Pros and Cons

It is likely the inexperienced laparoscopic surgeon may gain the most from the da Vinci Surgical System.

Besides the experience required for performing complex reconstructive procedures, standard laparoscopic surgery is also handicapped by the reduction in the range of motion due to a fixed trocar position determining the angle of the working field. The robotic instruments are designed with seven degrees of motion that mimic the dexterity of the human hand and wrist. Each instrument has a specific surgical mission such as clamping, suturing, and tissue manipulation. In addition, three-dimensional vision is afforded to the surgeon rather than a two-dimensional view in standard laparoscopy. Other advantages include potential loss of tremor, decreased trauma to the patient in comparison to open procedures, and comfort for the surgeon.

Disadvantages include the lack of tactile sensation and thus visualization of anatomic landmarks is the key to successfully completing the operation. The surgeon is away from the operating table and therefore must depend on an experienced assistant. Active communication between the primary surgeon, first assistant, and staff is imperative.

Although the learning curve for the surgeon may be short (in our experience less than 10 cases), there is a substantial learning curve for the ancillary staff. Many hours of in-servicing may be required and consistency in the assignment of staff to da Vinci robot cases allows for a smooth transition between cases.

Finally, the cost of the da Vinci robot is always a consideration. An initial investment of over $1,000,000 and subsequent running costs may not make this procedure feasible at many centers. However, as the robotic prostatectomy becomes more popular, the da Vinci robot system may become more readily available at many institutions.

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