Slashdot Mirror
Robots Approved For Cardiac Surgery
An anonymous reader writes "CNN has an article up on
a new robotic heart-surgery system. By making 4 relatively small incisions into the
patients chest the da Vinci
Surgical System, guided by real surgeons, uses its pencil sized "tools" to conduct
several different heart procedures including closed-chest coronary bypass surgery. By
operating on a patient with their chest closed, patient recovery times have reduced
from weeks to just days. Despite the robotic surgery taking longer than traditional
operations, this reduced recovery times makes the robotic surgery cost less
overall than traditional open heart surgery. Fortunately, if anything goes
wrong with the robot, the human surgeons can jump right in and pick up where the robot
has stopped. Already the robot (in place in over 130 hospitals world wide) has been
FDA approved
for Mitral Valve repair surgery. More insightful info on the da Vinci System here."
It's not the first such system, either.
Isn't this the same robot that was just involved in a patient death?
I mention it because I caught the news about a robot being involved in a surgery accident on the newswire a couple days ago, and then yesterday I caught a puff piece on the DaVinci system on the TV news (ABC, I think?) - no mention of that recent fatality.
No mention of the fatality in the CNN article, either. And for that matter, no mention of it here. I find this very strange. Slashdot editors missing it, I can understand. But wouldn't even the most brain-dead journalist make this connection? Let alone the big-leaguers?
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The manufacturer is Intuitive Surgical
I have seen the machine in action and had the opportunity to "play" around with it myself. Hackensack Medical Center in NJ has two of these machines (called Mona and Lisa respectively). IT IS NOT AUTOMATED. The term robot is such an abused phrase, it is just a very very advanced instrument, the surgeon has absolute control every second. The robotic action of the machine just allows the surgeon to perfrom actions that are more percise than humanly possible. It is a very safe system so far; and it greatly reduces the post-op trauma of typical cardiac bypass (since the incision is very small and does not need the cutting of the sternum). Currently hospitals like Hackensack are learning to do more and more operations with the machine like mitral valve replacement. /nigel
But the surgeons are right there in the room. The answer is simple. The patient will sue:
- the surgeons involved
- the hospital
- the manufacturer of the device
- possibly the other staff depending no the nature of the, uh, "problem"
Once in court, the insurance companies for these individuals will duke it out and the "blame" for the "accident" will be divvied out between all the members. So the docters will be held x%, hospital y%, manufacturer z% where x+y+z==100.
This is standard lawsuit fare, no different really. It's all in the percentages and who pays what amount. In the end it's always trivial to find all parties involved at least partially responsible.
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Yes, it's quite possible that smaller incisions and a greater separation between the patient and the surgeons / nurses would reduce the chance of post-op infections, not just Staph, but of all kinds.
A slightly different problem occurrs to me, though:
In the UK recently in the light of nvCJD there've been moves to make surgical implements which are used in high-risk procedures (in this case those on lymphatic tissues) strictly single use. Even including things like cauterising irons. It seems likely that this is going to be an increasing trend as we get progressively more paranoid about this kind of thing... so, how much of this robot is disposable? What does that do to the cost-balance and to the quality of the parts being used (in the case of the cauterising irons the rule has been repealed as cheaply imported 'disposable' irons were killing patients)?
I assume all the parts that actually go inside the patients are fully sterilisable at the very least, but this does add extra wear to the parts and increase the risk of a mechanical failure...
It just goes to show; there are people around who will argue the contrary to anything. I know if you were considering surgery with this machine you'd be upset if you felt these facts weren't getting out.
It's not the journalist's job to decide what was the fault of the machine and what wasn't. I basically trust the surgeons to do the right thing; it's the journalists I'd keep my eye on.
As I've said elsewhere, it's unclear how the accident happened, obviously, but with something like this I consider both the underlying technique as well as the user interface potential risk factors. Of course, it could just have been human error, but that's the whole point of risk factor analysis; the line between "human error" and a false expectation or a design problem does not actually exist.
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In this story we hear about a surgury that went tragically wrong. A patient died when his aorta and another blood vessel supplying the kidney were accidentally cut. No one noticed for about 90 minutes.
In no way is this a "robot" it is a motion transference device. It reproduces your motions with multipliers applied to them (either greater than or less than 1 multiplier) for increasing or decrease the distance traveled of the instrument. It is progress when compared to plain laparoscopy because you are no longer as limited to the angles and degree of freedom.
We have a few points to clear up. Foremost, the article clearly does not draw the conclusion you claim, and your own quote underscores the point quite nicely. It relates only a statement by the hospital administrator. These are two entirely different things. This is only a claim by one of the parties, and moreover, an administrator with an incentive to avoid lawsuits/negative publicity. The only claim you can make about what the article "says" is a negative one. It does not say what caused the accident at all; it only points out, "something went terribly wrong."
I'm not even sure how you can believe your own words. By your "no room for ambiguity" standards, this should be an article titled "surgeon error results in patient death." It should say not "something went terribly wrong," but "the surgeon made a terrible mistake."
Fortunately, you immediately contradict yourself by admitting that it is unclear what caused the problem - the correct conclusion to draw from the article. Perhaps, if you were considering surgery with this tool, you would suddenly take a much keener interest in these fine points. By the way, taking into account the nature of the injuries, do you think this would have happened without the robot?
Your reasons for silence by journalists are particularly specious. Finding "no mechanical problems" should not be confused with "finding no problems" - again, two entirely different things. Even as a layman, I would not assume the problem was mechanical. Nor would I assume that any part of the machine "acted without prompting." Neither are very reassuring assertions. Rather, considering the circumstances (aorta cut going unnoticed for 90 minutes), one expects an interface problem, or a problem with the underlying technique. Remember, you're working in unconventional ways in tight spaces. The purpose of these trials is to evaluate the risks. Cases like this can expose important ones.
Perhaps if people left choices about medical treatments to their doctors, and there were no regular ads for drugs, medical facilities, and services targeted directly at consumers, you could make the argument that the mainstream press could be forgiven the omission. Unfortunately, this is not the case.
What do you consider "undue media attention?" Should fatalities be kept secret? Or just "not reported" in most venues? Would you like to discuss the difference? And remember, we're not talking about a quick spot; this is during extensive coverage of the device and the technique... not even then?
But where you've made the largest leap of all is the false dilemma between silence and "a media scare [that] could easily set this medical development back several years." I'm frankly shocked; proper handling, full disclosure, and maximum awareness of cases like this push medical development forward, not backwards. The only thing they might set backwards are the bottom line of the company selling the drug/device/procedure. The incentive on the part of that company to minimize such evidence, to "make the product appear to be perfect" is very powerful, often with hundreds of millions and even billions at stake...
I'm surprised to find myself getting this basic, but the foundation of both capitalism and democracy is one of full disclosure, where voters and buyers are trusted to make their own decisions given all the facts. It does not admit "fear of scaring people off" as a reason not to discuss fatalities resulting from a new product or service.
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I don't know much about the medical proffesion but I do remember units from the time I donated blood. Pretty much 1 unit is the amount one person can donate at a single time.
Looking at Google:
unit (of blood)
a unit of volume for human blood and various blood components or products. A unit of whole blood is 450 milliliters, which is about 0.9510 U.S. pint. For components of blood, one unit is the amount of that substance that would normally be found in one unit of whole blood. The adult human body contains roughly 12 units of whole blood.