“Wow, Jaded Julie! That da Vinci robot is the greatest thing to hit the OR since anesthesia.”
“No way, Curmudge, am I going to let a robot operate on me. It might run amok and start ripping out my innards.”
“This isn’t ‘Star Wars,’ Julie; this is the ultimate in modern surgery. The robot simply mimics the movements of the surgeon’s hands and fingers. In a demonstration, I sat at the console and remotely maneuvered pumpkin seeds around inside a jack-o-lantern. Except for the fact that I don’t know anything about anatomy, even I could be a surgeon.”
“I shudder at the thought. As I understand it, the robot is an enhancement to laparoscopic surgery, which I already considered a great innovation. However, I’ve been both amazed and somewhat apprehensive at major surgery performed through three little incisions.”
“Before we reassure and further astonish you, let’s set the stage. The patient has at least three small incisions, one for the camera and two for the robotic probes. The surgeon sits at the console, puts his hands on the controls, and views the inside of the patient (‘the field’) through a binocular scope. What the surgeon sees is also projected on a monitor above the patient so the nurse can follow the action and anticipate the surgeon’s need for different probes.”
“Hey, Curmudge, this is getting interesting. I can appreciate why you got a kick out of ‘operating’ on a pumpkin.”
“There are two features of the robotic probes that provide the da Vinci’s great advance over conventional laparoscopy. At the end of the probe is a ‘wrist’ that can rotate and allow the probe to reach areas that are inaccessible to a conventional probe. The other enhancement is the da Vinci’s ability to shrink the surgeon’s motions by a factor of 5, i.e., when the surgeon moves 1 cm, the probe moves 2 mm. This permits delicate work that would be impossible with a conventional laparoscopic probe or extremely difficult with gloved fingers in open surgery.”
“I’m sold, Curmudge. Buy me one for Christmas with your Social Security check, or more realistically, donate your check to the hospital foundation. But seriously, what kinds of operations can be performed with the robot?”
“Most things that are currently done with conventional laparoscopy: hysterectomies, radical prostatectomies, cholecystectomies, nephrectomies, and several others. I suspect that all of these can be done better and safer with the da Vinci robot. And following surgery, the patient has less pain and can go home sooner.”
“For a surgeon, training in any new technique has to be a serious undertaking. That is undoubtedly true with learning to use the robot.”
“Julie, I believe they start by observing, and then they practice on pigs. Initial surgery on human patients is closely observed by experienced surgeons. That’s facilitated by the monitor above the patient that we described earlier.”
“Considering your enthusiasm, Curmudge, I assume that you will volunteer for robotic surgery as soon as possible.”
“My last major surgery was 51 years ago, Julie. I’m quite willing to wait another 51 years for the next.”
Affinity’s Kaizen Curmudgeon
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About Me
Kaizen is a Japanese word meaning change for the better. A curmudgeon is a crusty, irascible, cantankerous old person. The Kaizen Curmudgeon blog consists principally of conversations between the Curmudgeon and Jaded Julie. Their topic is Lean (the Toyota Production System) and its applications in health care. We attempt to depict Curmudgeon as the resident Old Guy who possesses some degree of perspicacity and is not nearly as grouchy as the formal definition of curmudgeon suggests. As her name implies, Jaded Julie is a nurse who has “had it up to here” with waste and inefficiency. She is unsophisticated, somewhat feisty, and does not appreciate having to learn the Japanese terminology of Lean. Of course, both the Kaizen Curmudgeon and Jaded Julie are fictional. The author of Kaizen Curmudgeon is a retired Associate Professor of Chemistry who has been a volunteer in health care since 2004.
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