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Will Surgeons Lose Proficiency for Open Procedures?

Will Surgeons Lose Proficiency for Open Procedures?

Media outlets (Wall Street Journal, Gizmodo) are again reporting that automation is degrading pilots’ skills, although this has been known for over 2 years. I blogged about the subject back then as part of a comparison of pilots to surgeons. My point was that surgeons did not have autopilots to rely on in the operating room. These new reports have prompted some to wonder whether robotic surgery will lead to the deterioration of surgeons’ skills. In my opinion, that is not likely at this time because the robot is not really doing the surgery by itself. It is simply a tool that helps the surgeon and is under the surgeon’s complete control at all times (except when it runs amok). However, ever since the advent of laparoscopic surgery over 20 years ago and its popularity for many of the common procedures surgeons do, there has been concern that surgeons may eventually lose proficiency for open procedures. And a number of other open operations have been done less frequently due to alternate ways of treating patients such as non-operative or interventional radiologic techniques. Here are some examples from the ACGME resident log data for the academic years 1999-2000 and 2011-2012. We are approaching the critical lower limit for open gallbladder surgery expertise, especially when you consider that only the most difficult cholecystectomies will be done as open cases from now on. What will happen in 20 years when few surgeons will have sufficient skill to remove a very inflamed open gallbladder? Does anyone really believe that a surgeon can confidently take out an enlarged spleen having done fewer than two...
Robotic Hysterectomy/Cholecystectomy

Robotic Hysterectomy/Cholecystectomy

This video depicts the use of Da Vinci Si High Definition Robotic System to perform Hysterectomy with Cholecystectomy in the same patient. This pre-menopausal female presented with large fundal uterine myoma with cholelithiasis. It explains the port placement, OR configuration, docking, various steps and instruments required for Total Robotic Hysterectomy. The patient cart was redocked after changing the patient position for cholecystectomy once hysterectomy was completed. Video provided by: Parveen...

Comparing Hysterectomies for Endometrial Cancer

Each year, more than 40,000 women are diagnosed with endometrial cancer in the United States. This diagnosis, often resulting in the need for a hysterectomy, leads many patients to consider their treatment options. Tradi­tionally, the surgical options have been somewhat limited for these women, including open hysterectomy and laparos­copy. Open hysterectomy has been associated with important caveats for patients to consider, including scarring, excessive procedural blood loss, and extended hospital stays with long recovery times. Minimally invasive laparoscopy significantly reduces some of the risks associated with open hysterectomy. Robotic surgery equipment has also emerged after receiving FDA clearance in 2005, and these procedures are increas­ingly being used for patients with endometrial cancer. Treatment Options for Endometrial Cancer In the December 2010 issue of Obstetrics & Gynecology, my colleagues and I reviewed eight studies involving nearly 1,600 women who underwent open surgery, laparoscopy, robot-assisted hysterectomy, or lymph node dissection. We compared them with laparoscopic or laparotomy cases to analyze surgical technique, complications, and periopera­tive outcomes. Comparative studies that looked at clinical outcomes of robotic-assisted surgeries were also summarized and compared with traditional laparoscopic or laparotomy techniques for the treatment of endometrial cancer. “Robotic-assisted surgery has the potential for enhancing outcomes in women receiving operative treatment for endometrial cancer.” According to our analysis, women undergoing surgery for endometrial cancer can benefit from minimally invasive hysterectomy that is performed by skilled surgeons with or without the help of robotic technology. Laparoscopic surgery with or without robotic assistance took about the same time to complete and resulted in similar hospital stay durations. It should be noted, however, that about half as much blood was...
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