da Vinci Surgical System
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Da Vinci Surgical System
|Year of creation||2000|
(initial FDA clearance)
The da Vinci Surgical System is a robotic surgical system made by the American company Intuitive Surgical. Approved by the Food and Drug Administration (FDA) in 2000, it is designed to facilitate surgery using a minimally invasive approach, and is controlled by a surgeon from a console. The system is used for prostatectomies, and increasingly for cardiac valve repair and gynecologic surgical procedures. According to the manufacturer, the da Vinci System is called "da Vinci" in part because Leonardo da Vinci's "study of human anatomy eventually led to the design of the first known robot in history."
Da Vinci Surgical Systems were used in an estimated 200,000 surgeries in 2012, most commonly for hysterectomies and prostate removals. As of September 30, 2017, there was an installed base of 4,271 units worldwide – 2,770 in the United States, 719 in Europe, 561 in Asia, and 221 in the rest of the world. The "Si" version of the system costs on average slightly under US$2 million, in addition to several hundred thousand dollars of annual maintenance fees. The da Vinci system has been criticised for its cost and for a number of issues with its surgical performance.
While the use of robotic surgery has become an item in the advertisement of medical services, there is a lack of studies that indicated long-term results are superior to results following laparoscopic surgery.
The da Vinci System has been used in the following procedures:
- Radical prostatectomy, pyeloplasty, cystectomy, nephrectomy and ureteral reimplantation;
- Hysterectomy, myomectomy and sacrocolpopexy;
- Hiatal hernia repair;
- Transoral robotic surgery (TORS) for head and neck cancer (FDA-approved since 2009)
The da Vinci System consists of a surgeon's console that is typically in the same room as the patient, and a patient-side cart with four interactive robotic arms controlled from the console. Three of the arms are for tools that hold objects, and can also act as scalpels, scissors, bovies, or graspers. The surgeon uses the console's controls to maneuver the patient-side cart's three or four robotic arms (depending on the model). The da Vinci System always requires a human operator.
The Food and Drug Administration (FDA) cleared the da Vinci Surgical System in 2000 for adult and pediatric use in urologic surgical procedures, general laparoscopic surgical procedures, gynecologic laparoscopic surgical procedures, general non-cardiovascular thoracoscopic surgical procedures and thoracoscopically assisted cardiotomy procedures. The FDA also cleared the da Vinci System to be employed with adjunctive mediastinotomy to perform coronary anastomosis during cardiac revascularization.
Critics of robotic surgery assert that it is difficult for users to learn and that it has not been shown to be more effective than traditional laparoscopic surgery. The da Vinci system uses proprietary software, which cannot be modified by physicians, thereby limiting the freedom to modify the operation system. Furthermore, its $2 million cost places it beyond the reach of many institutions.
The manufacturer of the system, Intuitive Surgical, has been criticized for short-cutting FDA approval by a process known as "premarket notification," which claims the product is similar to already-approved products. Intuitive has also been accused of providing inadequate training, and encouraging health care providers to reduce the number of supervised procedures required before a doctor is allowed to use the system without supervision. There have also been claims of patient injuries caused by stray electrical currents released from inappropriate parts of the surgical tips used by the system. Intuitive counters that the same type of stray currents can occur in non-robotic laparoscopic procedures. A study published in the Journal of the American Medical Association found that side effects and blood loss in robotically-performed hysterectomies are no better than those performed by traditional surgery, despite the significantly greater cost of the system. As of 2013, the FDA is investigating problems with the da Vinci robot, including deaths during surgeries that used the device; a number of related lawsuits are also underway.
From a social analysis, a disadvantage is the potential for this technology to dissolve the creative freedoms of the surgeon, once hailed by scholar Timothy Lenoir as one of the most professional individual autonomous occupations to exist. Lenoir claims that in the "heroic age of medicine," the surgeon was hailed as a hero for his intuitive knowledge of human anatomy and his well-crafted techniques in repairing vital body systems. Lenoir argues that the da Vinci's 3D console and robotic arms create a mediating form of action called medialization, in which internal knowledge of images and routes within the body become external knowledge mapped into simplistic computer coding.
On August 11, 2010 Edward Hospital released a video on YouTube of them demonstrating the Da Vinci Si Surgical System's precision by performing the task of peeling the skin of the grape off of a grape. In 2017, a clip of the original video was added to a video created by Cheddar's YouTube channel with the caption “They did surgery on a grape”. People began sharing the post with the same caption “They did surgery on a grape”. The initial versions of the meme made fun of the dry caption in the Cheddar video, by adding the caption “They did surgery on a grape” as many times as they could to their post. The phrase has also become very popular on Twitter, with many tweets trying to use the phrase in as many creative ways as possible.
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