Jacky Lai: Here's The End of My Clerkship in Urology: "It's a 2-hour-surgery in traditional open surgery. Laparascopic surgery was invented to be faster and less invasive, but our robotic surgery - smaller wound but a lot more time. The major concept to prevent surgical complication is to reduce time consumption - do as fast as we could and make the wound as small as we could. The longer anesthetic time means the greater complication rate. Anesthetic time longer than 6 hours is by all means a critical risk factor in post-operative care, not to mention that patient with prostatic cancer in need of surgery is often old-aged. Quite frankly, I'm really disappointed with the Da Vinci Surgical System. It's so far an advertisement more than quality improvement."
I came across this blog entry online. From what I can tell, it was from a medical student observing a robotic prostatectomy.
I found several things interesting.
"Laparascopic surgery was invented to be faster and less invasive"- actually laparoscopy was invented to make things less painful and less invasive, but not faster. The first laparoscopic nephrectomy by Dr. Clayman took about 8 hours. As equipment improved and surgeons had more experience, the times improved to similar to open surgery, or in some cases, quicker.
"The major concept to prevent surgical complication is to reduce time consumption - do as fast as we could and make the wound as small as we could. The longer anesthetic time means the greater complication rate. Anesthetic time longer than 6 hours is by all means a critical risk factor in post-operative care, not to mention that patient with prostatic cancer in need of surgery is often old-aged."
This is simply inaccurate. there are many more factors important to reduce complications including blood loss, avoiding injuring other structures, preserving nerves and muscles. Time is not an important factor, especially in laparoscopy where there is minimal fluid loss.
Speed at all costs is often frowned on as it may lead to higher complications.
For lap or robotic prostate surgery I tell people that I am helping to train that they should try to keep the time to 7-8 hours when the patient has his head down as a general rule to help prevent problems from the positioning.
Prostate cancer patients are usually rather healthy since they usually would not have surgery unless they have a good 10 year survival.
I applaud your blogging and you certainly are entitled to your opinion, but the typical operation in my OR lasts 1 1/2-3 hours and is far superior than what I could achieve with traditional open surgery.
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