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".

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."

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

[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

[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.

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?

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...

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

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.

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.

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.

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.

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.

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 !!!!

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.

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.