New Study Indicates More Practice Needed on da Vinci

The medical article by Wright and others earlier this year about hysterectomies done with the da Vinci robot has led to a response letter by physicians at Brigham and Women's Hospital in Boston. They point out that poorer results in those undergoing robotic surgery might be explained by the lack of experience of physicians using the machine. The response is by Maruthappu and others, and appears in the June 12, 2013 issue of JAMA, at p. 2320. The Wright article, which was published in JAMA in the Feb. 20, 2013 issue, p. 689, was by gynecologists at Columbia University College of Medicine.

The authors of the letter state that it may take more than 10 years "for acquisition of expertise and skill maturation" before hysterectomies performed robotically can match those done by ordinary laparoscopy. They also state, as do almost all doctors, that what is needed is truly random trials to compare the safety of doing hysterectomies via robot with earlier forms of surgery.

In their reply, the authors of the earlier Wright article agree that a large learning curve is involved in performing robotic surgery, and they show concern for "adoption of novel surgical procedures..before standards are set to define proficiency." At present there are no standards by which any particular surgeon using the robot can be graded as to how proficient that doctor is on the machine.

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