I often get asked about the reliability of the daVinci robot and can it break down. I also received a comment from a reader about a bad experience with her husbands robotic surgery.

In my 299 robotic operations, we have had several problems.

The daVinci robots are complicated mechanical devices. They can break down. Robots can break down in different ways. They can have hardware failures, such as broken arms. We had this happen to our 4th arm on our standard daVinci once and performed the operation with only 3 arms.

They can have software failures and the robot is made to stop working and will not allow you to move any instruments. This happened twice. Once it was for a robotic nephrectomy which I converted to a laparoscopic nephrectomy without trouble.

The other one was 3/4 of the way through a davinci S dvP and I brought in our standard robot, which was not in use, and finished the operation with our 2nd robot.

2 other operations were affected by robotic failures that were discovered before the operation was started and 1 case was cancelled and 1 was delayed until our robot was fixed.

Robots can break down occasionally, and contingency plans should be in place, including conversion to laparoscopy or open surgery.

I am not familiar with any injuries caused by robotic failure or malfunction.

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ScienceDaily: Single Dose Of Antibiotics Before Surgery Sufficient To Help Prevent Infection: "Single Dose Of Antibiotics Before Surgery Sufficient To Help Prevent Infection
A single dose of antibiotics prior to surgery appears to prevent infections occurring at the surgical site as effectively as a 24-hour dosing regimen, and with reduced antibiotic costs, according to an article in the November issue of Archives of Surgery, one of the JAMA/Archives journals."

I have been using 3 total doses on antibiotics for most of my robotic kidney and prostate operations. I will need to review this study and may switch to a single dose for prevention of infection. I have not had a single wound or deep infection in almost 250 robotic operations. I have seen urinary tract infections that I think is the result of the catheter and 2 men developed testicle infections 2-3 weeks after robotic prostatectomy.

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I am often asked about other robotic surgical platforms other than Intuitive's Da Vinci Surgical System.

There currently aren't any systems that are being used to perform laparoscopic surgery to my knowledge. Prior to 2003, when Computer Motion merged with Intuitive Surgical, Computer Motion had a product called the Zeus surgical system.

This system had a flat screen 2-D monitor and didn't have endowrist instruments. I believe the movement of the instruments was not intuitive, but more like regular laparoscopy (this may have been upgraded prior to its retirement). One nice feature of the Zeus was the AESOP camera system, which was voice activated and gave a still picture. This was a small upgrade overall to conventional laparoscopic surgery, but not in the same class as the current da Vinci system.

I found a picture of the system online at thinkquest.org.

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This is a monthly update on the growth of Robotic Surgery in my practice.

Original blog entry about robotic surgery growth was in November of 2005 and is updated monthly.

For February, I performed 13 robotic operations including 11 prostate removals for cancer, 1 prostate operation for BPH, and 1 reconstructive operation on a kidney.

Continue reading "Robotic Surgery Growth in New Jersey (Essex County)- Feb 2006 Update" »

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In my opinion most patients with prostate cancer are candidates for robotic prostate cancer surgery, or the daVinci Prostatectomy.

The ideal patient would be one with early prostate cancer that is likely confined to the prostate. The patient also needs a good chance of living at least 10 years.

Certain surgeries and medical conditions can make a patient less than ideal, but probably still a candidate.

Read on to find out my take on certain conditions and please comment if you can think of any others.

Continue reading "Robotic Prostate Surgery: Am I a candidate" »

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The new Davinci S made an appearance this week in New Jersey. I had a chance to trial it today.

Continue reading "Davinci S- the newest robot from intuitive surgical" »

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Debra Morrison, MD, anesthesiologist at UCI gave a talk on anesthesia and robotic prostatectomy. While many of the points she reviewed have been covered elsewhere, there were a couple of suggestions that she had that I had not heard of before. She mentioned that with the extreme Trendelenburg position not only is the diaphragm pushed up into the chest but the trachea can be displaced towards the head. This can result in the ET tube migrating into the right mainstem bronchus and an abrupt increase in difficulty ventilating the patient. She is a pediatric anesthesiologist so perhaps she has seen this in that age group but I have not seen or heard of it happening in an adult. Still, it is worth keeping in mind in case you ever experience a sudden deterioration in the patient's status. The problem may be corrected by simply withdrawing the tube a cm or two until ventilation is returned to normal. At least try that before aborting the procedure and breaking everything down.

Continue reading "PACRIM - Anesthesia" »

Posted by Dale Russell M.D. | Permalink | Comments (1) | TrackBacks (0) | | |

The most cited drawback of robotic surgery is the loss of fine feeling of the instruments on tissue.

The other drawbacks are the expense of the surgical system and the need for precise positioning of the robotic arms to provide for a full range of motion without repositioning the arms.

Continue reading "Haptics- A robotic limitation" »

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1. What does an operating room need to house a da Vinci robot?

2. What staff are required?

Continue reading "The Robotic Operating Room" »

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For all the advanced features for the da Vinci surgical system it is surprisingly reliable.

Continue reading "da Vinci reliability" »

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