Suture Compromise With Remote Surgical "Robots"
The use of remotely controlled surgical "robots" is a relatively new phenomenon in surgery. Among its disadvantages are general lack of surgeon experience, a cluttered operating field, and high cost. Now comes first word of a new potential problem: Suture compromise.
One of the central features of remotely controlled "robots" is that they are remotely controlled. What this means, specifically, is that the surgeon does not stand or sit at the operating table. Rather, (s)he sits a distance away, with surgical movements transmitted through electronics, not mechanical feedback. In a newly published study, researchers in Ohio found that "robotically" manipulated sutures were at 35% less sturdy than unmanipulated sutures. This implies over-handling by the surgical system in which the surgeon cannot feel just how hard (s)he is manipulating the sutures.
On a practical level, the implication of this laboratory study not clear. After all, many patients have great surgery with all forms of radical prostatectomy, including open and laparoscopic surgery with or without remotely controlled "robots." However, remotely controlled surgical "robots" have been associated with unusual injuries, which suggests that just as surgeons cannot tell just how hard they are driving sutures, they are equally unable to tell just how hard they are driving anatomical structures and the patient's tissues; this is one possible factor in suboptimal surgical outcomes.
The study's finding places an important emphasis on the technical aspects of prostate surgery. One can only hope that it will be taken to heart by surgeons who are learning to perfect their technique. As for patients, they will do well to remember that at the end of the day, the technical aspects of surgery are driven by surgeon experience. So no matter the inherent limitations of the instruments being used, it is the surgeon's experience that determines if they will be used well.
One of the central features of remotely controlled "robots" is that they are remotely controlled. What this means, specifically, is that the surgeon does not stand or sit at the operating table. Rather, (s)he sits a distance away, with surgical movements transmitted through electronics, not mechanical feedback. In a newly published study, researchers in Ohio found that "robotically" manipulated sutures were at 35% less sturdy than unmanipulated sutures. This implies over-handling by the surgical system in which the surgeon cannot feel just how hard (s)he is manipulating the sutures.
On a practical level, the implication of this laboratory study not clear. After all, many patients have great surgery with all forms of radical prostatectomy, including open and laparoscopic surgery with or without remotely controlled "robots." However, remotely controlled surgical "robots" have been associated with unusual injuries, which suggests that just as surgeons cannot tell just how hard they are driving sutures, they are equally unable to tell just how hard they are driving anatomical structures and the patient's tissues; this is one possible factor in suboptimal surgical outcomes.
The study's finding places an important emphasis on the technical aspects of prostate surgery. One can only hope that it will be taken to heart by surgeons who are learning to perfect their technique. As for patients, they will do well to remember that at the end of the day, the technical aspects of surgery are driven by surgeon experience. So no matter the inherent limitations of the instruments being used, it is the surgeon's experience that determines if they will be used well.
I have always wondered about feedback with robotic surgery. I think LRP is the best out of the three options, the surgeon has feedback and the patient still has faster recovery. I would still choose an expert with open surgery than a novice, or even intermediate surgeon with the robot, if LRP was unavailable.
Good article.