The DaVinci Robot – Dr. Lackore

Do you want new technology that has
  • NOT been shown to improve any key outcome?
  • NOT been shown to reduce bleeding, pain or speed recovery?
  • NOT been shown to save time or reduce costs?

All of the above is sadly true about DaVinci Robotic Surgery.

On average, It also takes nearly an hour longer AND costs nearly $3,000 MORE .

Bottom Line:  
Compared to existing
Advanced Freehand Laparoscopic Surgery
performed by an experienced surgeon
the DaVinci Robot has NOT 
been shown to improve outcomes.
despite taking longer and costing more.
Powerful 2013 Statement by ACOG:  In March, the American College of Obstetricians and Gynecologists released a statement that said in part, “There is no good data proving that robotic hysterectomy is even as good as—let alone better—than existing, and far less costly, minimally invasive alternatives.” The statement said that conventional laparascopic hysterectomy and a procedure performed through an opening at the top of the vagina have proven track records and were generally preferable to robotic hysterectomy. That statement, however, was assailed by other physicians who use the robot.
1. Sarlos D, Kots L, Stevanovic N, et al. Obstet Gynecol 2012(Sep);120(3):604-11

Powerful 2013 statement from the AAGL*:  American Association of Gynecologic Laparoscopists    “The available evidence indicates that robotic-assisted and conventional laparoscopic techniques for benign gynecologic surgery are comparable regarding perioperative outcomes, intraoperative complications, length of hospital stay, and rate of conversion to open surgery. However, published reports demonstrate that robotic-assisted laparoscopic surgery has similar or longer operating times and higher associated costs”  link to the full AAGL* article

CONCLUSION:  “Researchers who are not biased by marketing or profit motives have found VERY LITTLE BENEFIT  to Robotic surgery over Advanced existing techniques performed by an experienced freehand laparoscopic surgeon.”

MORE THOUGHTS:  It is reasonable to worry that the DaVinci Robot is being used for marketing purposes by both Hospitals and Physicians trying to gain patients (market share) at the expense of providing a balance of BOTH the most effective and efficient approach. This  was the case when the laser was introduced to Gynecology in the mid 1980s.  The LASER was used for marketing purposes.  Now we infrequently use the LASER in GYN because it is generally an inferior technology when compared to Harmonic Scalpel, Ligasure tissue fusion devices and others.

Of Course THE DaVinci Robot is  NOT all bad.
The DaVinci Robot may be helpful/justified for:
A subset of especially demanding Advanced laparoscopic surgeries including:
… Pelvis frozen by endometriosis (less than 1 in 200 cases).
… Invaisive GYN Cancer – you are referred to Gyn Oncologist
… Certain mesh procedures (if your willing after all the lawsuits).
… A Morbidly Obese Patient / a Giant Fibroid Uterus

Click Videos Below for DaVinci Robotic info – NBC report
DaVinci Tragedy                                     Da Vinci Deaths                                 Complete NBC Report
  

THE FUTURE:  With time, evolution of techniques, training and experience, we may define an appropriate small group of procedures that actually benefit from using a Robot.   In the meanwhile ask tough questions.  Is the DaVinci Robot being used because:

1. the surgeon lacks freehand skills and MUST use a robot to be able to do the surgery at all?
2  the surgeon just wants to sit during the 1-3 hour procedure?
3. the surgeon and hospital are using it for marketing despite best evidence showing no better outcomes with increased costs and longer cases?
FINALLY:  How will the Robot help or hurt YOU personally? and what is the independent evidence for it?