Study examines how surgical innovation can have side effects for patients -
Researchers at the University of California, San Diego School of Medicine have found that the risk of harm to the patient rose two -fold in 06 - the record year that the country's teaching hospitals have adopted the pursuit of minimally invasive robotic surgery for prostate cancer. The results of the study are published in the July 2 online edition JAMA Surgery .
"This study focused on the stages of innovation and how the rapid adoption of new technology in surgery this case, a robotic surgical system may lead to undesirable effects for patients, "said Kellogg Parsons, MD, MHS, surgical oncologist, UC San Diego health system and the first author of the paper." There is a real need for standardized training, rules governing competence and accreditation surgeon, and guidelines for the hospital to focus when new technologies reach the operating rooms of academic and community hospitals. "
in 03, an estimated 617 minimally invasive robotic prostatectomies (MIRPs) conducted in the United States. in 09, this number increased to 37.753 procedures. in 05, patients were twice as likely to experience an adverse event if they were MIRPs the object relative to traditional open surgical procedure. The following year -06 - was considered the starting point for the adoption of tipping MIRP when he equaled or exceeded 10 percent of all cases
"The trend here is not new to robotic surgery the same phenomena occurred with the passage .. minimally invasive approaches to the gallbladder and kidney surgeries, the two surgical procedures that are now well documented to improve safety and outcomes, "said Christopher Kane, MD, professor of surgery and interim chair of the Department of surgery, UC San Diego School of Medicine, who was not involved in the study. "Every time a new technology is adopted there is a temporary period where there may be an increased risk for the patient. This can be reduced by thorough surgical training, accreditation standards vigorous and prolonged mentoring by experienced surgeons. This report should encourage the adoption of more stringent certification standards proposed by the professional organizations rather than by the different hospitals. "
Kane added that robotic prostatectomy by experienced surgeons has proven beneficial to the patient with less blood loss, reduced infections and shorter hospital stays.
" a responsibility to deploy a surgical technology should include the responsibility to monitor as it diffuses into the real world to ensure security, "said David C. Chang, PhD, MPH, MBA, outcomes research director at UC San Diego School of Medicine and lead author of the paper. "Surveillance of surgical safety should be continuous, rather like the Centers for Disease Control monitor changes in trends of infectious diseases across the country."
The UC San Diego team used indicators patient safety, developed by the Agency for healthcare Research and Quality (AHRQ) to develop a nationwide sample of data to analyze the performance of surgery providers and the potential for adverse events in '03-09 hospital. data on the prevalence of robotic prostatectomy was drawn from AHRQ and compared with data published by Intuitive Surgical Inc., maker of the da Vinci robotic system.
" a potential intervention is the development of standardized training and certification programs, as the aviation industry requires inexperienced crews with new types of aircraft, "said Parsons, who is also an associate professor of surgery at UC San Diego School of Medicine. "An independent monitoring system continuously updated for the adoption of a new surgical technology is also essential. Previous estimates of the absorption of robotic prostatectomy, exclusively supplied by the robot manufacturer, significantly overestimated how quickly it was adopted by the surgical community. "
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