Comment by pixelmonkey | Hacker News Reader

Comment by pixelmonkey | Hacker News Reader

I'm a programmer and my wife is a robotic surgeon who did many, many operations with these da Vinci machines (and also trained with them in residency). Her focus is on what's known as "MIGS", described here: https://en.wikipedia.org/wiki/Robot-assisted_surgery#Gynecol...

Glad to ask her any engineering- or programmer-minded questions that HN folks might have about what robotic surgery is like. (I'll collect any that are posted here, turn a list of them into a batch for her, and transcribe her answers.)

One thing that I notice that the author of this article leaves out is that though trainees are often "watching" a surgery rather than controlling it via the second console, this is a much better form of "watching" than most surgical trainees are typically accustomed. This is because both consoles attached to the robot get the immersive PoV of the primary surgeon. This should be compared to the alternatives, "'straight-stick' laparoscopy" and "open surgery", wherein the view of the surgery for trainees is usually quite limited.

FWIW, my wife trained "both ways" (robotic and 'straight-stick') and believes there are trade-offs -- it depends on the patient condition and what one is trying to accomplish.

I'm curious to learn more about the main advantages of the da Vinci machines in certain contexts, over 'straight-stick' surgery.

The article's author, who is a roboticist rather than a surgeon, paints a picture where robotic surgery does not have a clear advantage over straight-stick surgery due to a lack of training: "In fact, a recent survey of 50 randomized control trials that compared robotic surgery to conventional and laparoscopic surgeries found that outcomes were comparable, and robotic surgeries were actually a bit slower. From my perspective, focusing on education, it’s something of a miracle that outcomes aren’t worse, given that residents are going to their first jobs without the necessary experience. "

To learn from an alternative perspective, what might be an example of a patient condition or objective where robotic surgery may have a meaningful advantage over conventional surgery?

> To learn from an alternative perspective, what might be an example of a patient condition or objective where robotic surgery may have a meaningful advantage over conventional surgery?

Stereotactic surgery in Neurosurgery.

Aren't these non-intrusive and done using gamma knives?

I read somewhere that computer+radiologist perform the planning of beams and the gamma knive does all the work

You still have biopsies, SEEGs and anything else that requires deep brain invasive action.

Radiation oncologist*, this is far outside my (radiologist) scope!

Another example is robotic-assisted pedicle screw insertion in patients with challenging spinal deformities

Is there someway for the trainees to do simulations on these machines? You'd think if they can simulate landing the space shuttle, you could simulate doing a surgery.

I'd actually think a surgery simulator is more difficult than a space one.

Kind of like the difference between a kebel space program and an ultra realistic physics and material simulator.

I'd be shocked if there wasn't at least a few "games" to practice dexterity and perform device diagnostics.

Eg: Suture Practice Kit (physical, not digital) https://a.co/d/g7Ecn72

In cataract surgery there are three main kinds of simulation I'm aware of.

1. Computerized i.e. Eyesi Surgical Simulator

2. Practice surgery with real equipment on synthetic eyes designed to replicate human tissue

3. Practice surgery with real equipment on human cadaver / pig cadaver eyes

Many ophthalmology residency programs use a combination of these for training.

[0] https://eyewiki.aao.org/Cataract_surgery_training_around_the...

Yes, they have simulators that bolt on : https://www.intuitive.com/en-us/products-and-services/da-vin...

Other manufacturers also have them

I spoke to a radiologist in a regional hospital in a rural area. I believe they were in talks among themselves at the hospital to buy one of the da Vinci machines. This physician’s contention was that new surgeons operating mostly through these robots aren’t necessarily effective to react to a bleeder during a procedure. He was no doubt skeptical of the surgeons he was seeing operating with these things. Curious what your wife thinks.

Also… any words of wisdom for someone about to enter med school?

how would your wife respond to the claim in the article that the outcomes between robotic and traditional surgeries appear the same?

Not the GP but my fiance is also an OB and is also qualified on robotic surgeries. Robotic candidates are typically more difficult cases than more traditional surgeries, so even an equal prevalence of positive outcomes would indicate that robotic surgeries are worth the additional training/time/expense/etc.

I think it'd be pretty hard to do a true apples-to-apples comparison. You'd want to find traditional surgeries that were complex enough that robotic surgery would be indicated, yet for some reason they went ahead with traditional surgery anyway. Almost by definition this would push you more toward emergent surgeries which have worse outcomes overall given their acute nature. You could probably find areas where transfer to a facility with a robot would take too long but you're bringing in a lot of other confounding variables (comparing robotic surgeries at a well funded academic institute with lots of residents and fellows to a small poorly staffed hospital in the sticks, for example).

> and believes there are trade-offs -- it depends on the patient condition and what one is trying to accomplish.

I am interested in the trade offs & what it is not a good fit for.

I realize that is a broad “question”. But any insight is appreciated

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