Da Vinci operating system
The Da Vinci operating system is a robot-assisted surgical system from Intuitive Surgical in California , with which minimally invasive operations in the urological and gynecological field are carried out, in particular robot-assisted laproscopic prostatectomy (RALP) and cystectomy .
The robot was named after Leonardo da Vinci .
history
The Da Vinci system was developed in the 1980s with the support of the research institute SRI International . In the early 1990s there was a collaboration with medical technicians on behalf of the Defense Advanced Research Projects Agency (DARPA). The robot should make it possible for surgeons to operate remotely in crisis areas. In 1997 the prototype "Lenny" was created, linguistically based on the young Leonardo da Vinci. The prototypes "Leonardo" and "Mona" (named after Mona Lisa by da Vinci) followed. In 1999, the introduction of the “da Vinci Surgical System” began, initially in Europe, as the USA was not yet approved. From 2000 it was approved by the FDA in the USA and found rapid distribution there. The system was initially used for heart operations and then primarily for urological interventions.
Shortly before Intuitive Surgical went public , its main competitor, Computer Motion, Inc., sued for patent infringement. Computer Motion entered the medical technology market in 1997 before Intuitive Surgical with its own cheaper "ZEUS Robotic Surgical System" . Although the ZEUS system was approved in Europe, the US FDA had not yet made a decision on approval. The FDA, in turn, first approved the Da Vinci system. This led to uncertainties in the young market of surgical robotics ; the litigation weighed on both companies. In 2003, Intuitive Surgical and Computer Motion agreed to merge , which ended the litigation between them. The ZEUS system was finally abandoned in favor of the Da Vinci system.
In 2008, 77 percent of all prostate operations in the USA were performed with 600 Da Vinci systems. In 2011, more than 1,400 surgical robots were in use in US clinics, and around 52 of these devices in Germany by 2011.
As of September 30, 2017, around 4,271 Da Vinci surgical systems are installed worldwide, 2,770 of them in the USA (65%), 719 in Europe (17%), 561 in Asia (13%) and 221 (5%) in the rest of the world.
Systems
- da Vinci System , approved in the USA since January 1999, since 2000
- da Vinci Si , since April 2009
- da Vinci S.
- da Vinci Xi , since spring 2014
- da Vinci X , CE mark in Europe since April 2017
Operating unit
The operating unit consists of a control console at which a surgeon sits and a patient-side robotics unit (operating robot) with four arms and a video tower for controlling the three-dimensional camera and the lighting technology. The surgeon receives a ten times enlarged 3D image of the operating field via the console and can use it to control the arms of the robot with the microsurgical disposable instruments. The surgeon controls the arms and instruments in real time with his hand movements with millimeter precision with a reduction of up to five times. Involuntary movements such as hand tremors are evened out. Even fine structures such as nerves and blood vessels can be precisely displayed thanks to the up to tenfold magnification of the 3D camera system. The surgical robot cannot be programmed and cannot perform any independent movements.
The tiny, interchangeable Endowrist instruments at the ends of the robotic arms were specially developed for the system and can be moved in seven degrees of freedom - more than that of the human hand.
advantages and disadvantages
Benefits for the patient
- general advantages of minimally invasive surgery:
- small external cuts
- less blood loss
- faster wound healing
Advantages for the surgeon
- relaxed sitting, head and arm posture during the operation, which often takes several hours
- Spatial, enlarged screen display of the organs and instruments
- stocky and "adjusted" movement of the instruments
disadvantage
- high acquisition costs (1.1 to 2.0 million euros)
- higher operating costs than for an open procedure (reusable angular instruments of around 100 - 500 euros per procedure) and maintenance costs (5 - 10% of the acquisition costs per year).
- The instruments can only be used ten times. The system counts every time it is used.
- higher effort in the reprocessing of instruments and endoscopes in the CSSD
- Training period for the surgeon
- longer surgery than open surgery
criticism
Critics repeatedly criticize the high costs of the system. A Da Vinci operating system costs up to 2 million euros. The instruments used are generally only used ten times and then have to be replaced. The company took advantage of its monopoly position . This leads to about a third higher costs than a normal laparoscopy. A study by Columbia University in New York published in The Journal of the American Medical Association evaluated more than 264,000 uterine removals using conventional and robot-assisted laparoscopy and could not prove any advantages. The study emphasized that in particular the propagated lower blood loss could not be proven.
In the past, operations with the Da Vinci system have resulted in deaths several times. This resulted in injuries that were not discovered immediately. Among other things, this is said to have been triggered by fault currents that lead to overheating of surrounding tissues. The company responded by improving the covers and emphasized that such false flows could also occur in conventional laparoscopic operations. The US Food and Drug Administration is currently investigating these and other cases in which patients have been harmed. Several legal proceedings are therefore pending in the United States. The company was repeatedly accused of failing to properly report incidents to the relevant authorities.
The Swiss Medical Board (SMB) also sees no clear advantages in its report published in March 2019.
Trivia
In 2012 Yuri Ancarani made a film "Da Vinci" in the form of an artistic documentary, it was shown in 2012 at the Rome Film Festival.
See also
Individual evidence
- ↑ https://www.intuitivesurgical.com/company/history/
- ↑ Minimally invasive heart surgery - looking through the keyhole . Website on Gesundheit.de
- ↑ a b Technology in the operating room: Expensive surgery with Dr. Robo , Der Spiegel, April 1, 2013.
- ↑ Archived copy ( memento of the original from October 27, 2017 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. .
- ↑ System overview of the manufacturer .
- ↑ Questions About Robotic Hysterectomy , New York Times , February 25, 2015 (English)
- ↑ http://www.20min.ch/schweiz/news/story/Roboter-Operationen-sind-vor-allem-teurer-19739264 Robot operations are above all more expensive , April 8, 2013.
- ↑ Patients Scarred After Robotic Surgery , CNBC, April 19, 2013 (English).
- ↑ da Vinci Robot Allegedly Marketed to Less-Skilled Doctors , lawyersandsettlements.com, April 23, 2013 (English)
- ↑ Robots under fire: system restart on the operating table , N24, April 11, 2013.
- ↑ Michol A. Cooper, Andrew Ibrahim, Heather Lyu, Martin A. Makary: Underreporting of Robotic Surgery Complications . Journal for Healthcare Quality, August 2013 doi : 10.1111 / jhq.12036
- ↑ Robot-assisted operations rarely make sense. In: swissmedicalboard.ch. March 15, 2019, accessed May 17, 2019 .
- ↑ Bruno Amrein, Simone Zaugg: “DaVinci” surgical robot - not better, but more expensive. In: srf.ch . May 17, 2019, accessed May 17, 2019 .
- ↑ https://programm.ard.de/TV/Themenschwerpunkte/Dokus--Reportagen/Alle-Dokumentationen/Startseite/?sendung=2872411020344535
- ↑ http://yuriancarani.com/works/da-vinci/
Web links
- English website of the manufacturer Intuitive Surgical, Inc. in Sunnyvale (California)
- German website of the manufacturer