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Dr_Esquire t1_iz11ye6 wrote

The problem with these robots is that they are mega expensive. This results in other related problems. Namely, A hospital cannot buy a lot of them. This means that the surgical residents at these hospitals can only log so many hours on the machine (at places Ive trained, it was mostly reserved for senior residents. So training is limited. Hospitals also cant really afford to have two different brands, and residents also dont really have time to learn two different brands. So again, training becomes limited.

Why is this a problem? Because training in surgery is massively important. Stuff has to become so second nature that unexpected issues need to be semi-familiar or at least things you can deal with since the main issues are happening almost in the background of your head. So by making training so difficult, it actually limits the usefulness of these robots as you have fewer people who can allocate time (sufficient time) to learn one, and even fewer that can allocate time to learn more than one.

As a total aside, Im not in surgery, so take with grain of salt, but I dont see the actual present day utility of these machines. Every robotic Ive observed in school was basically something you could do in probably half the time manually. I could very well be missing the nuances and underestimating problems that arise with manual vs robotic. And it also could be a more preparing for the future, when these machines are more useful and need ready users. But as they currently stand, I dont get the hype about robitic surgeries.


terroroftoma t1_iz15c9l wrote

The robot has massively changed the game in oropharynx cancers. Before the robot we would have to split the mandible or do a lingual release to access these tumors. Especially with the healthier, younger HPV-related population, we have been able to cure their disease with limited impact on quality of life.

I’m not sure what is special about the robot in the article. I suspect it’s mostly for marketing.


persimmonsfordinner t1_iz1ilcj wrote

There isn’t anything particularly special about this system, it is mostly marketing. There are other systems that surgeons can use to complete the same minimally invasive procedure that have been around for a couple decades.


ohaikthxbai t1_iz33b7x wrote

This is not necessarily true. This new robot is modular while the older models have all instruments and camera coming from one giant unit.

It also has an open console as in the surgeon controlling the robot arms can still directly look at the patient without having to completely give up control or visualization of the machine's camera view.


persimmonsfordinner t1_iz3nslc wrote

These aren’t the huge benefits that CMR sells them as. The footprint of a modular robot is massive and the single-unit isn’t as restrictive as it would seem. From the care team perspective, OR footprint is a huge deal, if your hospital isn’t new with huge ORs.

I’m also not sure what the benefit of an open console is- all the MDs I’ve spoken with don’t feel disconnected in a console that they can pop their head out of quickly. It’s not like they’re in a different room than the patient?


ohaikthxbai t1_iz3pdof wrote

Not sure what CMR is selling to end users, I'm just speaking from seeing that modular robot in an OR and how much less space it takes up compared to the booms of the newest da vinci models. Wheeling the Versius arms around a room is faster and less burdensome than driving the massive da vinci patient cart doing 18 point turns in an OR that already has tons of other equipment. Remember with a modular robot you can choose to bring in a camera and 2 arms if that's all you need, save the space of a 3rd arm.

MDs aren't aware of what they're missing when they're buried in the da vinci console because they've been conditioned to value its "immersion". It depends on your specialty but for procedures that have the instrument arms potentially colliding, the console surgeon can't see that. They can't look at a patient scan without taking their head out. They can't see patient vitals or other activity in the room without disengaging the robot. To "pop their head out quickly" versus not pop your head out at all and use the same room awareness you'd have in an open/laparoscopic surgery has value. It's like looking through 4K binoculars instead of a 1080p panoramic view when you're captaining a ship, but the binocular manufacturer keeps selling you the fancy 4K visuals.


ohaikthxbai t1_iz32zu8 wrote

This is true more for tongue base tumors than predominantly tonsil tumors. You really don't need a robot to do a proper radical tonsillectomy, though a robotic platform may enable more surgeons to do a proper radical tonsillectomy.

I think what's novel about this robot is its modularity and much lower profile. It also has an open console, as in you're not tunnelling your head into a console when operating the robot - you're wearing glasses but have an open view of the OR including the patient's bedside.

I think this might confer an advantage for those who do transoral robotic surgery because with da Vinci you are still dependent on the quality of your bedside assistant to know when and how tools and the camera are colliding with the patient's teeth and with each other. With an open console you can see the patient without taking the camera view out of your field of vision.


jedikunoichi t1_iz290wr wrote

I'm the robotic coordinator for our operating room. We have two robots and you're right, they're very expensive, but we have no shortage of doctors who are trained in robotic surgery. One of our newest surgeons did 2 years of nothing but robots at USC in his fellowship. I have more doctors wanting to do cases then I have time to do them. They would operate 12 hours a day, 7 days a week if I let them.

Doctors don't have to be trained on robotic surgery during residency. It's nice if they can be, but Intuitive has extensive training programs and proctors. I'm sure other robotic surgery companies have similar training programs. About half of my current surgeons didn't train in residency or had minimal training when robotics was new.


ohaikthxbai t1_iz3477q wrote

This new system lets surgeons practice VR using an Oculus headset, which is way cheaper than an entire da Vinci console.

Not a substitute for real surgical proctoring, but makes a huge difference early in the learning curve.

Intuitive wants more surgeons to use their machines but doesn't do any real competence based training to make sure their devices are used properly - they put all that burden on hospitals so the company can't be sued for improper use or inadequate credentialing.


Dr_Esquire t1_iz338wr wrote

The post-residency training is still training. For people like surgeons whose baseline residencies are already very long, without getting into the medical field pushing for fellowship post-residency, any extra time is often a bigger investment than it seems.

Also, "intensive" training can be fine as catch up, but (if I had to guess) probably depends on users having some baseline understanding and ability with the machines. A 40yo who never touched one like will feel pretty wonky at the controls and a 1-3 month course likely wont fully fix that. Also, again, comfort needs to be there; you cant just use a machine to do surgery if youre not super comfortable with your mastery of it.


Jai_Cee t1_iz221kb wrote

This robot has a VR trainer so you could even practice at home


ohaikthxbai t1_iz33opb wrote

This is a great point and a considerable advantage over older robot systems. The older robot systems require you to use the actual operating console that's used in the OR to use their virtual reality training modules. That means you either do your VR training in the OR, or the hospital needs to purchase a separate robot console strictly for training.

This new system lets folks train using an Oculus, which is probably 1/1000th of the cost Intuitive charges for a standalone VR simulator.


rem1021 t1_iz34vkt wrote

Open surgery is faster, but patient outcomes are much better with robotic-assisted surgery. Additionally, reimbursement is typically higher for minimally invasive surgery (i.e. laparoscopic or robotic).