Who should be responsible when your robotic surgeon f*cks up?

Illustration for article titled Who should be responsible when your robotic surgeon f*cks up?

Back in 2007, a surgical robot’s arm broke off inside a patient’s body during a procedure for prostate cancer. The fracture was so bad that the urologists had to enlarge the wound to get the broken instrument out. The question now is, who’s responsible? The surgeon using the device, or the manufacturer?

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As we’ve discussed before on io9, robot ethics is increasingly becoming a concern, particularly when the allocation of responsibility is concerned. It’s not always obvious who’s to blame when a robot breaks the law or hurts someone by accident. Depending on the situation, it could be the user, the manufacturer, or even the robot itself.

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Illustration for article titled Who should be responsible when your robotic surgeon f*cks up?

In this case, it appears that the angst is being directed at the manufacturer of the da Vinci surgical robot, a company called Intuitive Surgical that’s based out of Sunnyvale, California. Bloomberg Businessweek says 10 product liability lawsuits have been filed against da Vinci's makers in the past 14 months.

As New Scientist points out, the company has a lot of explaning to do:

The lawsuits, which the firm is defending, make for grisly reading — they allege, variously, that da Vinci has caused liver and spleen punctures during heart surgery, rectal damage during a prostate operation, and a vaginal hernia after a hysterectomy. There are also a number of cases of unintended burns from the robot's cauterising tools. The FDA's inquiry, says spokeswoman Synim Rivers, aims to "determine if the rise in reports is a true reflection of problems, or simply an increase due to other factors".

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New Scientist says that “more than 2,500 of the $1.7 million da Vinci robots are at work in hospitals worldwide, taking part in nearly 1.5 million operations in the past decade.”

Now, all this said, it’s not immediately obvious that ISS should take all the blame. They are providing a tool, after all, one that’s being controlled by real flesh-and-blood humans — foibles and all. Surgeons control the robot’s four arms from a console equipped with a stereoscopic 3D view of the operation, magnified up to 10 times.

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Again from New Scientist:

"The console has brilliant, unsurpassed 3D vision, unlike laparoscopic systems with 2D screens," says Ben Challacombe, a consultant urologist at Guy's and St Thomas' NHS Foundation Trust in London. "It also has fantastic control instruments that filter out hand tremors, whereas long laparoscopic tools only enhance tremor." As a regular da Vinci user, Challacombe says the legal issues Intuitive Surgical faces are far more likely to be down to incorrect use by surgeons rather than robot faults.

That view is backed by James Breeden, president of the American Congress of Obstetricians and Gynecologists. "Studies show there is a learning curve with new surgical technologies, during which there is an increased complication rate," he says. And some surgeons only get two days' training on da Vinci.

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Two days training!? For real?

Interestingly, a recent study by Columbia University researchers found that robotic surgery has no real advantages over live surgeons with proper instruments and training.

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Sure, but you know that’s not gonna last. What I want to know is, when can we start blaming the robots?

Image: Prometheus; Intuitive Surgical.

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DISCUSSION

andrewswright
andrewswright

For the record - the tools would not have "broke off inside a patient’s ass." In robot-assisted laparoscopy, the surgical instruments are actually inserted through small (8mm) incisions in the abdomen. Also the prostate isn't actually connected to the anus or rectum. It is felt in a rectal exam only due to proximity - masses in the prostate can be felt through the rectal wall on digital examination or transrectal ultrasound.

I've done >75 robotic cases myself and stopped after running the numbers. Patient outcomes were no better than standard laparoscopy, and the operations actually take longer (due to setup time) and cost significantly more. While the robot offers some advantages including magnification, 3D imaging, and tremor filtration, it also has a major disadvantage in that it lacks haptic feedback (touch and feel sensation). With the current generation of robotics there are no operations that the robot would allow me to do that I can't already accomplish laparoscopically.

Intuitive has done a fantastic job marketing, but there is beginning t0 be a big pushback. ACOG (American College of Obstetrics and Gynecology) recently published a statement generally critical of surgical robotics, which has set off a firestorm of controversy in the world of minimally invasive surgery (http://www.acog.org/About_ACOG/New…

As an aside, the da Vinci is not a true robot - it is actually a telemanipulator. It has no autonomous or semi-autonomous capabilities but merely follows the movements of the surgeon at the operator's console.