Prostate surgery with a robot called “da Vinci” is often pushed as the latest and greatest technology and a way to get a better outcome. But on the key long-term complications — urinary incontinence and erectile dysfunction — the “minimally invasive” robotic surgery may be no better than traditional surgery, and may be worse if the operator is inexperienced. This can mean a preventable injury to the patient, and thus medical malpractice, if a careful inquiry isn’t made up front about the surgeon’s experience with the robot.
A study in the Journal of the American Medical Association (JAMA) criticizes the benefits of the “minimally invasive” robotic surgery as oversold. The operation does cut the average time in the hospital from three days to two, but brings with it both more short-term complications plus more long-term injuries like impotence.
The lead author is Dr. Jim Hu of Brigham and Women’s Hospital in Boston. “There has been rapid adoption of minimally invasive radical prostatectomy, however, outcomes have not been superior,” Hu said.
Surgeons are trained to use the robot in a weekend course with the manufacturer. Dr. Hu said that a big part of the problem could be surgeons not getting enough experience with the device. He said he has now done more than 700 robotic prostate surgeries, but “it took several hundred cases before I thought I was doing really well in preserving erectile function and continence.”
The same robot is also used for other surgeries. Again, the question for patients to ask ahead of time is the operator’s experience with the device. No one deserves to be a guinea pig unless they really know up front what they’re getting into.
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