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Da Vinci Robotic Surgery Linked to Nerve Injuries

Jan 1, 2013

Intuitive Surgical Inc.’s da Vinci surgical robots pose a new health problem – specifically, nerve injury – for recipients of procedures that make use of the devices. So reports Reuters Health, relating details of a new study by the University of Virginia School of Medicine in Charlottesville that was published in The Journal of Urology.

As per the study, one in 15 of those who have robot-assisted surgery on their prostate, kidney or bladder tend to develop a nerve injury due to the pressure placed on the body by its positioning on the operating table as required by the intended procedure.

Positioning for robotic surgery requires patients to be steeply inverted, with their head towards the floor and their feet upward. Such positioning provides the surgeon with better traction for the procedure, the study’s researchers indicated.

The issue, however, is that this position also allows gravity to tug at the patient’s body, pulling on it and putting stress on areas not typically strained in daily life.

"When somebody is in that position, there's a chance they could slide down - it's like [lying upside down on] a big ramp," the study’s lead author, Dr. Tracey Krupski, told Reuters Health.

"When you slide, you then could be pulling, or having the drag on some of the nerves. It's like a constant pulling on the muscle."

Krupski and her colleagues reviewed the records of 334 robot-assisted urology procedures performed at their institution in 2010 and 2011. The surgeries were primarily performed on the prostate, kidney, adrenal gland and bladder.

About 6% to 7% of the group, or 22 patients, awoke from their procedure suffering from some sort of injury, primarily weakness, numbness or immobility in the hands or feet. Although more than half of the injuries went away within one month, five lasted longer than six months, the team noted in the study, Reuters Health reported.

Procedures of longer duration were more likely to cause injuries, the study said. Specifically, patients who were operated on for more than five-and-a-half hours tended to suffer from a nerve injury, while those undergoing procedures that took four hours or less generally had no injury caused by their positioning on the operating table, the study noted.

At the same time, the study reveals, doctors and nurses can take action to mitigate the possibility of patients developing a nerve injury during robotic-assisted surgery; they can do so by paying attention to the affect the inverted positioning is having on the patient. By slightly readjusting them when necessary, health officials can help to offset subsequent problems, Reuters Health reported.

"When you're putting a patient in a steep position, those issues [related to nerve injuries] are heightened," Dr. Myriam Curet, a surgeon at Stanford University in Palo Alto, California, and chief medical advisor at Intuitive, told Reuters Health.

"I think it's part of the discussion that any surgeon has with their patient about what the risks of surgery are."

Indeed, Krupski told Reuters Health that the key take-away the study is the fact that by simply engaging a patient in a discussion, doctors can help to make them aware of the potential for a nerve injury resulting from robotic-assisted surgery.

"You tell the patients that ‘[they] might transiently wake up with one of these things that the vast majority of the time goes away,'" she said.

And although Krupski does not consider the potential of a nerve injury of varying duration to be of sufficient danger to warrant sounding any sort of alarm concerning the da Vinci surgical robots, the study is not exactly the kind of news the device manufacturer needs right now.

Intuitive has been under fire lately, with the U.S. Food and Drug Administration (FDA) reporting plans to investigate the company, while lawsuits have piled up, charging the manufacturer with not adequately training surgeons, thereby putting patients at risk.

Most recently, a judge in a Washington state court failed to quash one lawsuit against Intuitive, and the company has also had to deal with a flurry of media reports exposing confidential corporate emails that reveal how some company employees were so focused on selling the $1.5 million to $2 million surgical systems that they would deemphasize the training aspect.

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