By THÉRÈSE MARGOLIS
It’s been hailed as the new gold standard for a wide range of surgical procedures, from cardio-thorax interventions to bariatric bypasses to prostate cancer treatments, and the benefits of robotic surgery over conventional open surgery or standard laparoscopic surgery are hard to deny.
Robotic-assisted laparoscopic procedures can dramatically reduce recovery time and hospital stays for patients, as well as post-operative pain and scarring, and they can also improve a physician’s precision, control and flexibility in maneuvering around internal organs.
First introduced in mid-1980s, when a robotic surgical arm was used in a delicate neurosurgical biopsy, minimally invasive robotic surgery has been on the rise worldwide in the treatment of uterine cancer, gastrointestinal problems, urinary blockages and hysterectomies.
But while the use of robotic surgery in the United States has become the new standard in minimal invasive interventions since the introduction and Food and Drug Administration (FDA) approval of the Da Vinci System by the California-based Intuitive Research Corporation in the year 2000, here in Mexico, the procedure is still relatively unknown.
“A lot of people still don’t understand the benefits of robotic surgery,” explained gynecologic oncologist Dante Carbajal Ocampo, who has been conducting robotic procedures at Mexico City’s Sociedad de Beneficencia Española since the hospital first purchased a Da Vinci system early last year.
“Robotic surgery, to a large degree, takes the matter of human error out of the equation.”
Seated in front of a computerized module that operates the robot, the physician can comfortably operate without worry of tremors or other unintentional movements.
Although the robot is not autonomous and cannot do anything without the specific direction of the surgeon, Carbajal Ocampo said that it allows for more exact control over a procedure, since every action taken in a surgery can be coordinated by a single physician, and the physician can use computer-generated movements to create precision incisions.
It also allows for better coordination between members of the operating team, he said.
“With regular endoscopic surgery, a doctor can see what is happening inside the patient on a two-dimensional level,” Carbajal Ocampo said, “but with the Da Vinci system (which has now become the international benchmark of robotic surgery), he or she can see what is happening in three dimensions, which means there is much less likelihood for a mishap.”
Moreover, Carbajal Ocampo said that robotic surgery offers doctors far more flexibility and movement than conventional laparoscopic surgery, and the learning curve for mastering the machinery is much shorter.
Carbajal Ocampo also said that since there is generally less bleeding and cutting involved in robotic surgery compared to conventional open surgery and laparoscopic surgery (which can entail the need for up to three ports, compared to usually only one port with robotic surgery), patients are less likely to suffer infections or other complications.
But robotic surgery does have its disadvantages, the main one being price.
Generally speaking, the cost of a robotic-assisted surgery over open surgery is four times higher, and compared to a normal laparoscopic surgery, it is about 30 percent higher, Carbajal Ocampo said.
“This is a problem for a lot of patients because, unfortunately, many private insurance companies are not willing to pay the difference,” he said.
“But the advantage of robotic surgery is that it offers greater security and safety for the patient, and that is something that not all insurance companies take into account, even though they should.”
Ironically, Mexican public health services are often more advanced than their private counterparts when it comes to robotic surgery.
There are robotic surgery systems in state-run hospitals belonging to the National Institute of Social Security (IMSS) and the National Institute for Social Security and Services for State Workers (ISSSTE), as well as in the Mexican military hospitals Central Militar and Hospital Naval, and even one at the Hospital Regional de Alta Especialidad in Zumpango, in the State of Mexico (EdoMéx).
But while top-rank private hospitals such as the Hospital Español, ABC Medical Center and Grupo Ángeles all have robotic surgical systems, the majority of private hospitals in Mexico do not.
According to industry sources, while there are now an estimated 3,000 robotic surgical systems operating in the United States, in Mexico, there are only 19.
The cost of a robotic operating system can run between $2.5 million and $8 million, which makes investing in a Da Vinci or other robotic machine a daunting proposition.
And with insurance companies looking to cutting costs of patient care (even when it may not in the best interest of the patient), many private hospitals are leery to splurge on a pricey robotic system.
Also, to be able to operate a robotic system, surgeons must undergo at least three months of training be board certified internationally.
At the same time, there have been medical problems that resulted from the use of robotic surgery, including bleeding from unintentional lacerations to surrounding tissue.
And because the surgeon is not in direct contact with the patient, the hands-on tactile element is eliminated, meaning the doctor cannot feel the “give-and-take” of an organ he is operating on.
“There are no guarantees when it comes to surgery,” Carbajal Ocampo said.
“But robotic surgery is the vanguard of modern medical intervention, and while it is not suitable for every patient, nor every type of surgery, it is becoming more and more mainstream every day. It is the future of surgery and it bears the promise of safer, less invasive and less debilitating treatment for patients. It is the leading surgical approach for the future, and, in the world of medicine, the future is right around the corner.”
Dante Carbajal Ocampo is an attending gynecologic oncologist at the Hospital Español.
His offices are located within the hospital, as Ejercito Nacional 613-903, in Colonia Polanco (tel: 5255-4866/5545-3375).