Robotic surgery procedures have increased dramatically since they were first approved by the FDA in 2000, and so have the percentage of patients who have been injured by them. There are 2000 da Vinci systems installed in the US medical facilities today and 367,000 robotic procedures were done in 2012, mostly for gynecologic and urologic procedures with hysterectomies and prostatectomies accounting for the vast majority of cases. But while the percentage increase in the number of surgeries between 2011 and 2012 was 26%, the number of adverse events to patients increased by 34%, with a total of 282 robotic surgery injuries last year. Even more troubling is that a study in the Journal for Healthcare Quality reported that the number of reported injuries in 2012 only represent a small fraction of the actually injuries that occurred. The study found that a number of adverse events were not even reported.
The manufacturer, Intuit Surgical, contends that errors are caused by inexperience surgeons without adequate training. However the numbers of injuries caused by the device are underreported. Micro-cracks in the cautery scissors used to dissect tissue in certain versions of the robot are believed to be responsible for intraoperative burn injuries to internal organs. Many surgeons also believe it is easier to make errors using the robot because of the lack of tactile feedback that makes it impossible for a surgeon to feel how firm the blood vessel or tissue is that is being dissected resulting in accidental severing and tearing.
Robotic surgery costs more but is justified by its proponents on the basis of supposedly better outcomes. However, a study in the Journal of the American Medical Association in February 2012 reported that the complication rates for robot assisted hysterectomy were the same as with laparoscopic surgery despite its $2,200 greater cost. The American College of Obstetrics and Gynecology then declared that robotic surgery is not the only or the best minimally invasive approach for hysterectomy, and it is certainly not the most cost efficient. The public has been inundated with marketing that touts the supposed benefits of the da Vinci robot. No doubt the public perception that more sophisticated technology is better technology is played upon by the manufacturer to increase the use of their product. However, the evidence shows that surgical errors with the robot occur at about the same frequency as other more time tested and less expensive surgical techniques. Patients need to question both the need for and the surgeon’s experience in performing robotic surgery – newer and more expensive treatment is not always better, even if the insurance company will pay for it.