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.

Comments

Is this a robot?

[Anonymous Coward]

Or is this a human surgeon performing surgery with a very sophisticated set of tools? I know the word 'robot' makes for good headlines. Does an RC Car qualify as a robot? It does in "Robot Wars".

Re:Is this a robot?

[Hayzeus]

I doubt it's straight remote control. Maybe some very limited (semi) autonomous behaviour.

Re:Is this a robot?

[Ichijo]

Is this a robot? Or is this a human surgeon performing surgery with a very sophisticated set of tools?

From the topic description:

...if anything goes wrong with the robot, the human surgeons can jump right in and pick up where the robot has stopped...

From the CNN article:

...totally robotic operation...

These imply the human surgeons can just sit and watch while the robot goes about its work, but Da Vinci's web site says otherwise. I don't think there's any artificial intelligence involved, but I see where the confusion lies.

Scary...

[Ligur]

I can imagine counting slowly backwards from 10 and just before I doze off hearing: "I'm sorry dave, I'm afraid I cannot do that."

Windows

[entrager]

*insert obligatory "It better be running Linux instead of Windows" joke, pointing out that it might crash and kill someone if it's running Windows*

robots vrs doctors

[Shymon]

i'll bet many people think that the bugs that are in this thing (and there are always bugs on anything this complicated) make for a somewhat scary prospecte to go under the knife held by said machine. but think about it, how many times have you screwed up a math problem? now how many times has you TI83? i'll take a robot's steady hand to a live doctor any day.

Re:robots vrs doctors

[entrager]

but think about it, how many times have you screwed up a math problem? now how many times has you TI83? i'll take a robot's steady hand to a live doctor any day.

I would argue that a robot capable of performing heart surgery is slightly more complicated than a TI83. Let's all remember that the number of errors in a system typically goes up with the complexity.

Re:robots vrs doctors

[Guppy06]

"but think about it, how many times have you screwed up a math problem? now how many times has you TI83?"

First off, I don't have a TI-83. Real men have TI-92+s. Or a slide rule. Which I also have.

Secondly, what if the robot was running off, say, one of those famously screwy Pentium 90's or 100's with the floating point bug?

Third, what if it runs on Windows 95?

That being said, I'd still rather have the robot than some med school flunky that got his or her degree from some small Caribbean country.

I hate to be the guy who points this out, but

[Featureless]

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?

Re:I hate to be the guy who points this out, but

[_ph1ux_]

also, since they were removing his kidney - how did they manage to cut his aorta?

Re:I hate to be the guy who points this out, but

[rob-fu]

Poor guy. Even though his vital signs remained normal, the surgeons did not see what happened 90 minutes later, and it was too late. The surgeon was called to fix the problem but the damage had been done.

Using this technology in surgeries, etc. is great, but could this be a case where humans blindly put their trust in the machine? Until this technology is perfected and absolutely error-free/failsafe/100% accurate, I'll opt for the human to do the surgery.

Re:I hate to be the guy who points this out, but

[root_dev_X]

yes and no.

it depends largely on where the aorta is cut. If you're talking about the major section of the aorta, near the aortic and mitric valves, then yes - the internal bleeding would be catastrophic, and the patient would die in a matter of minutes.

it sounds like this article is describing a cut in the aorta farther away from the heart than you're thinking. that would cause significantly less bleeding, and since imaging of such a location would be a secondary consideration, a complication in that area could go unnoticed for some time.

at any rate, a surgical system like the da Vinci could one day save many, many lives. I've got Marfan's Syndrome, and suffer from leaky aortic and mitric valves, as well as an aorta within 5mm of dissection. Closed-chest robotic surgery of this kind, which causes almost no damage to the heart and its effected connective tissues, would almost eliminate the need for me to undergo open-heart surgery one day.

Systems like this should be adopted cautiously, but i think that their introduction would lead to a dramatic drop in complications post-op, which is one of the the leading causes of death among open-heart surgery patients. Even those that survive the surgery are often left with drastically diminished cardiovascular capacity, due to the degree of trauma inflicted on the heart during the surgery. This was my father's case - he underwent open heart surgery twice to replace his aorta. The repeated surgery left his heart on a hair's trigger - the result of complications non-invasive surgery could have prevented.

pardon the soapbox, but this is a fairly close-hitting topic for me.

-WarbleVX

Re:I hate to be the guy who points this out, but

[Zathrus]

Apparantly so... but how many patients die due to surgeon error while on the table? Or afterwards due to complications from surgery?

Complications include things like having your chest split open again a few hours later. Yes, it happens. I've had to pick up 12 units of blood for a patient that had this happen (and at one of the best cardiac hospitals in the US too, not some random place). Those 12 units lasted long enough to get him from ICU to surgery. No idea if he survived or not - I was just a gopher.

Will the robot be flawless? Seriously doubt it. But you don't reject a new tool just because it has flaws -- as long as it has fewer flaws (or, hell, even more predictable flaws) than the tool or method that preceded it.

I'm very sorry for the person that died, as well as their families, and I hope that whatever situation caused that will be analyzed and fixed so that it doesn't occur again.

Re:I hate to be the guy who points this out, but

[Anonymous Coward]

Pick up a copy of Gray's anatomy some time. The aorta is a major blood carrying vessel that runs pretty much the entire length of the body trunk. Actually, you can read the relevant exceprt from Gray's here. They probably damaged the abdominal section of the aorta? (IANAS) I think to a certain extent this highlights the danger of being over-reliant on one set of sensors or inputs, i.e. just what you get through the screen controlling the 'bot.

Re:I hate to be the guy who points this out, but

[Zathrus]

Until this technology is perfected and absolutely error-free/failsafe/100% accurate, I'll opt for the human to do the surgery.

Yes, because human surgeons are perfect!

That's why malpractice insurance is so damn cheap.

Re:I hate to be the guy who points this out, but

[American AC in Paris]

Isn't this the same robot that was just involved in a patient death?...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?

In reading the article, it would seem that the culpable party was the surgeon, not the machine. To trumpet the fact that the Da Vinci robot was involved in the operation would be a disservice to science and medicine--this was human error, not equipment malfunction.

It would be wrong to spotlight the tool in this case, just as it would be wrong to spotlight the surgeon had Da Vinci malfunctioned.

Re:I hate to be the guy who points this out, but

[pussycat]

It is of course horrible that someone was killed by this less intrusive surgery, when they might have lived with the more intrusive and more often performed traditional sternum-cracking surgery.

IANAMD, however I am certain it is not the first time that a new surgical technique designed to be less risky for the patient was actually more risky because of the novelty it presented the surgeons performing it. There's no way to leapfrog the novelty of the technique, but in the long run, for the general public, it will be less risky because it is less intrusive.

Re:I hate to be the guy who points this out, but

[Featureless]

Quite true. I'm far more concerned with the journalists covering the device than with the surgeons.

Re:I hate to be the guy who points this out, but

[Idarubicin]

The article you cite states unequivocally that preliminary investigations found no mechanical fault in the device. If the reports indicated that the robot's arms spontaneously began making stabbing motions without input from the surgeon, then it would be important for the news outlets to report this incident. Surgeons can make mistakes, whether they are working with their own hands or controlling robotic ones.

I, for one, would much prefer to be operated on using this new system--the electronics damp out tremors, and I don't have to worry about a surgeon sneezing and lacerating my intestine. The trauma of major incisions is eliminated, saving me from weeks of hospital food, pain meds, and severe scarring.

Surgeons will take time to become accustomed to this new system. Without a gaping incision, it is harder to see what's going on. There are new failure modes possible. A nick in the aorta is immediately obvious in conventional surgery, not so much so under these conditions. There may also be a 'novelty' penalty. This is a new technique, so there aren't really any experts in the field who have performed thousands of procedures with these devices. There is a learning curve.

Nevertheless, medical decisions are usually made on the basis of a risk calculation. If there are fewer overall complications and deaths, then I'll accept 10 robot-related deaths per year in exchange for the prevention of 100 lethal post-op infections due to poor wound healing.

Re:I hate to be the guy who points this out, but

[gid-goo]

Cracking the sternum is a strange way to remove a kidney.Seems like you're a bit out of the way and all. Ho hum, I'm not a surgeon though, I just read the article.

Re:I hate to be the guy who points this out, but

[jpmorgan]

Until this technology is perfected and absolutely error-free/failsafe/100% accurate, I'll opt for the human to do the surgery.

These 'scalpel' things are too dangerous. Until the technology is perfect and nobody dies from them (because we know the doctor never makes a mistake), I'll stick to my leeches.

Somedays I wonder how these attitudes survive evolution...

Re:I hate to be the guy who points this out, but

[mysticgoat]

The CNN article was talking of the use of this robotic technique in cardiac surgery.

The patient death concerned the use of the same equipment, but in renal surgery. This is a very different situation-- the surgical approach is entirely different-- the whole operating room is set up differently. Very different techniques are in use. The profiles of risk factors are extremely different both in the OR and postop.

This is analogous to developing a trans-Sahara four wheel drive vehicle and all the procedures for its safe use, and then trying to adapt it to arctic conditions. Yeah, snow drifts and sand dunes have a lot in common. With some modifications to the procedures, the vehicle might well be as safe on the snow as on the sand. But the fact of an accident in a Montana blizzard of itself means nothing with regards to the vehicle's safe performance in the Sahara.

In my opinion the news has acted responsibly in not tying the fatal renal operation into a report on a new and extensively developed set of cardiac procedures. There is as yet no reasonable basis for making that connection, and there might never be.

Re:I hate to be the guy who points this out, but

[mysticgoat]

The aorta runs from its arch over the heart to where it bifurcates in the pelvic bowl into the left and right femoral arteries. The kidneys sit very close to the aorta, and another huge vessel, the inferior vena cava. The kidneys connect between these two.

During renal surgery, the patient is positioned on his side and the table is bent upward to stretch the area between the base of the rib cage and the crest of the pelvis. One of the implications of this is that bleeding from a nicked vessel could easily go undetected with the blood pooling at the bottom of the abdominal cavity. This would be consistent with the ninety minute delay before the patient developed signs of trouble. If he had not been recovering from anesthesia, he may well have reported a lot of pain and shown signs of an "impending doom" anxiety that would have tipped off the nursing staff to a problem. But during those ninety minutes he would have been returning to consciousness.

I am very puzzled by one aspect of this case. It seems from the reports that excision of the kidney was intended from the start. That would require the kind of long incision whose avoidance is one of the chief reasons for using the robot. Also the renal procedure is an abdominal one, not a thoracic one, and the risks that the robot was designed to minimize are much less severe in the abdominal cavity. So I'm puzzled about what the perceived benefits for using the robot in this area were supposed to have been.

don't trust it...

[TechnoVooDooDaddy]

Fortunately, if anything goes wrong with the robot, the human surgeons can jump right in and pick up where the robot has stopped.

unless it has stopped after impaling itself thru your heart i guess..

I don't mind having a surgeon drive, but totally automated makes me a bit nervous.

Re:don't trust it...

[Anonymous Coward]

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

Who to Sue?

[drblunt]

But who will the overly litigious American peoples sue if something goes wrong? The doctor, who is, for all intents and purposes, not there? At any rate, while I am clearly attempting to facetious (sp?), this is really a very big step forward. I just don't want it working on me until they've worked out the bugs.
Doc

Re:Who to Sue?

[binaryDigit]

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.

Re:Who to Sue?

[obiedxss]

The doctor, who is, for all intents and purposes, not there

No, he is not there, but he is not at the controls. Who was at fault for the Valdez oil spill? r>The captain was in charge and he was bui (boating under the influence). He did not actually throw the oil overboard himself but when he steered the boat into the reef, he caused the oil to spill.

The scientists will be at the helm of the robots so if anything goes wrong, they will have to take the rap and they will have to defend themselves in court when someone sues for malpractice.

Re:Who to Sue?

[outsider007]

The doctor is there and is fully responsible for anything that goes wrong.

I think this is an extremely mission critical tool and the engineers should take the rap if it blue-screens. I mean what happens if a patient dies because a scalpel breaks in half and it turns out the scalpel company was cutting corners that month? is that the doctor's fault?

But if the guy gets sewed up with the robot still inside, thats another story..

Cardiac Surgery

[Detritus]

I had a teacher who enjoyed explaining, in gory detail, how they sawed his sternum in two, pried open his rib cage,, fixed his heart problem, and then stapled his sternum back together. This new technique sounds much less painful.

Re:Cardiac Surgery

[binaryDigit]

And that points out the number one problem with this procedure, lack of cred. I mean, man, the horror stories, plus that massively (literally and figuratively) cool scar to show off at the pool parties and by the beach.

Re:Cardiac Surgery

[MrEd]

No kidding. Not only does traditional surgery give you the the big scars and the cobbled-together sternum, but the sliced muscles - I'm stuck with (at best) a 5-and-a-half-pack from a severed nerve. Good conversation topic (hey baby wanna see my scar?) but certainly worth giving up for the simplicity of this remote manipulator (not robot!) surgery.

Other problems?

[insanecarbonbasedlif]

A lot of times when doctors go to operate on someone with heart problems, they discover other defects or abnormalities with the heart and surrounding vessels. Will a robotic system that is minimally invasive create "tunnel vision" so that doctors are unable to see other potential problems?

Re:Other problems?

[poot_rootbeer]

A lot of times when doctors go to operate on someone with heart problems, they discover
other defects or abnormalities with the heart and surrounding vessels.

Funny, my auto mechanic always seems to find a bunch of latent problems with several unrelated parts of my engine whenever I go in for a simple oil change...

Re:Other problems?

[Skyshadow]

Will a robotic system that is minimally invasive create "tunnel vision" so that doctors are unable to see other potential problems?

Realistically, the number of problems found incidentally in surgery is dwarfed by the number of problems that cutting open someone's chest, sawing their sternum in half, jacking open their ribcage and then stapling the whole thing back together again.

It's like saying that it's better to reboot a healthy system when the webserver crashes because you might fix other problems that you haven't noticed yet -- Windows logic.

incisions?

[sczimme]

By making 4 relatively small incisions into the patients chest
...
Fortunately, if anything goes wrong with the robot, the human surgeons can jump right in

I think they're going to need bigger incisions...

manufacturer's url

[tomhudson]

The manufacturer is Intuitive Surgical

scary but probably good

[chunkwhite86]

This while sounding scary at first, is probably a step in the right direction for surgical medicine.

I however, would not like to be one of the beta testers for this thing!

I hope the control computer is not networked

[jki]

...or else we will have a new generation of assassins who hack in the hospital network and just accidentally puncture your heart. I mean really, this is a bit scary - especially because based on my experience many doctors do not exactly know what is happening on their computer and how to keep it secure - and to make sure no-one plugs any device on their network or any software on their computer during the visit....and even if the computer is not networked, do you really think it would be impossible for someone to slip in a device providing wireless access to that machine. Has anyone noticed any articles on these issues?

Re:I hope the control computer is not networked

[Idarubicin]

Okay. First of all, this system is not your regular off-the-shelf PC. I'm sure it will have a "no user-serviceable parts inside" sticker, and it is designed so that tampering is difficult.

That said, if you really wanted to assassinate someone in a hospital, there are quite a few ways to do so that are already accessible to the determined murderer. Slip into the recovery room and inject a shot of potassium chloride into one of the victim's IV bags. Very effective. Or just use a pillow, if you have some privacy.

If you want them to die in surgery, tamper with the equipment that monitors vital signs. Continuously read out healthy blood pressure and pulse. Bonus points if you can deliver a small electric current across the EKG leads. Mess with the anaesthetic gas mix. Quite a few people die under general anaesthetic even when things go right.

Frankly, if you're going under the knife and you're going to be unconscious, then you're pretty vulnerable. Be glad that your surgeons are using tools to minimize the trauma to you. If you really fear assassination, then lock yourself in the basement with a bottle of Scotch, and wait for your inflamed appendix to kill you itself.

Re:I hope the control computer is not networked

[jki]

You're kidding, right? Wireless access to a piece of hospital equipment? What protocol do you expect it to speak, exactly?

Instead, explain me why it is impossible? If the control console has any interface it is likely that tbere exists something that you can plug into it. And there probably is some interface for doing maintenance tasks. There's bunch of off-the-shelf gadgets which allow you (simulate running) about anything over anything, for example serial over wlan. IMHO, obfuscation is the only thing that guards the console unless someone can point otherwise.

Re:I hope the control computer is not networked

[jki]

If you really fear assassination, then lock yourself in the basement with a bottle of Scotch, and wait for your inflamed appendix to kill you itself.

I do not fear assassination - I just wanted to raise discussion hoping someone would have more details on HOW it is secured - they obviously must have thought about it and there might be something to learn. If the control console has any interface it is likely that tbere exists something that you can plug into it. And there probably is some interface for doing maintenance tasks. There's bunch of off-the-shelf gadgets which allow you (simulate running) about anything over anything, for example serial over wlan. IMHO, obfuscation is the only thing that guards the console unless someone can point otherwise.

Re:Hmm

[killthiskid]

What do you think is scarier, having your chest peeled open like a book, or the alternative. As someone whose father just recently went through open heart surgery, I can say the process would be nerve racking either way.

And while the surgery is bad, the recovery is probably worse. Painful, long, and frustrating. Anything that can shorten the recovery process is a wonderful thing, IMHO.

That's just silly!

[L. VeGas]

Robots don't have hearts, unless the Wizard gives them one, and if you know a wizard, hey, who needs surgery?

I'd prefer...

[fireboy1919]

"...it better not have any software."

When it comes to something that needs to be that robust, I want a control system consisting of highly reliable real-time (not pseudo-realtime like embedded distros) microcontrollers.

I want parts designed to last 20 years, not something that could fail in one due to a motherboard failure, or at any time due to a hard drive failure. Software just doesn't cut it here.

Hmm...

[c0dedude]

Robotic surgery really gives a new meaning to the blue screen of death eh? Grab the paddles, we gotta restart!

Re:Hmm...

[Etrigan_696]

General Protection Fault in module Mitralvalve32.dll.
You may be able to continue normally. Press any key to continue.

*presses key*

General Protection Fault in module SuperiorVenaCava32.dll
You may be able to continue normally. Press any key to continue.

*presses key*

WARNING!!! System Resources Dangerously Low. It is reccomended you save your work and restart the system.

Ironic??

[jimmyCarter]

The heart has its reasons which reason knows nothing of. -- Blaise Pascal

Anyone else find this random quotes appearing at the bottom of stories today ironic? I haven't looked at Slash, but it looks like two quotes are randomized daily maybe?

Re:Ironic??

[_ph1ux_]

Yes, Mr. President, I did find it Ironic as well. Seriously.

No more "lost" watches ....

[binaryDigit]

Now it will be

"the robot left a servo in the patients chest, DOH!"

Robotic Surgery Link - CSTAR

[tartanboy]

Here is a link to CSTAR, which is a national centre in Canada for robotic surgery. The page talks about a few of the systems mentionned in the article.

They seem to have quite a few robotic surgery firsts. Pretty neat stuff.

Risk factors

[Featureless]

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.

Our men in Uniform

[theedge318]

This bodes well for our men in uniform, who don't have the sterile environment and the number of skilled doctors available in a hospital. As one who has worked on 3D visualization projects for Army Surgeons, tele-medicine and robotic surgery are major concerns. Army medics are incredible people who put their lives on the line and their backs to the bullets to save other people ... but they don't have the necessary skills.

This is definitely only the beginning, while most of us /.ers are sitting behind our computers screens (assumedly) close to a medical center, our men in uniform don't have the luxury. This can provide solutions to save lives, where previously they would only be put on a morphine drip to ease their last moments.

[ADV] Robot Insurance, because you never know!

[Xerithane]

Robot Insurance? Yep, it's not a laughing matter for some people.

For when the metal ones come for you...

Hey, hold on

[Featureless]

We don't know anything about the trial - so let's not guess about rates. I'm just saying it's very bad when such an accident (occurring just a few weeks ago) is not worthy of mention in a long news article or TV program covering the device. Especially when it clearly appears to be the result of procedural error - this isn't someone's hand slipping. It should (rightly) draw new attention to the doctor, the device, and the underlying techniques, so it's very spooky when the news covers the device without ever mentioning it's just been involved in a patient death under questionable circumstances.

Re:Hey, hold on

[Featureless]

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.

I was waiting for someone to make this mistake

[Featureless]

In reading the article, it would seem that the culpable party was the surgeon, not the machine.

Really? Point out where the article draws that conclusion.

As I just 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.

Re:I was waiting for someone to make this mistake

[American AC in Paris]

Point out where the article draws that conclusion.

Well, to quote the article,

The hospital and Intuitive Surgical Inc., which manufactures the da Vinci Surgical Systems robot, evaluated the machine and found no mechanical problems. [Hospital president Isaac] Mallah said the robot did not cause the problem. It does not act without prompting and is always controlled by a trained surgeon.

There really isn't room for ambiguity in that statement; the hospital president says flat out that the robot was not the cause of the problem.

As I just 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.

Yes, it is unclear how this happened, but I stand by my statement that the machine should not receive undue media attention at this time, especially in light of the fact that 1) the investigation is young, ongoing, and under the auspices of regulatory agencies; and 2) the machine was found to have no mechanical problems.

A media scare could easily set this medical development back several years. Doing so prematurely on and little evidence would be a terrible disservice to those who could benefit from this type of surgery.

Re:I was waiting for someone to make this mistake

[Featureless]

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.

Re:I was waiting for someone to make this mistake

[jpmorgan]

Really, they just shouldn't have reported on the robot until the investigation had been cleared up.

But, the investigation is currently underway. While a number of people associated with the situation have stated that the robot wasn't at fault, we'll just have to wait and see what the result is. So, what should be done in the meantime?

If you report that somebody died under the robot without knowing the full facts and filling our your article with speculation, you're just going to scare people. Now, perhaps the robot needs to go back for redesign, but if the investigation shows up an issues, it'll probably get its FDA approval removed (don't forget, it is approved for use by the people empowered to keep your surgeon from using something dangerous on you) -- and then you can report to your heart's content and scare people rightly... although it'll be moot since it'll have its approval revoked anyway.

But what if it wasn't the robot's fault, and you just created a scare? People who would have been operated on by the robot now refuse, end up elect for something that's actually more dangerous and you get more people dying due to complications.

So why don't we all just sit and wait for the results to come out before making judgements?

Re:I was waiting for someone to make this mistake

[American AC in Paris]

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?

Remember saccharine?

It was found that, in near-fatal quantities over an extended period of time, saccharine could cause cancer in lab rats.

The media picked up the results of the study, read "saccharine causes cancer!", and the rest is history. For years, saccharine was considered a horrible, dangerous substance by many people, despite repeated responses from scientific authorities to the contrary. Why? They'd seen it on the news! They'd read it in the paper! Saccharine causes cancer!

Was it responsible, ethical, or right of the media to so thoroughly slander the safety of saccharine? Is this how the media is meant to keep the public informed?

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.

And I'm saying, again, that the fact that the Da Vinci machine was used in this operation has been disclosed, that an investigation by regulatory agencies is underway, and that media speculation on this matter would be premature and irresponsible at this point.

The media is not a panacea for society's ills, no more than the government or industry. I continue to believe that the media is acting in a careful, responsible fashion.

You repeatedly attack me for advocating silence; I do not advocate silence. I advocate discretion. I advocate responsibility. I have full faith in the media's ability to root out foul play and bring it to light--journalists live for such a major break, and there are undoubtedly several digging into the matter. I also know fully well that an unscrupulous or agenda-driven journalist could do immense harm to the progress of this surgical device by playing off people's fears of robots and machines performing heart surgery.

Full disclosure is but part of the foundation of both capitalism and democracy. Trust, diligent review, and due process are all essential bricks in that same foundation.

Why is it that you do not clamor for the details of the surgeon's history? Why do you not ask about whether or not he's been under undue stress, or if he has a history of errors in other surgical procedures--after all, it is a hospital official who claims that the surgeon is experienced and highly skilled, and don't hospital officials have a vested interest in protecting their own? I mean, this guy is still practicing at that very hospital! Why have you chosen to target an entirely surgeon-guided tool instead of the surgeon himself?

Re:I was waiting for someone to make this mistake

[Featureless]

That's just it - reporters are meant to stay out of the judgement business. The idea is to just report facts. And in in-depth coverage, they shouldn't fail to report a fatality like this because "it might scare people."

Re:I was waiting for someone to make this mistake

[Featureless]

Thanks, I think. I'm got a chuckle and appreciated your point at the same time. I'm no libertarian, and I'm no neoliberal either (whatever that is). I don't actually like the fact that we have consumer-targeted advertisements for drugs and devices like the DaVinci; it's just that it seems to be the status quo now... Perhaps, in a world of declining healthcare standards, it's inevitable.

Re:I was waiting for someone to make this mistake

[Featureless]

Here we get to the crux of the issue - something I am wishing I could have postscripted into my original post, since it would have saved me some considerable typing later. I am not interested in attacking the robot, or the surgeon. I have no bias, nor prejudgement about what caused the accident - I accept it as ambiguous. Now, look at the type of procedure being perfomed. Precisely the sort of thing that limits "sensory inputs" to the surgeon. Look at the type of injury; an aorta cut going unnoticed for 90 minutes. This should hopefully answer your question about anyone should anticipate that the problem was related to the technique, and/or possibly limitations in the device itself.

I am deeply disillusioned with the media industry, though in this case, I am not even making an allegation of corruption. Foremost, they have an inherent problem with their dependency on advertising and sponsorship, often by the very companies they are reporting on. Like Aurther Andersen doing "consulting" for Enron while "auditing" their finances. Then there's the inexplicable consolidation, which leaves ownership of huge swaths of the media in a single pair of hands. You are naive to assume the media is doing the right thing in a particular instance. But I digress.

You say "I do not advocate silence. I advocate discretion." We have a very specific context, in which I don't think you even have that hair to split. I understand your point, and your anecdote about saccharine is instructive, but your false dilemma remains. There is a long distance between the "discretion" of glossing over recent fatalities during in-depth coverage of a device or technique, and doing "immense harm to...progress." A terribly long distance.

I am not advocating irresponsible or "unscrupulous" journalism; however, I worry that with your emphasis on "discretion," you are. I think it obvious that journalists doing in-depth coverage of DaVinci could report on the fatality, and even quote experts involved in the investigation, without arousing panic that would set back science.

Frankly, both "discretion" and "openness" have been tried over the years in various media cultures. As it turns out, a policy of "discretion" is unambiguously dangerous (did you ever spend any time in the Soviet Union?) and a policy of "openness," for all its "perils" is unquestionably safer, not to mention its respect for the dignity of the audience.

Let an unscrupulous journalist fear-monger about robots surgeons. I will line up with you to condemn it. This doesn't even touch my point.

Also, I wanted to ask; do you think I am correct in my understanding that massive-dose experiments are conducted in order to discover through "saturation conditions" what potential cumulative effects and other risk factors might be; thus increasing the case for further (including long-term) study? Or will you imply that massive-dose experiments are simply animal torture which serves no scientific purpose? To put it in perspective, I don't avoid eating saccharine, but I think you're equally out of bounds implying, as you perhaps have in both cases we've discussed so far, that there is no risk that these new developments won't pan out in the end, and no gain in media coverage of any problems.

Re:Hmm (The Dr. McCoy Problem)

[zanerock]

It sounds great to me. Less recovery time, less trauma, more precision, etc. It probably won't be long till it's faster. Similar systems will probably start to provide all sorts of services. Eventually, you might begin to carry such things on capital ships and cruise liners, have "emergency stations" at rest stops that can repair heart attack damage instantly, etc.

Just like Star Trek. Which brings me to my concern. I can't really envision Dr. McCoy jumping in there. Once such systems are commonplace, will the doctor eventually become a mere medical technician? In 50 years, will the guy watching the surgery know what to do when MS Surgery blue screens?

Not that the percentages might be better, humans make mistakes too, but I'd hate to see the profession suffer. If nothing else, it will decrease the demand and even the perceived need for highly skilled surgeons (well into the future, of course). This could cause a shortage in which it really is just a sys-admin watching Dr. Roboto tinker with your innards, ignorant of what the hell is going on.

I would like to ask a favor

[Loco3KGT]

Of all manufacturers of these devices : Please don't try to divide by zero. I like my life.

Robotic surgery may cause brain damage

[peripatetic_bum]

There was a recent article in the JAMA which reported that there was a decrease in cognitive ability in people how had major cardiac surgery.
They thought it might be due to the time spent on the heart-bypass machine or that time spent with the body cooled might be affect the brain in some unknown way yet. Thuse when reading this article and it stating that the surgery takes much longer but the hospital stays are shorter might in fact be hiding the fact that the rate of cognitive damage might go up and not be detected until months afterwards.

Re:Robotic surgery may cause brain damage

[Skyshadow]

Thuse when reading this article and it stating that the surgery takes much longer but the hospital stays are shorter might in fact be hiding the fact that the rate of cognitive damage might go up and not be detected until months afterwards.

So you're saying that because there's no evidence of something, it must be true? My freshman year logic instructor would not approve.

Re:Robotic surgery may cause brain damage

[IIRCAFAIKIANAL]

acutally, what I am saying is that there a defintely connection between having heart surgery done and the patient suffering decreased congitive abilities. The report (i dont which but it is there, its been mentioned in big newspapers also) states that they are not sure if it heart bypass machine or cooling but is defintely there and I am pointing out that if they are going to make heart surgery even longer that this might make the mental side-effects even worse.
Thanks.
Are you a philosophy major or computer science?

Correlation != Causation
It could be something else entirely. For example, the decrease in cognitive ability could be due to the invasiveness of traditional surgical methods or from ingesting too much hospital food - I jest, but the fact remains that one study does not prove anything, especially when it only establishes correlation (which is weak) instead of causation (which is strong).

Human in the loop?

[kzinti]

Fortunately, if anything goes wrong with the robot, the human surgeons can jump right in and pick up where the robot has stopped.

Yeah... assuming the doctors notice that anything is wrong. As pointed out in the Risks Digest recently, a surgeon-controlled robotic surgery in Tampa went terribly wrong in October; while attempting to remove a patient's cancerous kidney, the surgeon (or robot - the root cause hasn't been identified) cut the patient's aorta, an accident which went unnoticed until an hour and a half later! The man died two days later from complications related to the surgery; no mention of whether the complications are a result of the accident. But if they were, would the hospital or doctor admit it?

--Jim

Lower risk of Staf Infections?

[wideBlueSkies]

My wife lost her father a couple of years ago.

He had a triple bypass, and was up and around his room the next day. We were like "way to go dad!".

The day after that he had a fever. Within a week he was in a coma, and 2 1/2 months after the operation he was gone. It was horrible. And all because he caught a Staf infection.

It could be that maybe a surgical implement wasn't as clean as it sould be... more than likely, he just caught it from bacteria floating around in the air. He was on the table for more than a few hours.

I hope to god that advances like this can keep someone else from going through the hell that he (and we) went through. The way I see it, the less invasive the procedue it, the less likely it is that an infection will occur.

Re:That is awesome

[orthogonal]

How the heck is this [parent comment: That is awesome....Until it's hacked by Chinese!!!] funny?

It's funny as a heart attack.

Drum roll, please!

(Actually, it's quite a bit funnier: I chuckled at the joke a lot more than I chuckled when I had my heart attack.)

Re:Concern: Time Under Anaesthesia

[orthogonal]

changes in personality in bypass surgery survivors,... might be caused by impurities introduced via the bypass pump, resulting in some brain damage

Could well be. It's the right brain that's pessimistic, if I recall correctly, so perhaps damage to the left brain caused this.

On the other hand, pychological stress resulting from the heart disease or the surgery might be to blame as well. In my case, since having a heart attack, I'm rather more pessimistic (realistic?) about my chances of living a long life.

Of greater impact on a daily basis, however, is that I tend to worry over any shortness of breath, heartburn, angina, or upper back pain, wondering if it is the onset of another attack. As these symptoms are also symptoms of common and negligable problems, I end up spending more time than I'd like, wondering if I'm about to die or end up in an emergency room. That tends to make a man a little less cheery.

Re:No thanks. This kills

[Skyshadow]

That case clearly shows the flaws with this technology... It made the surgeon lazy. He expected the robot to just 'do what it should' with no problems. He didn't check for internal bleeding. The patient died because of it.

You're joking, right?

Look, this thing isn't a "robot" in any real sense -- it's not taking away control from the doctor, it's a sophisticated tool which has the potential to do as much for surgery in the next few decades as the laproscope did in the last few.

If the doctors start skipping steps, it's their fault, not the tool's. Like certain other people in this thread, you're applying Windows logic ("It should have done this for me and covered my ass!") in a UNIX situation -- the tool is meant to be used by someone who understands it and knows what they're doing.

If some newbie rm -rf's his filesystem, it's his fault, not the OS's.

Doc

[_ph1ux_]

I am still waiting for my own holographic doctor.

Re:Lower risk of Staph Infections?

[girl_geek_antinomy]

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...

On the next season of Junkyard Wars ....

[nicodaemos]

Today teams, you're going to have to build an artery clearing, laser cutting, heart pumping cardiac surgery robot!!!

Each team will do three surgeries tomorrow in a head to head competition. The team who spills the least amount of blood and has the most living patients at the end, wins!!!

Okay teams, you have 10 hours to complete your robots. Get ready, set ..... go !!!!

unit?

[devphil]

I should know this kind of thing already, given the exposure I've had to the medical field, but how much blood is in a "unit"? Saying "12 units" doesn't communicate anything to a non-medical guy like me.

Actually, on further thought, it communicates a very wrong thing to me -- I'm a Type I diabetic, and to me "one unit" [of insulin] is 0.01 cc, or 0.01 ml. So "12 units of blood" sounds like something I would lose out of, say, a scraped knee. :-)

Re:unit?

[Julian352]

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.

Re:unit?

[Zathrus]

As another poster said, it's roughly a pint.

Blood that you get from blood banks is not the same as what comes out of your arm though -- donated blood is processed into three different parts - red blood cells, platelets, and plasma. White blood cells (leukocytes) are usually removed because they're often not well tolerated by the recipient.

Red blood cells are generally referred to as a "unit". It's fairly easy to type-match since there's only 8 different base types (A, B, AB, O, and +/- RH of each; RH factors can now be removed so it's no longer a big factor - I'm O+ but the red cross stalks me down every 56 days because I'm as good as an O- for being a universal donor).

Platelets are needed for coagulation - when you get a cut platelets gather at the area and cause the blood to thicken and form a scab.

Plasma is the majority of the blood - it's essentially a suspension which everything else is in. It's also how the body gets rid of wastes and transports stuff around (including red blood cells, horomones, etc).

See this one in comp.risks, issue 22:36?

[Lucas Membrane]

"In an surgical operation to remove a cancerous kidney at St. Joseph's Hospital in St Petersburg, a three-armed da Vinci robot (made by Intuitive Surgical Inc.) was being controlled by an experienced doctor from a 3-dimensional computer screen, 10 feet away. The robot technology for cutting blood vessels is supposed to decrease bleeding, pain, and recovery time. Unfortunately, the patient's aorta and another blood vessel were cut, and this went unnoticed for an hour and one-half. Two days later, the patient died of complications. The developer found no mechanical problems, and absolved the robot, which had been used successfully in 10 similar operations."

Re:Lower risk of Staph Infections?

[girl_geek_antinomy]

Are you thinking of staph or strep? Streptococci are routinely present in the throats of healthy individuals. Some strains of staph are skin commensals, that is to say they live on the skin without causing any problems under normal conditions. Staph are a common sauce of post-operative infections, and are the culprit in MRSA, or Methicillin Resistant Staphylococcus Aureus, the antibiotic resistant hospital 'superbug' now seen throughout the world. They are frequently carried into hospitals by patients and visitors.

As just a matter of information...

[carlcmc]

I'm on staff in the Urology division at Mayo Clinic in Rochester, Mn. (www.mayo.edu www.mayoclinic.org and www.mayoclinic.com). We have one these da Vinci's and we use it for partial and total nephrectomies (removal of the kidney) and other various urological related surgeries.

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.

Trademark (da Vinci�)

[Cheese Cracker]

I'm sure Leonardo would have been happy to see his family name trademarked... Well, there's a difference... this company spells it with a lower case 'd'... Thank goodness we got innovative marketing people nowadays!

Dr. Bender, Heart Surgeon

[Rai]

Sounds like a plot for a halloween episode of Futurama with "Dr. Bender, Heart Surgeon" :)

Alternative title for article:

[Dannon]

'Tin Man' Heart Surgeon

I just attended a conference on this...

[dmarkle]

I just attended a conference on this at Columbia University this summer. It's a nice idea, but it still has a long way to go. Right now, there are 3 big problems with the system: 1) As stated before here, surgeries take longer = more time under anaesthesia, less times docs and OR staff and hospital resources have for other cases 2) COST! These robots are NOT cheap, and their operating expenses are huge. Combine that with the training time for docs to get used to the system, and you have one really expensive bot. 3) In *most* cases, these bots aren't doing surgeries that can't already be done laproscopically by a good surgeon. This makes point 2 all the more problematic, obviously. The promise of telemedicine with one of these bots hasn't really been done much either - most of the time the doc is sitting down right next to the patient at the "terminal"... One can only dream of the risk that would be introduced when you put a WAN link between the terminal and the robot, no matter how fast/low latency it is. So it's a neat idea right now, but only for experimental purposes. My big problem with the conference and with techniques like this is that it's a waste of $$$ when there's so much "low hanging fruit" when it comes to Computing + Medicine. *Why is it* that docs are still WRITING perscriptions on paper pads, which can be forged, lost, etc, and can't be cross referenced automatically with other 'scrips that other physicians have perscribed for the same patient? Why is it that countless millions are wasted every year in filing paper forms, in transcribing records because insurance/docs/hospitals information systems are incompatible? How come every doc doesn't have charts/xrays/etc at any desktop/laptop/tabletpc they want in a hospital or in their own practice? How come docs don't have entire formularies of drugs at the tip of their fingers at all times? The tech for all this stuff has been around for years, but where is it? Come on! My $0.02 ($0.03 CDN)

Re:Hmm (The Dr. McCoy Problem)

[outsider007]

such systems are commonplace, will the doctor eventually become a mere medical technician?

McCoy was a bad example. Take the holographic doctor from Voyager. His role was to diagnose patients and reccommend treatment. If something went wrong with his instruments, Torres or Kim were brought in to fix it.

Re:Hmm (The Dr. McCoy Problem)

[zanerock]

The problem ends up being more of an economic one than a technical one, and could be very serious. I'm not talking about doctors becoming obsolete, I'm talking about a breakdown in market forces that intices peopel to the profession.

My original posting was done at work, so was limited, but to expand on the idea, it goes like this. Robotic/machine/semi-automated surgery becomes commonplace (and I'm talking many decades here). Because of this, demand for a fully trained doctor decreases. People can use computer programs and home diagnostic equipment, standard operations are now mostly automated, with many procedures not even requiring an atending physician (those where an error or complication would not introduce greater risk and need not be dealt with immediately).

This wouldn't mean that we wouldn't still need doctors, it would mean that doctors don't get paid as much. Insurance is already through the roof and many doctors routinely refuse to deliver babies or perform certain procedures where the likely hood of a suit is much greater. If machines speed up procedures, then even with greater reliability, the overall incidence of complication (especially since many complications are due to patient factors) might not decrease, and the net effect would be a wash (I'm assuming the doctor population goes down).

Why does the doctor population go down? Because insurance costs and costs of doing business are unlikely to decrease (indeed, with all this equipment, they'll likely increase), while pay, respect, and power decrease.

Certain types of doctors will still be in high demand, but, I'm saying that there are certain scernarios where the overall number of doctors decreases to problematic levels.

Re:I would LOVE to see MD's put out of a job by SW

[zanerock]

MDs in the western democracies, but they basically are in charge of controlling the supply of their own competiton

As are lawyers, plumbers, dentists, and many of the professional professionals. I'm only talking a scernario, and a long term one at that.

I've made this point elsewhere

[Featureless]

So I'll be brief.

1) No mechanical fault != no fault. I'm amazed I have to point out this distinction so often.

2) "There are new failure modes possible." Exactly. See? I think you already understand.

3) "I'll accept 10 robot-related deaths per year in exchange for the prevention of 100 lethal post-op infections due to poor wound healing." You just made those numbers up. Wouldn't it be nice if that were true? That's what the trial is meant to establish.

4) I have no criticism for the robot or its designers. Any judgement (positive or negative) would be premature. My point is about the news media, which has sloppily or mysteriously (probably the former) failed to mention some relevant facts when reporting in-depth about the device - like a very recent fatality under provocative circumstances.

Do you think surgeons perfoming that kind of operation (removing a cancerous kidney) routinely sever the aorta and then fail to notice for 90 minutes? This sort of info is just the sort of thing that rounds off a well-written story on a new technique.

Re:I've made this point elsewhere

[Featureless]

It's called sleight of hand. It can leave the reader with a false impression that those numbers have some legitimacy. Much like the article left many readers with the false impression that the DaVinci was "unambiguously" not to blame for the accident.

Re:That is awesome

[btellier]

The comment is funny, but the underlying reality is not. I already posted this today, but I think it has relevance here:

---
I've always wondered why Palestine/Iraq/Afghanistan doesn't simply train armies of script kiddies. They could cause as much mayhem as any suicide bomber in a Starbucks. Obviously I don't condone that kind of shit, but you have to wonder how far away we are from that reality. These suicide bombers aren't taking out tactical leaders, they're trying to incite fear and publicity.

Imagine an army of 1000 Iraqie script kiddies backed by 10 smart Iraqies who know how to audit C code and use disassemblers. I'm sorry to say that we'd be fucked.
---

How much coverage did the DoS'ing of eBay, Yahoo, Etc Co. get? WAY more than the bombing of some ship in Yemen.

All I can think of in these situations is a bug that a guy I know found in BIND. 90% of the root DNS servers in the world were vulnerable to it, just as they are to the recent ISS one. If someone in Afghanistan had found that instead of us, what would they do with it? They'd Hacked By Chinese every one of them. Imagine the implications of all the root NS's being hacked. Imagine the productivity loss in just a few hours. This is what we're up against. I'm afraid.

not a robot

[g4dget]

This is not a robot, it's teleoperation. "Robot" generally refers to a mechanical device that carries out complex functions on its own, without human guidance. Teleoperation seems like a really good idea for surgery, but robotic surgery would be premature given the state of the art.

Could it be used for the Big Dig?

[Kopretinka]

I've heard the Boston Central Artery (aka Big Dig) compared to a heart surgery performed on a marathon runner while he is running marathon. I wonder if the robot could be used in the Dig, too. 8-)

Reliable software possible

[jpmorgan]

Dude, you do realise it's possible to write reliable software, right? It's just hard, which is why you don't usually directly interact with extremely reliable systems on a day to day basis.

Think about the computer systems that control fly-by-wire planes in flight, the space shuttles, or nuclear weapon control systems.

Re:Hmm (The Dr. McCoy Problem)

[Cro Magnon]

The holographic doctor still couldn't replace real doctors. In the early days, he was stuck in sickbay. Even after he could make "house calls" there were malfunctions, and Kes or Tom had to fill in.

"Possible"

[fireboy1919]

You've mentioned several applications that have known less reliability than the medical industry. Still, you should consider that the amount of reliance upon the software in the aforementioned applications is very small compared to the reliance on non-software based control systems. The fine level control (such as the guidance lock, stability, propulsion) are all handled by individual controllers almost all of the time.

In THIS application, the course control is handled by a human rather than a software AI. So no software is needed.