Comments
imaginary_num6er t1_iqptgtg wrote
Didn't a clinical study show that robotic surgery without haptic feedback had worse outcomes than regular laparoscopic surgery?
https://www.acpjournals.org/doi/pdf/10.7326/M20-7006
>A total of 50 studies with 4898 patients were included. Of the 39 studies that reported incidence of Clavien–Dindo complications, 4 (10%) showed fewer complications with robot-assisted surgery. The majority of studies showed no difference in intraoperative complications, conversion rates, and long-term outcomes. Overall, robot-assisted surgery had longer operative duration than laparoscopy, but no obvious difference was seen versus open surgery.
ELONGATEDSNAIL t1_iqput1k wrote
It takes longer because setting up the robot takes time . It's also more complex so inheritly there will be more hang ups. It can move in ways our hands can' t so surgeons can do some neat stuff with it. There are some surgeries i would just get done lap and not robotic.
jenkinsleroi t1_iqpzgro wrote
Is there any commercial system with haptic feedback? Part of the reason hospitals promote DaVinci is because of marketing and to keep up with the Joneses, rather than improved outcomes.
TheHiveminder t1_iqqt8cu wrote
Yes, numerous. It's been a thing for about 15 years.
TheTruv t1_iqrmbne wrote
Which ones?
medmems t1_iqvp804 wrote
It’s been in knee surgery for a long time (mako robotic assisted system) and newer minimally invasive robots like CMR surgical’s are including haptic feedback.
jenkinsleroi t1_iqs2qwo wrote
Less than ten years ago there was nothing but the DaVinci, and it still does not have haptics. Which systems do you know of?
AndarianDequer t1_iqs5qhf wrote
You are correct, anybody that says otherwise is wrong. The DaVinci system does not currently have haptics and never has had haptics. No robotic platform does. The technology is there, I've seen it, I've tried it, but it's not ready for public use. The instruments are more costly when haptics is added in and surgeons aren't willing to pay the additional cost at this time. In the cost is a dramatically decreased, it will absolutely be a thing.
TheHiveminder t1_iqs3qpz wrote
You are fundamentally incorrect, there were a dozen vendors by 2010.
Google is that way ---->
Deere0001 t1_iqptj72 wrote
I had kidney surgery and they used the Da Vinci. Saved me from being cut in half
mick_ward t1_iqq6sr2 wrote
Hernia patient here. Da Vinci was used. Now, everything that's supposed to be inside stays inside.
damnedspot t1_iqr2jrd wrote
Same. I didn’t know what it was called, so when I got wheeled into the room, I said something like “Oh, you have a Mr. Handy!” Don’t remember much after that.
WimbleWimble t1_iqrrgj0 wrote
"try out" as in grab someone and remove their appendix?
ooru t1_iqt866s wrote
Ha, nothing so interesting. They can practice with tiny silicone rings of various sizes on a grid of tiny cones, and I got to try that. With the VR headset and controls, it felt pretty 1:1.
fergus_63 t1_iqpy7bg wrote
Proud to do my part in making sure the motors they use are up to spec. Intuitive is doing great things and the company I work with as a Quality Technician make the motion components. It's really cool stuff and I take a lot of pride in it.
FabianOvrWrt t1_iqpuag4 wrote
Well, they did surgery on a grape, I'm sold on such a technology.
BrosephQuibles t1_iqpx3y0 wrote
They also occasionally train surgeons how to use these things with raw chicken breasts.
I work in an operating room and we have two da Vinci robots that do a lot of general and obgyn cases.
Edit: typo.
FabianOvrWrt t1_iqto8wy wrote
That's very interesting. I wonder which animal has the best resemblance to our bodies in order for surgeons to practice specific procedures.
BrosephQuibles t1_iqtokzr wrote
The chicken breast was just to familiarize themselves with the machine more than anything. I walked into one of the ORs the other day and the Da Vinci rep was training a surgeon on the machine and they had a model tissue that resembled skin far better than a chicken breast.
When using a multi million dollar robot they typically don’t cut corners on training, I just happened to see the robot operating on a chicken breast that one day. Haha
coltrainstl t1_iqrjxg0 wrote
Would that grape still, be ripe, today?
AllNightPony t1_iqpvybf wrote
Just going out on a limb here - but does anyone know of a leading stock or ETF to invest in here?
ThailurCorp t1_iqpydn7 wrote
ASXC
Asensus Surgical
$0.46 per share.
BenLangley t1_iqq2hs4 wrote
Not financial advice.
ISRG - Intuitive Surgical
https://finance.yahoo.com/quote/ISRG.
Founded in 1995, one of the pioneers of robotic surgery and has an impressive track record in the industry.
Best know for it's da Vinci surgical system.
[deleted] t1_iqpwqvo wrote
[removed]
36-3 t1_iqquasy wrote
I had a surgeon using a Da Vinci robot repair a hernia. It was repaired well and I have no complaints. Except - my insurance didn’t cover the extra cost. The US health system sucks, big time.
victim_of_technology t1_iqptkop wrote
This reads a little bit like an advertisement but it is still quite interesting.
jenkinsleroi t1_iqt42g7 wrote
That's because it is an advertisement, written in partnership with Intuitive. Nothing negative will be said about it in the article.
If you read through the comments though, you can find about the downsides. There is still the problem of showing that clinical outcomes are better than traditional surgeries, and for each condition. And even then, getting insurance to pay is a problem. As far as I know it's been mostly.limited to prostatectomy, although they are making inroads into other fields.
victim_of_technology t1_iqtcc47 wrote
I agree. It’s a good discussion.
[deleted] t1_iqpr0lb wrote
[removed]
DogP06 t1_iqqn4kw wrote
I work on a competing system. Can confirm, these machines are awesome.
CremasterReflex t1_iqqu8jb wrote
It’s not so much “robot” surgery—- more like remote control.
theRegVelJohnson t1_iqr5og5 wrote
It's certainly a game changer for Intuitive's stock price.
I'm a surgeon, and I use the DaVinci. Yes, it's cool. But there remains a narrow range of things where it offers benefit (we can argue about how that's defined) over straight stick laparoscopy. You can basically break it down into:
- Procedures where laparoscopy has a steep learning curve, but robotics offer a potentially shorter learning curve making it more realistic for broad dissemination.
- Procedures where laparoscopy may be possible, but more complex cases are still challenging except for the most technically proficient. In these cases, robotic approaches may facilitate a minimally invasive approach.
There are harder to measure benefits related to ergonomics and surgeon perception of how the robot makes some things easier. But this doesn't always translate into a measurable patient benefit, while still carrying cost. The application of remote operation could eventually be interesting.
chillax63 t1_iqraorn wrote
There's no evidence that the outcomes are better. In fact, in many cases, the outcomes are worse. There are certain procedures, like prostatectomies that they're useful for. More than anything, these things are a marketing scheme for hospitals to be able to say that they have robotic surgery.
[deleted] t1_iqptlyn wrote
[removed]
prototyperspective t1_iqqc8pd wrote
Recently added a review about this to 2020s in computing, I think it probably needs quite a bit of time until this moves to practice (at least as much as the title implies):
>A review suggests only surgical robot platforms "that can effectively communicate their intent and explain their decisions to their human companions will find their way into the operating room of the future", defines levels of autonomy and suggests "positive evidence will soon emerge and build up" that would motivate "transition to clinical trials".
mango-vitc t1_iqqes2y wrote
I am curious how these can work so well without any haptic feedback? That seems such a critical component of any surgery.
Morpheosity t1_iqrogfp wrote
They have been chasing haptic feedback for years. Tough problem but they are close to getting it good enough to fan out widely. In the meanwhile, the doctors who've been using the technology for a long time have replaced tactile feedback with intuition based on the incredible 3d high-definition optics they have along with the 10-1 motion of the 360 degree wristed instruments. Their brains actually fill in the tactile feedback for them. It's pretty amazing.
mango-vitc t1_iqrpt47 wrote
This is amazing how well surgeons have adapted to this.
dandancheeseandham t1_iqqil74 wrote
It will be interesting to see healthcare change as narrow AI systems are put to work learning from data from these robotic surgeries.
It could potentially pave the way to autonomous systems for a lot of routine surgeries.
erice2018 t1_iqqy7m8 wrote
I am a gyn surgeon and did several thousand laparoscopic surgeries before the robot. Then I trained on the robot and did about a hundred with it. Now I went back to no robot - for some surgeries it is very helpful. For others it really is not helpful. A socket wrench is a wonderful tool, but not really great for building a fence. For 99% of gyn surgeries, personally I would not do it. It takes longer, costs more, and has NOT demonstrated better outcomes compared to normal laparoscopic surgery. Period. Even ACOG says so. My peers the majority of my peers believe a BIG reason to use it is the public perception that you MUsT be a better doctor if you use the robot
BSB8728 t1_iqr43jf wrote
The main problem is that there is a sharp learning curve for surgeons who are transitioning from open to robot-assisted surgery. Any hospital with an extra million bucks can buy a robot, but the surgeon has to be competent, and that takes a lot of practice. That's why simulation is critical to training before the surgeon operates on the first patient.
That being said, my husband's prostatectomy and my second knee replacement were done robotically. My recovery for the knee replacement was superior to my first surgery, and I went home the same day. My husband was in the hospital only one night.
robotstookourwomen t1_iqs7gt9 wrote
I just had my second cancer surgery in July using one of these robots and my scars are all almost gone already.
[deleted] t1_iqpvt68 wrote
[removed]
BigODetroit t1_iqq14cu wrote
Because the surgeon and surgical team get to sit. My hospital is about to buy it’s 3rd Da Vinci. I’m telling you, person who opens up a surgical center with 8 of these is going to make a killing.
[deleted] t1_iqq97w3 wrote
[removed]
NacreousFink t1_iqrk5id wrote
The person who opens a surgery center without consulting with the insurance companies who will not allow the more expensive procedure will find himself with a wasted investment.
These systems have been around for more than a decade. Their slow acceptance has everything to do with insurance companies refusing to pay for procedures using them. The surgery centers that did use them were almost all exclusively on the out of network model, which requires much more expensive PPO insurance to cover the procedures.
BigODetroit t1_iqrn5p8 wrote
This is the evolution in laparoscopic surgery. Very few of the surgeons in my hospital are doing traditional minimally invasive procedures. The robot is steadier, safer, everyone gets to sit, and the docs get out of the room faster than ever. This is the future.
I don’t know if you’ve been paying attention, but the trend in healthcare has a lot of regional and local health systems being gobbled up by nationals. My own hospital system is a massive, faceless consortium that threatens insurance companies all the time. Just recently our system decided to no longer accept Meridian over reimbursements.
NacreousFink t1_iqrphy5 wrote
There is no question that the robot provides better outcomes. The problem is that it costs $3k-$5k just to open one up to start a procedure. This has to be paid for by someone. Even though healing is easier, less loss of functionality, and chances of infection are lower, the insurers just won't pay for it.
I am not aware of M&A in the regional provider space. Hopefully someone can make the insurers cover this huge advance in medical treatment.
Quik99oli t1_iqqge36 wrote
We have 9 robots in our OR and we have surgeons clamoring to get robot time. More and more surgeons from all specialties are doing surgeries robotically.
Someone mentioned that it takes longer to setup a robot case. That’s not really true. I have seen turn arounds consistently in the 25-30 min range from patient to patient.
brockclan216 t1_iqr0k1m wrote
Back in 2009 I had neck surgery (herniated discs in C4 & C5) performed by a robot. The surgeon explained how it worked and it freaked me out. Saw it as they wheeled me in to the surgery suite. I just wanted them to knock me out so I didn't have to think about it.
Rupert--Pupkin t1_iqty3i2 wrote
What kind of surgery?
brockclan216 t1_ir04qvf wrote
Neck surgery on C3 & C4 to replace the discs. Surgeon said it would go in and elongate my neck a bit to open the space up. 😳
[deleted] t1_iqr3f9z wrote
[removed]
Tri_Ban_Had t1_iqrao3y wrote
DaVinci has had it’s way with me so many times the past 18 months… I though about getting a temporary robot tramp stamp for my upcoming hernia surgery.
panconquesofrito t1_iqroiqn wrote
I listened to a podcast a few years ago that was talking about the crazy amount of side effects that come out of surgeries using these machines. The main reason was that Doctors get little initial training with these machines.
Trumpologist t1_iqs0eo8 wrote
More and more surgeons are gleefully using their eventual replacements
Got it
MD4Bernie t1_iqtiwk9 wrote
Literally millions of dollars underwriting study after study, and the most they can show is that--in experienced hands, defined as surgeons who have done over 100 of the procedures in question--the robot is as good as (cheaper) regular laparoscopy (the operating cameras that have been the standard of care since the late 1900s). The "difference" robotic shills like to tout are exclusively in comparison to open procedures, which aren't really done anymore (because laparoscopy was such a huge advance).
The Da Vinci is a hugely expensive, dangerous cure in search of a disease. First, the disease was prostate cancer. When robotic surgeons couldn't do as well as run-of-the-mill urologists, Intuitive went after Gyn-Onc. And then bariatrics. Last I heard they were thinking routine gallbladders might make their ridiculously expensive investments pay off.
My advice, as a physician whose solitary job is to protect patients from surgeons, is to find the surgeon who has done the very most laparoscopic versions of whatever surgery you require, and ask him or her to operate on you.
Sure, if you are charitable and want to donate your body to science fiction, let a surgeon perform a robotic surgery on you, knowing that in a few decades your sacrifice might be part of the reason the operating robot can ... umm, I confess I don't even know that the grand robotic vision is. But you can be among the volunteers that suffered for its cause.
[deleted] t1_iqtvdig wrote
[removed]
Normal_Breadfruit_64 t1_iqu68ya wrote
It's mostly popular because it's flashy, feeds the surgeon's egos, and most of all the hospital can upcode and charge more for these high-tech procedures. It's great when it's medically needed, but 99% of the time it's just systemic casual financial abuse like so much of the tertiary US healthcare system.
[deleted] t1_iquux7c wrote
[deleted]
Siren1805 t1_iqqt4ft wrote
Interested how much can be done remotely as well, consults would be fascinating.
NacreousFink t1_iqrjela wrote
These robots have been around for quite a while. They provide much more precise incisions, meaning less trauma, faster healing, much lower chance of infection, and so on. Surgeons were excited to use them, and hospitals bought them.
Then the insurers said they wouldn't pay for the extra cost and would only cover old style operations using rusty spoons for scalpels.
And the machines sat there, under dust covers, not being used.
TronOld_Dumps t1_iqpyn8a wrote
Is it because no one wants to work anymore? That's what Republicans keep telling me at least.
[deleted] t1_iqqdsfo wrote
[deleted]
JFKFC50 t1_iqpvuf8 wrote
Here’s why, so they can charge you more and do less work:)
ooru t1_iqpsbxh wrote
I was fortunate enough to get to try out one of these machines (a Da Vinci Machine, specifically). They're absolutely amazing, and I'm not surprised that they're coming into broader use.