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This Surgeon Isn't Falling Out of Love With Intuitive Surgical Or Its Robots

Stocks in this article: ISRG

The attention-seeking Johns Hopkins surgeon Dr. Martin Makary says hospitals and other surgeons are keeping safety problems with robotic surgeries quiet. I can assure Dr. Makary there is no secret cabal of surgeons underreporting problems --we are not that interested or organized to do so.

Surgical robots like da Vinci are designed with redundant systems to curtail problems, including emergency stop buttons, web-based connections to a central server monitored by Intuitive Surgical, technicians on call 24 hours per day and manual ways to disengage the machine. Remember these robots are actually master-slave machines, meaning they're not free thinking or autonomous. Rather, the robots only do what surgeons like myself tell them to do with our fingers.

Crappy surgeons get crappy outcomes from surgery, whether they're performing procedures with a robot or with their own hands. Post-operative problems (including horrible deaths) happen all the time. That's the fault of the surgeon, not the robots. To err is human, to blame the robot is ridiculous.

An Intuitive Surgical bear told me via Twitter that he heard of a case where the robotic arm "could not be disengaged." Perhaps, but that's because the surgeon operating the robot is an idiot. It would take me two seconds to manually disengage a robotic arm. Another tweeter told me, "The patient's OR table was moved and the robotic arm punctured a piece of intestine." Again, the surgeon is to blame. How is the unfortunate incident, if it actually happened, the fault of the surgical robot? Look, I don't deny there are terrible stories of surgical mishaps out there, but the blame is on wayward physicians, not a machine.

What of the JAMA article crushing the gynecologists? Has anyone read it? I did, and let me say, if I was a woman with an ailing uterus, I would be running to get a robotically assisted hysterectomy. Why? Patients who got the robot left the hospital earlier. I would do anything to leave the hospital earlier. The complications rates between robot-assisted and "traditional" surgery were the same (see above nonsense about the FDA reports.) The only problem was the robot appeared to cost more. Guess what? Patients don't care about cost and surgeons don't either. As a practicing surgeon, do you want me to worry about cost when I'm standing over your loved one in the operating room? Or, would you rather I care more about producing a more favorable outcome? Outcome is going to trump cost every time. I will let others decide whether cost issues will eventually hurt the long-term health of Intuitive Surgical's stock price, but the use of the robot is unlikely to change with this JAMA paper.

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