ohaikthxbai t1_izab64w wrote

The OP's article seems to be talking about esophageal cancer not HPV related oropharynx.

ECOG 3311 demonstrates the value of robotic surgery in the deintensification of adjuvant therapy. Doesn't support your argument at all.

ORATOR 2 is a highly problematic trial - their two surgical arm mortalities were far more suggestive of issues with post-op care (in-hospital trach bleed) and surgical/radiation technique (spine infection AFTER radiation).

The surgeons in the ORATOR 2 trial had a morbidity profile that does not reflect any case series, trial, or database study based in the US. They were routinely doing tracheostomies, and they were not credentialing surgeons the way they did in E3311.

Personally the only useful information from the ORATOR 2 trial is: Don't get surgery with any of the surgeons who participated in the ORATOR 2 trial.


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_iz34o8o wrote

not sure why you're getting downvoted... you're not speaking with the intent to insult pathologists, you're just stating your experience. You're getting downvoted by people who are actually potentially insecure about the effect of AI on their profession. It's a touchy subject for sure. AI is not going to suddenly replace pathologists but an AI platform might enable 1 pathologist to do the work of 5.


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.


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.


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.


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.