surgeon operates while seated comfortably, viewing a highly magnified 3D image of the body’s interior. To operate, the surgeon uses master controls that work like forceps. (“Da Vinci Surgery: Da Vinci Surgical System Features” para 3) As your surgeon manipulates the controls, da Vinciresponds to your surgeon’s input in real time, translating his or her hand, wrist and finger movements into precise movements of miniaturized instruments at the patient-side cart. (“Da Vinci Surgery: Da Vinci Surgical System Features” para 4) Da Vinci's patient cart holds up to three EndoWristinstruments and one 3D camera. To access the target anatomy, your surgeon introduces the precisely controlled EndoWrist instruments into the body through a series of dime-sized incisions. A broad range of instrument types are available to help your surgeon perform specialized surgical tasks with precision and control. (“Da Vinci Surgery: Da Vinci Surgical System Features” para 5)
Dr. Frank Sun detailed in article dated September 30th, 2011 in the Lake County News-Sun also provides evidence of Da Vinci’s benefits, “It helps a surgeon, because I see better and I work better. The hands get me to places I might not have been before. And patients don’t have to stay (in the hospital) as long, there’s less bleeding and there’s less infections.”
Da Vinci’s use in a hospital setting is already beneficial and will probably continue to be however, the US Department of Defense has been exploring a radical application of the Da Vinci System. The abstract of “The da Vinci telerobotic surgical system: the virtual operative field and telepresence surgery” in the Surgical Clinics of North America Journal describes the article:
The United States Department of Defense developed the telepresence surgery concept to meet battlefield demands. The da Vinci telerobotic surgery system evolved from these efforts. In this article, the authors describe the components of the da Vinci system and explain how the surgeon sits at a computer console, views a three-dimensional virtual operative field, and performs the operation by controlling robotic arms that hold the stereoscopic video telescope and surgical instruments that simulate hand motions with seven degrees of freedom. The three-dimensional imaging and handlike motions of the system facilitate advanced minimally invasive thoracic, cardiac, and abdominal procedures. da Vinci has recently released a second generation of telerobots with four arms and will continue to meet the evolving challenges of surgery (The da Vinci telerobotic surgical system: the virtual operative field and telepresence surgery, Abstract 2003).
This application of the Da Vinci system in the battlefield would be highly beneficial from virtually all standpoints. Further, significant negative associations of the Da Vinci system have not yet been uncovered so it is safe to assume the system will continue to perform well.
Legal Issues
The Da Vinci system has been approved by the Food and Drug Administration allowing for its use in US Hospitals. Further, the Da Vinci system is being hundreds of locations worldwide, in major centers in the United States, Austria, Belgium, Canada, Denmark, France, Germany, Italy, India, Japan, the Netherlands, Romania, Saudi Arabia, Singapore, Sweden, Switzerland, United Kingdom, Australia and Turkey. Each of these countries will have their own standards to approve and to work with. This can become challenging giving the myriad of governing bodies. Further, robotics in healthcare is a growing field without a concrete standardization process for qualification determining an individual competent of use of the system except the manufacturers themselves and the surgeons. As such, it may be prudent to create an international organization overseeing the use of robotics in healthcare and potentially licensing certain individuals for use and or providing training courses. The New York Times reports:
A generation ago, the debate in medicine was whether robotics would ever play a role. Today, robots are a fast-growing, diversifying $1 billion segment of the medical device industry. And Wall Street has just two questions for the industry: How far is this going, and how fast? (para 3)
However, hospitals that have been leaders in adopting robotic technology say they are content to just break even for now, because the investment is partly about attracting surgeons who want to be leaders in research and training (para 29).
Social Concerns
In most circumstances change is not appreciated or enjoyed, robotics in healthcare may be no different than any other concept. We all appreciate to some extent the way things used to be as such many patients may not be comfortable with a menacing-looking, futuristic contraption with sharp pointy edges being inserted into their bodies. At this point in time they may opt for a “traditional surgery.” However, hypothetically speaking, if Da Vinci success rates significantly outweigh traditional surgery, patients wanting traditional surgery over Da Vinci may become a significant concern.
Security Issues
Although unlikely, it may be possible the system software of Da Vinci may be hacked allowing for unauthorized use and equipment malfunction. This could potentially result in a fatal accident causing loss of life and various unpleasant effects. Further, one author writes:
…it doesn’t mean that every type of operation comparison will turn up with the same results; patients need to be aware of this before going into these experimental procedures and made aware of the possible risks. For example, lung lobectomy procedures had to be changed during a study due to complications such as bleedings and air leaks. There was a change in position of the patient, which then ended with much better results and it was concluded that the da Vinci system was feasible and safe for the procedure in a “learning curve setting (Da Vinci blogspot, para 1).
Conclusion
From the current stages of development and clinical practice, we can see that the Da Vinci Surgical System is living up to its expectations providing surgeons with tools to perform more complex surgeries with minimally invasive procedures potentially reducing clinical recovery time, scaring, time and cost. However, the benefits of Da Vinci may be much more numerous allowing surgeons to one day perform operations which were once perceived to be impossible. The adaption of Da Vinci for the battlefield certainly is a testament to its versatility and capability. We are in a trial mode to see where robotic surgery takes us in the future.
