Robots In The Operating Room – What We Don’t Know Can Hurt Us

Robot-assisted surgery is here. Even if it is an improvement over human surgical techniques, how much information do patients need before their consent to the use of a robot is truly informed consent? Is there something different about a surgeon’s decision to perform robot-assisted surgery?

They may have a terrible bedside manner but, apparently, they can be terrific in the operating room. Meet your surgeon’s assistant, a robot. Robot-assisted surgery is here and likely to stay. There is an important question, however. Even if it is an improvement over human surgical techniques, how much information do patients need before their consent to the use of a robot is truly informed consent?

This is the question asked by Daniel Ostrovsky in the Daily Record. It is a question that all of us should consider. Virtually nobody would expect a long explanation of the precise surgical instruments to be used during an operation. And, nobody probably asks a great deal about the credentials and experience of the assistant surgeon. Is there something different about a surgeon’s decision to perform robot-assisted surgery?

I say yes, yes, yes.

Read more from the Daily Record and decide for yourself:

The family of Desert Storm veteran and Florida high school teacher Al Greenway filed a lawsuit against Tampa-Bay’s St. Joseph’s Hospital in Hillsborough County (Fla.) Circuit Court.

In the December 2003 complaint, Greenway’s wife and children alleged that he died after two inexperienced doctors employing robotic assistance to remove Greenway’s cancerous kidney, cut his aorta and the vena cava — two major blood vessels.

While specific lawsuits will be settled in court, the debate about disclosure rules as they apply to new technology in medicine continues.

“This to me is a different set of surgical instruments, so we are not doing a different operation; it’s not a new operation; it’s not a different procedure; it’s not an experimental procedure; it’s simply a different set of tools to accomplish the same operation,” [one surgeon] said. “So if I was in the operating room and I had a pair of scissors and I decided, you know, that the scissors aren’t working for me, I am gonna use a knife instead, I wouldn’t ask permission to use a knife instead of the scissors, I would just use them.”

[Another surgeon] took a different view.

“What we tell them early on is, ‘Listen, this is a new procedure and we think it’s going to confer some benefits, but you are the first one,’” he said. “Some of the patients opted [for] not having it done that way or having it done here because of that.”

“I actually show them pictures of the robot and I also show them footage of actual procedures that we have done through the view finder that the surgeon sees and they get a better idea of what the robot is,” he said. “They seem a little bit less anxious about it once they see it and they have a better appreciation of what it means.”

The federal Food and Drug Administration approved robot-assisted surgery in July 2000 for gallbladder surgery and treatment of reflux disease….

Russell H. Taylor, professor of computer science…, explained the robot provides a doctor with a three-dimensional view of the patient, while common laparoscopy offers only a two-dimensional image….

The robot also eliminates tremor, and scales large motions made by the doctor into fine instrument motions….

But Dr. Adrian E. Park, chief of general surgery at the University of Maryland Medical Center, takes issue with characterizing robotic assistance as nothing more than a technologically advanced tool.

“This is a little different from just using a different pair of scissors,” he said…

“If I think the other side is very weak, I will still say ‘there is an argument against this; I don’t think it’s a very strong argument’.”

And when it comes to the efficacy of robot-assisted surgery, there is a debate. Chambers and the Greenway family, in their complaints, cite a mountain of medical research questioning both the safety and the utility of the procedure…

If a robot is going to lay its “hands” on me during an operation I want a full presentation of the risks and benefits. I want to know what the medical community is debating. I want to have as much information as possible so that I can consider giving a truly informed consent.