The Pipeline

Robotic surgery controversy pressures hospitals to build credentialing standards


Khadijah Bhatti

A recent New York Times article questions the credentialing processes advocated by Intuitive Surgical for its da Vinci surgical platforms, calling on hospitals to ensure adequate training for and appropriate use of the robotic systems.


Hospitals must formalize robotic surgeon credentialing

Although the article focuses on how Intuitive’s lax training recommendations may be insufficient for safe practice, it more importantly highlights the need for hospitals to own and formalize the training process for their robotic surgeons.

In order to avoid adverse health events attributable to low surgical proficiency on the robot, hospitals must ensure all surgeons receive adequate, supervised training on da Vinci platforms and that surgeons and administrators alike understand appropriate procedural applications of the robot. Surgeons should be urged to reject marketing pressures and use the robot only when clinically optimal.


Is Intuitive's influence in the OR safe for patients?

According the article, Intuitive’s recommendations for the proctoring of robotic surgeons may fall short of the minimum training necessary to ensure safe use of the da Vinci platform.

Using emails between Intuitive representatives and hospitals to substantiate its claims, the article shows Intuitive's efforts to decrease the amount of supervised training before surgeons use the da Vinci independently and to push conversions to the robot in order to meet personal quotas.


Intuitive claims neutrality in credentialing standards

Although company representatives claim that Intuitive does not offer suggestions for determining “who is qualified to operate its robotic equipment," evidence suggests that the company has eased its own training provisions in recent years. In 2000, the company provided the FDA with a proposal outlining its plans to abet training by providing a three-day hands-on training at Intuitive facilities and a 70-item exam to surgeons interested in robotics.

By 2002, this had dwindled to a 10-question online quiz and one day of hands-on training. In conversations with the Advisory Board, many hospital administrators admit that Intuitive representatives advocate for more aggressive use of the robot, but these administrators recognize the company’s incentive to do so.

This article has renewed the industry's focus on the safety concerns surrounding robotic surgery and places the onus of safe use on hospitals and surgeons.


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