Da Vinci Robot in Headlines

Posted on May 6, 2010

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Intuitive Surgical, Inc.’s Da Vinci surgical robot was in the news recently in the Wall Street Journal regarding a string of surgical errors on some procedures at Wentworth-Douglass Hospital, a small community hospital in New Hampshire.

On the market since 2000 but gaining notoriety recently, the da Vinci promises minimally invasive robotic surgeries with greater precision, range of movement and visibility for doctors (remote arms and high-tech camera viewing), and a smaller incision, less blood and thus faster healing for the patient. It is utilized mainly in heart, urological and gynecological surgeries.

One of the controversies is whether the device is a must-have for its technical merits or for its cachet and ability to woo patients. In the industry it is seen as a sign of progress, but administrators explain it is merely a pawn in a “medical arms race”. The WSJ reports its purchase price is $1 to $2.25 million, plus $140,000 in yearly maintenance, and $1500 to $2000 per surgery for replacement parts. Over 850 hospitals in the U.S. have them, but critics say the frequency of use for surgeon proficiency on the device (between 250 and 700 surgeries per year) is often not met, leading to potential procedure complications.

Interestingly, only twenty hospitals in the nation are licensed to train on the robotic mechanism. Locally in Jacksonville, Orange Park Medical Center and Memorial Hospital both announced new da Vinci system purchases in the past six months.

To me, two key questions that affect healthcare design arise as technology is adapted to the healthcare environment. One: how are physicians to adapt to new technology if training and practice with the new technology is so hard to access and achieve, respectively? Two: is JCAHO or any other reviewing agency knowledgeable enough about all new equipment to determine safety and proper protocol on this and similar new technologies? If not, than whom?

Are we, as designers, builders and facility owners left to figure it out on our own? We know how that works with imaging equipment. CTs, MRIs and the like have been around quite a while and I know architects who would still rather have a tooth pulled than coordinate all the technical requirements of an MRI installation. Somehow the future must hold promise for us, the facilitators and maintainers of the newest technology, as well as the docs who use it.

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