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Author: gatorswamp Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 1416  
Subject: Re: What does ISRG have that MAKO doesn't.... Date: 1/30/2013 2:01 PM
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Yup. I went to undergrad at Fla, as did my whole family.

The Da Vinci ports are 8mm vs. standard 5mm ports. So technically the incisions are larger than the laparoscope, although you will never have seen that mentioned. They are also cutting port (have a blade and cut through), vs "splitting" ports (sort of spread tissue without cutting), so theorectically port site hernias could be higher.

The fulcrum effect of robotic trocars is what makes robot enthusiasts say they hurt less. I don't buy it and have made many of both. I don't think that has any bearing on whether to use a robot or not. We have a hard time proving incisions hurt or don't, and proving one trocar vs another is splitting hairs frankly!

As for an assistant, someone has to change the instruments. I guess his nurse does that, so maybe it is one less person I am not sure. For many robotic surgeries, a surgical assistant is still needed, to use a stapler, or pull out a specimen in a bag, or other things. Maybe not for your friend but that is not true for most I don't think.

I would be absolutely floored if someone proved to me that a lap hysterectomy patient needs to be in the hospital vs a robot one going home. I don't buy it. That sounds like something the company powerpoint would say. The most important aspect of discharge is expectations being set correctly before surgery. When I was a resident we did open gastric bypasses and patients went home 2 days after surgery. That was 12 years ago. Now we do them all laparoscopically and they still go home in 2 days because we are watching them closely. Now when I do one open for whatever reason, everyone thinks they need to stay 4 because they are not prepped the same way as far as expectations go.

One of the things I do is teach. I usually have junior residents with me and they learn the gallbladders. When I did single port stuff, they didn't learn anything and I did the whole case. They did not learn the skills I was supposed to be teaching them, and then it affected how they progressed. I have no idea how junior residents could be taught single port gallbladders when they don't know how to do it the regular way. They have to learn that first. So I am not pressing to do them now because 1) there is no medical advantage, 2) no one asks for it, 3) I don't impart what is needed on those I mentor. I will adjust as needed but in future we still need to train general surgeons who can operate!

To mebrownj's point, general surgeons are like handy men, sometimes you need a person who can fix lots of things to come help figure out what to do. People get so specialized now (including me in some respects), that care can suffer because it gets too fragmented. I don't think I have any business doing what the old general surgeons did, but I think we all want those type of people around when it is our turn for an issue.
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