Randomized trials in robotic surgery: a practical impossibility?

Excerpt

An eager new fellow in female pelvic medicine and reconstructive surgery, I began training at Hartford Hospital in July of 2008. Arriving at an institution with four Da Vinci robots, I quickly became aware of the controversy surrounding the relatively recent emergence of this technology. I heard the complaints of the disgruntled general surgeons, gynecologists, and urologists forced to question their tried and true techniques in the face of growing pressures driven by industry, institution, and even by patients. In contrast, I appreciated the excitement of surgical subspecialists confident that this technology would revolutionize their methods. Skeptics cited the astronomic costs, lack of haptic feedback, and risks associated with prolonged steep Trendelenburg position as potential pitfalls of the Da Vinci system. Champions of the robot touted its improved ergonomics, three-dimensional visual properties, shorter hospitalization, and decreased analgesic requirements as primary advantages. A common underlying theme to all of the debate was a fundamental lack of answers: there is scant quality evidence to guide judgment for or against the robot. …