Laser and Robotic Surgery

Lately there has been a lot of hype concerning Laser and Robotic surgery. But what is it and is it really better? Most of the time it is not.

Robotic surgery is not R2D2 doing surgery. It is more like a remote control hobby device; the surgeon is working from a remote control device while the machine follows his instructions. He (or she) is usually watching on a TV screen; but sometimes live. Recent advances may involve a 3D virtual reality; allowing remote operations by tele-medicine.

The advantages of robotics include a finer control of movement with less slipping of the knife likely. As well, surgery is possible in very confined locations. Disadvantages include the lack of direct visualization and two-dimensional pictures. A major issue is the lack of sensory feedback; most robotics do not allow that. The surgeon does not know when the tissue has a different feel or density.

So for most surgeries an experienced surgeon doing it manually is far better than robotics. Indeed in a recent study of benign ovarian lesions on 87,000 women researchers found there were 50% more complications in robotic cases.

Lasers are being used in surgery as special knives or scalpels. They burn a very fine line through tissue, and have minimal bleeding due to the cauterization. However, like robotics, there is no feedback from the tissue; and there effects of small surgical errors by the operator are magnified.

There are several tissue specific colored lasers but these also can damage normal tissue. I had three cases of patients who had green laser prostate surgery by an inexperienced laser surgeon. All three had severe complications and required additional surgeries and long term incontinence.

Much of the hype about laser and robotic surgeries has been promulgated by the manufacturers of this very expensive equipment whose surgeries are far more expensive than standard procedures. Like new drugs we need to be cautious; they are rarely major advances.

I review a surgeon's experience and complication rates. I much prefer an experienced surgeon using standard instruments. Never be afraid of asking how many of these procedures the surgeon has performed; if the physician gets insulted I would strongly recommend you go somewhere else.