ROBOTIC SURGERY: IS IT SAFE?
•
Robotic operations have long been heralded as the future of surgery. The conventional wisdom was that by using computer-guided instruments, surgeons could be much more precise, minimizing trauma, shortening recovery time, and getting better outcomes.
But lately, robotic surgery has gotten plenty of bad press. A recent report in the Journal of Healthcare Quality attributed da Vinci robotic surgery, a widely used robotic system, with 245 “adverse events,” which included 71 deaths.
Researchers also found eight cases that went unreported, which left them to suspect that many botched procedures may go undocumented.
One the nation’s leading robotic surgeons, David Samadi, M.D., tells that computer assisted operations may be a victim of their own popularity. Robotic surgery is safe when properly performed, says Dr. Samadi, chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital in New York City.
However, the booming popularity of these procedures is leading to operations being performed by poorly trained surgeons, which is resulting in complications, he says.


“Surgeons are excited about these procedures, and hospitals are pushing them to do as many as they can, which leads to complications. An experienced surgeon plus technology equals a successful outcome. Inexperienced surgeon plus robotics equals major complications,” Dr. Samadi says.
In an effort to perform more procedures, some doctors conduct two or more robotic surgeries at the same time, shuttling between operating rooms. “This is a practice which I am completely against,” Dr. Samadi sayd.

First approved by the Food and Drug Administration in 2000, the da Vinci Surgical System was used to perform some 367,000 procedures in the U.S. last year, up from 292,000 in 2011. The technique is most often used for Hysterectomies and Prostate cancer surgery.
Although Dr. Samadi is a strong proponent of robotic surgery, especially for prostate cancer, he is also concerned that the technique is now being used too broadly. He noted that the company that makes the da Vinci system lists many applications on its website, ranging from heart to weight-loss surgery, but he believes it is best-suited for bladder, kidney, and prostate cancer cases, as well as some gynecological procedures.
In terms of prostate surgery, Dr. Samadi has pioneered his own nerve-sparing approach, called the Samadi Modified Advanced Robotic Technique (SMART), in which the robotic technology is used to separate the prostate gland from the nerves. The result is better maintained urinary tract and sexual function, which translates into fewer cases of incontinence and impotence, he says.
By using his technique, Dr. Samadi recently performed a record six prostate cancer surgeries in only one day. “It takes me only an hour-and-a-half to do a surgery. When I hear a report of a surgery taking eight or nine hours, I know there are problems,” he says.
“Unfortunately, the big criticism of robotic surgery is that we have a lot of great technicians, but they are not great surgeons. They may be able to do the surgery, but they may leave the cancer behind, so you need to find someone who was a good cancer surgeon first before getting involved with robotics.”
In choosing a robotic surgeon, patients should select a doctor who has performed at least 1,000 of the procedures, he adds. more