WILL THE NHS STOP THIS BANDWAGON?

'I wanted to point out that the scientific evidence for robotic surgery is very poor. The standard way to investigate new medical or surgical treatments is with randomised controlled trials.I would advise that you don't do this for tons of micro-topics, of course, so don't go crazy creating a gazillion pages where the content could be condensed into one kitchen knives or just a few pages.Start with fiery Charred Octopus or the Guacamole Trio, which comes in tropical,diagnosisexpert goat cheese and ranchero flavors.'This is where a new procedure or treatment is compared with a current treatment. 'With robots, there have been a couple of very small studies and they were both poor quality,Large format entrees include Diver Sea Scallops with spaghetti vegetables and Provencal orchid sauce stainless steel kitchenware and Bone-In Dry Age Ribe Eye Steak.Another key to staying warm up on the roof: booze.' says Mr McCulloch.One of the early tests to show positive outcomes from robot-assisted surgery,But cyclists here said the work is only a small start on what needs to be done.All are vulnerable —sondaflex to scam artists as well as legitimate art buyers and are urged to use caution. in the journal Urology, in 2002, looked at only 30 patients who underwent the op this way. It found that they had the same general outcomes as 30 patients who had conventional keyhole surgery, but they went home earlier and felt less pain. 

'It is not really the sort of evidence you would regard as an adequate basis for such a major change with consequences for patients and for the cost of treatment,' adds Mr McCulloch.'The growing evidence of complaints and stories of adverse events is exactly what happens when you start introducing something without proper research and testing. You get a wave of tremendous enthusiasm followed by a reaction when the reports of the downside start to appear.'Mr McCulloch says this has disturbing parallels with the introduction of keyhole surgery for gallbladder operations in the Nineties.'At the start, there was very little scientific validation of the new procedure, because the surgeons' enthusiasm was so strong that pre-introduction trials were rendered nearly impossible.The Foster Farms salmonella outbreak this month has underscored the importance of cooking core barrel and handling poultry properly. 

'In the meantime, uptake of the technique without adequate training caused an epidemic of damage to the bile duct and other serious complications.'Mr McCulloch fears that British surgeons feel under increasing professional pressure to adopt the use of these unproven machines, perhaps without adequate training.'I would like to see proper mentoring programmes for surgeons who are going to do these operations. At the moment this is mostly done by the companies who build the robots,' he says.The current problems may largely come down to inadequate training of surgeons, says a leading British supporter of robot-surgery, Omer Karim, a consultant urological surgeon at Heatherwood and Wexham Park Hospitals NHS Foundation Trust.