Most likely, you are not a grape. Grapes don’t tend to read articles. Therefore, even though “they did surgery on a grape”, that doesn’t necessarily mean that robotic surgery should be at your breast or at your cervix just yet.
The U.S. Food and Drug Administration (FDA) has issued a warning about using robotically-assisted surgical devices for the removal of breast tissue (such as masectomies) for breast cancer, the removal of the uterus (hysterectomies) for cervical cancer, or the removal of any other cancer specific to women. That’s because the FDA has determined that “the safety and effectiveness of robotically-assisted surgical devices for use in mastectomy procedures or prevention or treatment of cancer has not been established.” The phrase “has not been established” is a polite way of saying, “we still don’t really know what the bleep may happen.”
Robots in theory may sound cool and may allow surgeons to make smaller incisions when they operate. That’s because robot arms could potentially slip into smaller holes in the body and combined with robot cameras allow surgeons to operate in smaller spaces. Such theoretical advantages have helped the use of robotic devices such as the da Vinci Surgical System grow in popularity. After all, it isn’t too difficult to convince patients to get smaller incisions in their body than larger ones. A smaller incision, in theory, should be less painful with less risk of an infection and heal sooner. That’s why such robotic surgery is considered a type of “minimally invasive surgery.”
There are some caveats, though. Minimally-invasive surgery with robots is not identical to traditional “open” surgery. Open surgery is when you make a large incision in the body. This allows the surgeon to directly see and touch different parts within the body. Doing so may not be as important for relatively simple surgeries such as removing a gallbladder when gallstones and not cancer are involved. But such actions may be quite important when you are trying to determine how much cancerous tissue is around. Naturally, when surgically trying to remove all the cancerous tissue, you don’t want to leave any behind. The question then is: has robot technology and the accompanying cameras and sensors advanced far enough to replicate or replace the direct observation and contact of open surgery?
The FDA is not so sure. The FDA announcement does cite the results of a clinical trial published this past November in the New England Journal of Medicine as cause for some concern. This trial randomly assigned over 600 patients with early stage cervical cancer to get either minimally invasive surgery (319 patients) or open surgery (312 patients). Of the 319 minimally invasive surgeries, 84.4% occurred through a laparoscope and 15.6% were robot-assisted.
Results weren’t as good for minimally invasive surgeries. Four-and-a-half years after the surgery, 96.5% of the patients who had gotten the open surgery were still alive with no sign of cancer, which was over 10% more than those who had gotten minimally invasive surgery (86.0%). A smaller percentage (91.2%) of the minimally invasive surgery group were free of cancer after three years than those in the open surgery group (97.1%) as well.
The challenge is that robotic surgery is still relatively new. There just isn’t enough data out there on its use for such cancer-related surgeries yet. It could be that results will get better as more surgeons get used to and experience using these robots. Moreover, not all surgeons are the same. After all, surgeons can use robots but are not robots. At least, they shouldn’t be. Some may be better and some may be worse at traditional surgery. The same applies to using these robots.
Plus, robot technology continues to evolve. The robots that will eventually take over the world as Skynet, replicate Justin Bieber, and make us their slaves haven’t been created yet. Over the next several years, robot arms may get more nimble and sensitive. The cameras and sensors may get better and be able to provide better visualizations of what is inside the body. As Sarah Connor said in The Terminator 2: Judgement Day, “The future’s not set. There’s no fate but what we make for ourselves.”
Thus, while Barney Stinson got excited about robots versus wrestlers on the television series How I Met Your Mother, you may not want to use robots versus cancer just yet. The FDA is emphasizing that they have “not cleared or approved any robotically-assisted surgical device based on cancer-related outcomes such as overall survival, recurrence, and disease-free survival.” Time and more studies are needed to determine the relative advantages and disadvantages. Meanwhile, technology and its use will continue to evolve. Therefore, as Barney says, “wait for, wait for it.”