Home E-Weekly May 11, 2010

Volume May Be Key to Robotic Safety

Published: May 10, 2010

The Da Vinci surgical robot may attract surgeons and impress the community, but in the hands of the insufficiently experienced it can be dangerous, which concerns some of its proponents.

It takes a surgeon 250 to 700 cases to master the robot for urologic procedures, says Dr. Jim Hu, MD, MPH, a genitourinary surgeon at Brigham and Women's Hospital in Boston, in a Wall Street Journal article questioning the safety of surgical robots in low-volume hospitals, where they are gaining popularity.

Of the 853 U.S. hospitals equipped with the robot, 131 have fewer than 200 beds. At the 178-bed Wentworth-Douglass Hospital in Dover, N.H., the robot has been used 300 times in 4 years, but not without complications, the article says. Two patients' bladders were lacerated; one suffered severed ureters during a routine hysterectomy; another died after his esophagus was perforated during stomach surgery in which an inexperienced surgeon was forced to convert to an open procedure. The hospital defends its complication rate as below that reported in medical literature, no lawsuits have been filed and a Joint Commission investigation did not call for improvements.

But some surgeons argue that a certain level of surgeon experience and case volume increase the safety of a robotic surgery program. And that smaller hospitals may not offer the volume necessary to hone robotic technique. For example, Dr. Hu compares his 1-year fellowship and assisting in 400 procedures before using the robot alone to the New Hampshire hospital's allowing surgeons to operate solo after 2 days on pigs and cadavers followed by 4 proctored procedures. That's not enough experience, he says.

Kent Steinriede

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