Da Vinci Surgical System

Group 1 TO2
Group Members - Breanne Crapo, Brock Lockie, Tye Noble, Raj Bhamra

Introduction


Recent developments in medicine have led to the creation of “The Da Vinci Surgical System” which enables surgeons to use mechanical hands to operate on patients. It was developed by Intuitive Surgical Inc. in order to perform minimal invasive surgeries. Many people question how safe these robotic procedures would be, based on the loss of haptic sensation by the surgeon. This would allow surgeons who have lost their dexterity to continue to operate. However, on the other side of the issue are those that believe this is a huge benefit to our society that is lacking in the availability of surgeons. The designers of the technology claim that this development will cut recovery time and increase the availability of beds in our busy hospitals. Leading one to question whether this technology is a benefit or detriment to our health care system. Should we trust a machine or a shaky doctor to poke around in human chests.

Brief History
The Stanford Research Institute developed the initial prototype for the da Vinci Surgical System in the late 1980s. Initially, work was funded by the U.S Army. The main interest of developing the system was to create a machine that could perform remote battlefield surgery. In 1995 a company called Intuitive Surgical Inc. headquartered in Sunnyville, California, was founded to expand and further develop this idea. Intuitive Inc, after 4 years of further development, had perfected the da Vinci Surgical System robot. The robot was first sold to hospitals in 2000. There is approximately a 25% annual growth rate in sales, which adds to the over 900 da Vinci Systems that have already been installed in over 900 hospitals worldwide. In 2003, the company acquired their only competitor, Computer Motion. In doing so, Intuitive Surgical had monopolized the industry. As of 2008, Intuitive Surgical has expanded to employ over 930 people worldwide. Intuitive’s revenue is also through the roof. The company’s total revenue increased 61% between 2006 and 2007, topping at around the $600 million mark.

List of Surgeries
The Da Vinci System is capable of performing all kinds of procedures so long as they can be done through 1 to 2 cm incisions called ports. To date, 10s of thousands of procedures have been performed including the following:

	General surgery

	Gynecological Surgery

	Colorectal Surgery

	Thoracic Surgery

	Pediatric Surgery

	Pediatric Urology

	Neurological Surgery

	Orthopedic Surgery

      Prostatectomy

      Hysterectomy

      Thoracoscopically-assisted cardiotomy

Videos
Videos of surgeries done using the Da Vinci system and patient testimonies can be found at the following links:

http://www.video.google.com/videoplay?docid=401374383985966148

http://futurefeeder.com/index.php/archives/2005/07/07/da-vinci-robot-surgery-system/

http://www.intuitivesurgical.com/corporate/newsroom/videos/index.aspx http://www.mercysanjuan.org/Videos/DEVCV134046

http://www.robotic-prostatectomy.com/multimedia.shtml

Advantages/Disadvantages


Precise fingertip control of fully articulating EndoWrist Instruments allow for motion scaling and tremor reduction, enhanced technique and capability in complex minimally invasive surgeries. The surgeons also experience improved precision, range of motion, dexterity, visualization and access. Patients experience shorter hospital stays, less pain, less risk of infection, less blood loss, fewer transfusions, less scarring, faster recovery. One main misconception of this system is that it is not a robot that performs autonomous programmed procedures. It works on real time and is not programmable and cannot make its own decisions, it moves just like a surgeon. Da Vinci interposes a computer between the surgeon’s hands and the tips of the micro instrument; relaying some feedback to accommodate for loss of tactile sensation, and this is augmented by the enhanced vision provided by the high resolution 3D view.

Advantages incurred by the Patient
1. Significantly less pain

2. Less Blood loss

3. Fewer Complications

4. Less scarring 5. A shorter hospital stay

6. A faster return to daily activities

7. Reduction of postoperative infection

Advantages incurred by the surgeon
1. Enhance Dexterity, precision, and control

2. More Comfortable for the surgeon, therefore reduces operating fatigue

3. Better visualization of the anatomy

4. Require less personnel(1 surgeon, 1 anesthesiologist, and 1-2 nurses); compared to 2-3 surgeons, 1 anesthesiologist, and several nurses for the simplest surgeries. Where, for most surgeries more than a dozen people are in the room.

Disadvantages
The Da Vinci Surgical System has many disadvantages. Since the machine is very expensive, it costs around $1 million, plus yearly maintenance, therefore causing the procedures to be expensive. The system is very large and occupies a large space making the patient less accessible to the assistant surgeon or nurse. This machine can’t be used on all patients as the device is not small enough for heart surgery in children. However one issue surgeons are facing is the fact they cannot feel the tissues in procedures, so they are put in difficult situations. This problem can cause the surgery to take 40-50 minutes longer on average; and up to 90 minutes longer for some procedures. When this happens the hospital is forced to pay the bill, however the doctors are not compensated if the surgery takes longer.

1. Surgeons experience a loss of tactile sensation

2. A steep learning curve for the surgeon

3. Expensive for the Hospital- roughly $1 million

4. Surgeons going through the training program do not feel comfortable with the technology until having operated on 12-18 patients

5. The surgeries take 40-50 minutes longer on average than traditional methods; it is predicted to decrease with the steepness of the learning curve

In Favor
Those in favor of using the Da Vinci system are likely those indulged in our fast paced society. They would be willing to spend more money for an efficient, quality stay at the hospital for minor invasive surgeries. These individuals have become accustomed to new technologies and see it as an advancement. They would be willing to go under the robotic knife, in order to utilize the aforementioned advantages.

Against
Those against the adoption of this technology are likely in fear of the loss of physical contact with their surgeon. These people are money conscience, traditional individuals who are not as open to new technologies. To them the disadvantages such as loss of the tactile sensation, out weigh the potential benefits experienced by allowing robot hands to do the "cutting".

Group Opinion
It is of our opinion that this new technology is an improvement to society as a whole, more specifically the healthcare system. It is fairly evident to us that the advantages of this technology outweigh the disadvantages. While it is expensive and there is a learning curve the long run benefit of the technology is freeing up hospital space and time, and improved results for patients.