As with all emerging technologies, shortcomings must be critically evaluated. The most notable for robotic prostatectomy are the loss of tactile sensation (haptic feedback) and instrument technical error/system failure.
We have previously reviewed our first 700 robotic prostatectomy series to assess for robotic malfunction.1
Between February 2003 and November 2006, 725 RLRP cases were available for evaluation. There were no intraoperative device failures that resulted in a case conversion. Technical errors resulting in surgeon handicap occurred in three cases (0.4 percent). Four patients (0.5 percent) had their procedures aborted secondary to system failure at initial set-up prior to patient entrance to the operating room. Data analysis retrieved from the da Vinci® console reported on a total of 807 procedures since 2003. Only four cases (0.4 percent) were reported from the Intuitive Surgical database to result in either an aborted or a converted case, which compares favorably with our results. Since the last computer system upgrade (September 2005), the mean recoverable and nonrecoverable fault rates per procedure were 0.21 and 0.05, respectively.
For all the advanced features the da Vinci system offers, it is surprisingly reliable. Throughout our RLRP experience, device failure resulted in case conversion, procedure abortion, and surgeon handicap in 0, 0.5 percent, and 0.4 percent of procedures, respectively. As such, device FR of 0.5 percent should be used when counseling patients undergoing RLRP. To avoid futile general anesthesia, a policy should be enforced to ensure that the da Vinci system is completely set up before the patient enters the operating room.
1. Zorn KC, Gofrit ON, Orvieto MA, Mikhail AA, Galocy RM, Shalhav AL, Zagaja GP. da Vinci robot error and failure rates: single institution experience on a single three-arm robot unit of more than 700 consecutive robot-assisted laparoscopic radical prostatectomies. J Endourol 2007;21:1341-1344.