Tallying the Mistakes and Malfunctions of Robot Surgeons 64
An anonymous reader writes: El Reg reports on a new study (PDF) that looked into malfunction and injury reports for medical procedures that used robot surgeons. From 2007 to 2013, 1.74 million such procedures were carried out, 86% of which were related to urology and gynecology. Of those, the study looked at reports of "adverse events," which were sent to the FDA. In that time period, there were 144 deaths, 1,391 patient injuries, and 8,061 device malfunctions. The malfunctions included "falling of burnt/broken pieces of instruments into the patient (14.7%), electrical arcing of instruments (10.5%), unintended operation of instruments (8.6%), system errors (5%), and video/imaging problems (2.6%)."
The more complicated surgeries involving vital organs were naturally the most dangerous. Head and neck surgeries accounted for 19.7% of all adverse results, and cardiothoracic procedures accounted for 6.4%. The much more common urology and gynecology procedures had adverse event rates of 1.4% and 1.9%. The researchers are quick to note that despite the high number of malfunctions, a vastly higher number of robotic procedures went off without a hitch. They say increased adoption of these techniques will go a long way toward resolving bugs and device failures.
The more complicated surgeries involving vital organs were naturally the most dangerous. Head and neck surgeries accounted for 19.7% of all adverse results, and cardiothoracic procedures accounted for 6.4%. The much more common urology and gynecology procedures had adverse event rates of 1.4% and 1.9%. The researchers are quick to note that despite the high number of malfunctions, a vastly higher number of robotic procedures went off without a hitch. They say increased adoption of these techniques will go a long way toward resolving bugs and device failures.
Not robotic surgeons. (Score:5, Insightful)
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Sorry, for this story, it's "Eye'll be back!"
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COMAPRISON REQUIRED (Score:5, Insightful)
In this case, we obviously need to know the error rate for normal surgeries.
It might be that the 'high' rate for robot surgery is in fact low when compared to non-robot surgery.
Re:COMAPRISON REQUIRED (Score:5, Interesting)
Even more importantly, how does it compare to similar-risk patients by the same set of doctors. Is robotic surgery used more with high-risk patients? Are the doctors using it competent at non-robotic surgery?
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That's apples to oranges - you can't compare the malfunction rate of the robotic device when a robotic device isn't used
What you can compare is outcomes, how often the patient recovers without complications. Robotic surgery is a clear winner there
Re:COMAPRISON REQUIRED (Score:5, Insightful)
No, that is the correct comparison.
You, as a patient, need to know whether to consent to a robot operated procedure, or whether to insist on a human surgeon. When you sign the dotted line, that is precisely the comparison you need.
Shachar
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I fail to see how that is relevant to my point.
There are two paths you might wish to take. You want to know the chances of something bad happening in each one, regardless of what each one actually is.
They need to be compared, because as far as the patient is concerned, they are alternatives she needs to chose between.
Shachar
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I think there are two measures, both valid:
1) How does robotic surgery compare to non-robotic surgery? (taking into account risk, as meloneg says) The answer to this could (in principle) help the patient decide which way to go.
2) What are the causes of errors, particularly errors that are unique to the particular method? The answer to this could (and I hope does!) improve the method.
Re:COMAPRISON REQUIRED (Score:5, Informative)
No. Robotic surgery is not the clear winner. For many procedures, robot surgery has a higher complication rate than the same procedures done without a robot.
Here's one example: http://www.wsj.com/articles/ro... [wsj.com]
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Summary:
Costs are about the same whether robots are used or not, but cyst remove is somewhat less expensive when using robots (~$4,100 vs. ~$4,900) but the complication rates when using robots are higher for both ovary remove (7.1% vs 6%) and cyst removal (3.7% vs 2.7%) when compared to regular laparoscopic surgery.
Comparisons between patient populations (Score:3)
What you can compare is outcomes, how often the patient recovers without complications. Robotic surgery is a clear winner there
You can only make that claim if you are comparing similar patient populations or can control for the differences. If robotic surgery is used on an patient population with less difficult conditions then it wouldn't be at all surprising if the outcomes were better. If the patient populations aren't statistically similar then any comparison which doesn't account for that difference is meaningless.
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This is why you also compare "hard outcomes", like "death for any reason", where the difference would be over errors, regardless of how classified by doctors or lawyers.
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Especially the % for "things dropped into the body". How often do human surgeons drop something in the body? My guess is that the issue in the robot case, the surgery has to be paused while a human scrubs in to fish the object out.
Re: COMAPRISON REQUIRED (Score:1)
Live humans are always scrubbed in for robo surgery, for this reason and others.
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It's well known from studies that the more procedures a doctor does, the better the outcomes. What happens in 50 years when robots do so much and experienced doctors are dying off by the boatload?
For that matter, same issue with robot cars and people drive like a beginner in an emergency?
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Gonna take a lot longer than 50 years to get robotics to replace straight/bent stick laprascopy. Payers (Medicare, Medicaid) have a strong preference for the older technology - to the point of dropping robotic certified physicians!
It also turns out that the advances in ROBOTIC surgery have lead to advances in Laprascopic surgery! Laprascopic surgery has more trained surgeons (effectively ALL of them), is part of regular surgeon training, has typically shorter anesthesia time (although this gap is closing)
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The idea is that the "robot" provides the surgeon with a greater degree of control; for example, reducing movement sizes allowing micromanipulation, provides enhanced force feedback, can cross reference a pre-surgical CT scan onto which "no touch" areas have been drawn so that if the operator attempts to cut into a "no touch" structure, the robot provid
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Re:COMAPRISON REQUIRED (Score:5, Informative)
"Critical Outcomes in Nonrobotic vs Robotic-Assisted Cardiac Surgery"
http://www.ctsnet.org/jans/cri... [ctsnet.org]
"Robotic surgery was more expensive ($39,030 vs $36,340) but was associated with a shorter length of stay (5 vs 6 days), lower mortality (1.0% vs 1.9%), and lower overall complication rates (27.2% vs 30.3%)."
When I needed to have a mitral valve repaired, I was told I was a good candidate for robotic surgery because I was relatively young and in good health otherwise. I went in Tuesday morning and left the hospital Friday afternoon, and instead of a twelve-inch scar down the middle of my chest, I have a 3.5-inch scar on my right side surrounded by three puncture wound scars (for the robotic arms). I'm glad I had the option.
That said, I'm concerned that some hospitals, having made a big investment in a surgical robot, might be tempted to get additional use out of it by adding on other procedures where the cost/benefit analysis isn't so clear.
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Unfortunatly laproscopic surgery for the big 3 bypasses isn't up to par yet. At least they don't slice open your entire leg to get a vein to play with anymore, pulling it out through a hole like a worm instead.
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"Critical Outcomes in Nonrobotic vs Robotic-Assisted Cardiac Surgery"
http://www.ctsnet.org/jans/cri... [ctsnet.org]
"Robotic surgery was more expensive ($39,030 vs $36,340) but was associated with a shorter length of stay (5 vs 6 days), lower mortality (1.0% vs 1.9%), and lower overall complication rates (27.2% vs 30.3%)."
When I needed to have a mitral valve repaired, I was told I was a good candidate for robotic surgery because I was relatively young and in good health otherwise. I went in Tuesday morning and left the hospital Friday afternoon, and instead of a twelve-inch scar down the middle of my chest, I have a 3.5-inch scar on my right side surrounded by three puncture wound scars (for the robotic arms). I'm glad I had the option.
That said, I'm concerned that some hospitals, having made a big investment in a surgical robot, might be tempted to get additional use out of it by adding on other procedures where the cost/benefit analysis isn't so clear.
If you were a good candidate because you were young & healthy that suggests there are higher risks associated with the robotic surgery but they were small enough they figured it was worth the convenience in your case. Of the paper you linked all I saw was the summary so it wasn't clear to me it corrected for doctors being potentially more risk-adverse with robotic surgery.
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Sorry about the link, it was the first I found that was specific to heart surgery. The other reply was accurate in that I only had one issue and there were no other issues that would require more extensive access. The main contraindication for the treatment is having a lot of fat. (I don't remember if it's surface fat, or if it's fat around your organs.)
There are risks with any procedure, but believe me there are plenty of risks associated with open heart surgery and the following recovery. Without the robo
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So I wonder if the higher cost is just for the surgery itself? Because if so the average reduction of a day of inpatient care would easily make up the difference is surgery cost.
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The numbers quoted in the summary aren't error rates anyway. They're percentages of total errors.
It's probably a bit difficult to compare actual error rates. Medical devices are subject to very strict adverse event reporting. Surgeons, not so much.
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But how does it compare (Score:1)
With traditional surgery methods?
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My powered steering went out once, but I jack off daily so I had no problem maintaining control of the car (as long as I kept my right hand on the wheel).
Re:But how does it compare (Score:4, Interesting)
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The appropriate comparison is with laproscopic (minimally invasive) surgery performed without the robot.
Comment removed (Score:4, Funny)
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Chalk up an error for yourself then. The actual rate is 99.92% success, where success is defined as no patient injury.
A little upsetting (Score:2)
"falling of burnt/broken pieces of instruments into the patient (14.7%), electrical arcing of instruments (10.5%), unintended operation of instruments (8.6%)"
I know this sounds juvenile, but if it's related to urology/gynecology I'm pretty sure that us Slashdot folk would like to see a zero percent failure rate. Dr. after 'falling of burnt pieces into patient" failure: "We've reamed your prostate for you and all of the cancerous mass has been removed. Your continence will return in a few months, but don't
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"They say increased adoption of these techniques will go a long way toward resolving bugs and device failures."
Translation: Buy more of our shit and we promise to fix it later.
Translation: Buy more of our shit.
Really, no amount of progress was ever made by kicking the problem down the road. We'll kick it as far as possible while we go off and play with another new/shinier ball. Version 2 will have twice the complexity and four times the bugs of version 1. Yada yada. The only promise being made here is your robot will be obsolete next year - be sure to toss it out along with your cellphone.
When people first started flying airplanes they were incredibly unsafe. They lacked even the most basic of safety systems, build quality and materials were very inconsistent, and even the most experienced pilots would frequently crash (a common crash would be upending on landing). Now, millions of people fly every year and it is one of the safest ways to travel, precisely because increased adoption of flying led to better engineering, materials, and safety procedures(essentiallly "resolving bugs and devic
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The overall numbers are in the summary. The patient injury rate was 0.08%.
KILLBOT 9000 (Score:2)
electrical arcing of instruments
electrical arcing of instruments?
electrical ARCING of instruments?
No thanks, I'll take chances with Roberto [google.com]. He may be crazy, but he just wants to stab you, not stab and electrocute you.