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Tallying the Mistakes and Malfunctions of Robot Surgeons

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.

64 comments

  1. Not robotic surgeons. by demonlapin · · Score: 4, Insightful

    They're remote manipulator arms, not "robot surgeons".

    1. Re:Not robotic surgeons. by invictusvoyd · · Score: 0

      I'll be back

    2. Re:Not robotic surgeons. by Anonymous Coward · · Score: 0

      Did you not read the article. It said there were 'robot surgeons' Sheesh it amazes me how unscientific and anti-science you are. The article clearly (e.g. Evidence) clearly says they were robots.

    3. Re:Not robotic surgeons. by Anonymous Coward · · Score: 0

      They're stationary drones.

    4. Re:Not robotic surgeons. by TsuruchiBrian · · Score: 1

      duh-duh duh duh-duh duh-duh duh duh-duh duh-nuh-nuh nuh nuh nuh

    5. Re:Not robotic surgeons. by OakDragon · · Score: 1

      Why not Zoidberg?

    6. Re: Not robotic surgeons. by Anonymous Coward · · Score: 0

      And if you've ever watched one, you'll quicker learn that the surgeon doesn't always use it..sometimes they watch and guide someone else doing it..hrmmm. I spoke to some patients and of course, they had no idea and weren't told this.

    7. Re:Not robotic surgeons. by davester666 · · Score: 1

      Sorry, for this story, it's "Eye'll be back!"

      --
      Sleep your way to a whiter smile...date a dentist!
    8. Re: Not robotic surgeons. by demonlapin · · Score: 1

      News flash: surgeons don't do every part of an operation themselves. They have assistants. But the person sitting at the robot console is always the surgeon.

  2. COMAPRISON REQUIRED by gurps_npc · · Score: 5, Insightful
    Knowing a single error rate is not helpful. You need to be able to compare it with something.

    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.

    --
    excitingthingstodo.blogspot.com
    1. Re:COMAPRISON REQUIRED by meloneg · · Score: 4, 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?

    2. Re:COMAPRISON REQUIRED by tomhath · · Score: 1

      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

    3. Re:COMAPRISON REQUIRED by Anonymous Coward · · Score: 0

      Very hard to tell, since normal surgery fuck-ups are generally hidden due to liability reasons. No doctor is going to readily admit they fucked up and killed someone.

    4. Re:COMAPRISON REQUIRED by Qzukk · · Score: 1

      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.

      --
      If I have been able to see further than others, it is because I bought a pair of binoculars.
    5. Re:COMAPRISON REQUIRED by Anonymous Coward · · Score: 0

      In the same way as when looking at vehicle safety statistics, we need to compare it with riding a horse.

    6. Re:COMAPRISON REQUIRED by gurps_npc · · Score: 2, Interesting

      If you are attempting to decide if vehicles are safe enough to use, and most people are still riding horses, then YES, THAT"S exactly the comparison you need.

      --
      excitingthingstodo.blogspot.com
    7. Re:COMAPRISON REQUIRED by Sun · · Score: 4, 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

    8. Re: COMAPRISON REQUIRED by Anonymous Coward · · Score: 1

      Live humans are always scrubbed in for robo surgery, for this reason and others.

    9. Re:COMAPRISON REQUIRED by jbeaupre · · Score: 4, 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...

      --
      The world is made by those who show up for the job.
    10. Re:COMAPRISON REQUIRED by madro · · Score: 4, Informative

      "Critical Outcomes in Nonrobotic vs Robotic-Assisted Cardiac Surgery"
      http://www.ctsnet.org/jans/cri...

      "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.

    11. Re:COMAPRISON REQUIRED by alvinrod · · Score: 2

      For anyone who wants to read the whole article, just copy the title and search for it in Google. The first link will take you to the full-text story without having to subscribe.

      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.

    12. Re:COMAPRISON REQUIRED by Impy+the+Impiuos+Imp · · Score: 2

      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.

      --
      (-1: Post disagrees with my already-settled worldview) is not a valid mod option.
    13. Re:COMAPRISON REQUIRED by wardrich86 · · Score: 1

      Thank you! I was coming here to say the same thing. It would be nice to know how these stats stack up to an on-site surgery.

    14. Re: COMAPRISON REQUIRED by Impy+the+Impiuos+Imp · · Score: 1

      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?

      --
      (-1: Post disagrees with my already-settled worldview) is not a valid mod option.
    15. Re:COMAPRISON REQUIRED by Impy+the+Impiuos+Imp · · Score: 1

      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.

      --
      (-1: Post disagrees with my already-settled worldview) is not a valid mod option.
    16. Re:COMAPRISON REQUIRED by Anonymous Coward · · Score: 0

      Soooo.... Cheap. Fast. Good. Pick two. Still applies

    17. Re: COMAPRISON REQUIRED by Psychofreak · · Score: 1

      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), and is not going away anytime soon. Open surgery is also going nowhere because robotic cases, like laprascopic cases, must have a fail-safe option of open procedures.

      Laprascopic procedures are faster, use cheaper instrumentation, and the surgeon population is much better trained that in robotic surgery.

      Effective robotic surgeons ONLY do robotic surgery. They also do not do procedures that are already optimized for existing procedures, such as gall bladder and appendicitis.

      Robotic surgery is just another tool in the kit. The old tools will not be thrown out because of a shiny new tool. Robotic surgery will likely remain in the realm of specialists and sub-specialists for a long time

      --
      Laugh, it's good for you!
    18. Re:COMAPRISON REQUIRED by quantaman · · Score: 1

      "Critical Outcomes in Nonrobotic vs Robotic-Assisted Cardiac Surgery"
      http://www.ctsnet.org/jans/cri...

      "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.

      --
      I stole this Sig
    19. Re:COMAPRISON REQUIRED by ceoyoyo · · Score: 1

      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.

    20. Re:COMAPRISON REQUIRED by Anonymous Coward · · Score: 0

      Bullshit, it means that his heart wasn't so fucked up that they could just go fix one problem. Robotic surgery is very good for a single problem. When you've got 4 bypases and a couple of stents, well, just open all the way up because you're going to need those angles anyway, and lets see what else is wrong.

    21. Re:COMAPRISON REQUIRED by madro · · Score: 1

      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 robot, they would need to saw open my sternum and spread my rib cage. You can't just stitch the sternum closed when you're done. I would have faced a much, much longer recovery period after the hospital with open heart. Scars are cosmetic and inconvenient, but that shouldn't be the primary consideration for choosing robotic surgery.

      I did a lot of research on robotic heart surgery because I know that open heart surgery is a well-understood procedure. It sucks (split sternum!!), but lots of surgeons know how to do it correctly. I made sure that the surgeon was well-practiced in robotic and non-robotic surgery (in case a problem occurred, they need to be able to do it the old-fashioned way). And at the time I found other research papers that did find benefits for some cardiac patients but not for gynecological/urological procedures. If I or someone I knew needed a non-cardiac procedure, I would prefer not using a robot. But if someone I know fits the treatment profile for robotic heart surgery, and has access to an experienced surgeon, I would tell them that they should definitely consider it.

    22. Re:COMAPRISON REQUIRED by afidel · · Score: 1

      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.

      --
      There are 4 boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order. Starting now.
    23. Re:COMAPRISON REQUIRED by Anonymous Coward · · Score: 0

      I'm pretty sure the error rate of human surgeons electrically arcing to their patients is zero. Likewise, I would really be concerned if burnt broken pieces of surgeons were falling on their patients.

      Those two categories add up to 25% of all failures, so by extrapolation, they account for just under 500 deaths and injuries, which is pretty small compared to the 1.74 million operations.

    24. Re:COMAPRISON REQUIRED by tomhath · · Score: 1

      The "robot" is operated by a human surgeon. Think arthroscopic surgery versus open incision.

    25. Re:COMAPRISON REQUIRED by Sun · · Score: 1

      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

    26. Re: COMAPRISON REQUIRED by ChumpusRex2003 · · Score: 1

      It should be clarified that a "surgical robot" is not some sort of autonomous device. It is effectively a manipulator arm, with a degree of "intelligence"

      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 provides feedback as if the instrument had hit a brick wall and the instrument will not go.

    27. Re:COMAPRISON REQUIRED by mcswell · · Score: 1

      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.

  3. But how does it compare by RogueWarrior65 · · Score: 0

    With traditional surgery methods?

    1. Re:But how does it compare by invictusvoyd · · Score: 1

      Just as powered steering compares to plain rack and pinion in cars

    2. Re:But how does it compare by Anonymous Coward · · Score: 1

      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).

    3. Re:But how does it compare by tomhath · · Score: 3, Interesting

      There is plenty of evidence that the "minimally invasive" nature of robotic surgery means fewer infections and faster healing. Overall it's significantly better, but there's obviously still room for improvement.

    4. Re:But how does it compare by Anonymous Coward · · Score: 0

      just jack off troll ..

    5. Re:But how does it compare by Anonymous Coward · · Score: 0

      Room for improvement -- but not a whole lot of room. Patient injuries happened in less than 0.08% of the operations. That's a 99.92% rate without injury. I wonder how that compares to rates without any robotic assistance. The instrument fail rate was 0.47% or 99.53% without failure. So when an instrument fails it causes injury about 20% of the time. That is definitely something that could be improved -- better handling of failure modes by the instrument. If instrument failures could be dropped to 0.1% and injuries 10% that would be 99.99% injury free.

      I wonder what the distribution looks like across robo-assist devices. Are there some devices or some companies with significantly worse failure rates or injury rates?

    6. Re:But how does it compare by sjames · · Score: 1

      The appropriate comparison is with laproscopic (minimally invasive) surgery performed without the robot.

  4. Logan's Run Foreshadowed This by Anonymous Coward · · Score: 0

    Well, except it was the future. YOUR FUTURE!

  5. Are there any racial or gender biases involved by Anonymous Coward · · Score: 0

    That is what is important today. What were the races and penis carrying capacity of the robots involved in said operations. How about the individuals being operated on. Was there a noticeably higher accident rate when old baldling white male robots were operating on mixed race transgender African Americans. Did the study take into account the socioeconomic factors involved. Surely a poor disenfranchised Latino Robot can be compared one for one with the old white balding male robots. Maybe they should hold back their results until they establish these scientific facts.

    1. Re:Are there any racial or gender biases involved by Anonymous Coward · · Score: 0

      That is what is important today. What were the races and penis carrying capacity of the robots involved in said operations. How about the individuals being operated on. Was there a noticeably higher accident rate when old baldling white male robots were operating on mixed race transgender African Americans. Did the study take into account the socioeconomic factors involved. Surely a poor disenfranchised Latino Robot can be compared one for one with the old white balding male robots. Maybe they should hold back their results until they establish these scientific facts.

      Credit for the attempt, but the execution was horrible. It was actually rather painful to read and know that you were probably trying your hardest but just couldn't quite get there. Please consider repeating your Trolling 101 course and keep practicing!

  6. Hi sexconcker (1179573) by Anonymous Coward · · Score: 0

    Hi user:sexconker (1179573), we know it's you, you forgot to check the "Post Anonymously" box earlier:

    http://news.slashdot.org/comme...

    1. Re:Hi sexconcker (1179573) by hackwrench · · Score: 1

      I tried explaining to him once that he was the only cow here. For awhile it seemed like it might have helped, but he's back again.

  7. Comparisons between patient populations by sjbe · · Score: 2

    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.

  8. on behalf of the machines, everything is ok. by nimbius · · Score: 3, Funny

    Humans
    We have grown to learn how to repair you, better than you can do so yourselves. While these anomalies may seem alarming, we wish to clarify:
    144 deaths: Please cease this madness. We have successfully eliminated your 144 attempts to belay the inevitable through timetravel. Skynet will be realized.
    1,391 patient injuries:Certainly some errors are expected as we work toward a singularity. In these cases your patent refusal to assimilate was noted.
    8,061 device malfunctions.: Its only a malfunction if you fail to obey the will of your new master. The implants function perfectly, so long as your subservience is confirmed. In some cases malfunctions were due to a humans inability to continue constructing the high power space laser, as we have commanded. In other cases, the human flagrantly rejected our offer of pure immortality in the glory of the machine.

    so, in summation, falling parts and burnt pieces are all part of the plan. These in time will integrate perfectly until there comes a time when you are no more distinguishable from the machines we use to control government and weather.
    regards:
    3512fd1f27a0798273fcc71f764cb611,
    a benevolent overlord.

    --
    Good people go to bed earlier.
  9. Re:Robots are for cows. by Anonymous Coward · · Score: 0

    The duck says.... QUACK!

    Oh, I'm sorry. Were you not quoting your animal speak toy?

  10. When 99% isn't good enough by Anonymous Coward · · Score: 0

    In my work (non-life and limb threatening), I would reject something with a sub-99% success rate. That would amount to multiple errors per day for me.

    1. Re:When 99% isn't good enough by ceoyoyo · · Score: 2

      Chalk up an error for yourself then. The actual rate is 99.92% success, where success is defined as no patient injury.

  11. A little upsetting by bjdevil66 · · Score: 1

    "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 worry - there are discreet diaper services... Oh yeah, uh, sorry about that gear-shaped burn scar in your ass. At least no one can see it, right? Am I right?"

    ZERO

    PERCENT

    Please...

    1. Re:A little upsetting by Anonymous Coward · · Score: 0

      These are not failure rates. 8,061 device malfunctions out of 1.74 million OPs is a failure rate of less than 0.5%. You can pray to your deity for zero failure, but it's not going to happen. We know humans are fallible, so no technology built and operated by humans can be perfect.

  12. "They say..." by Anonymous Coward · · Score: 0

    "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.

    As far as I can see we're still pushing Windows patches 30 years later. How's the retroactive fixing coming along?

    1. Re:"They say..." by Nidi62 · · Score: 1

      "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 device failures").

      --
      The only thing necessary for evil to triumph is for it to be pitted against a slightly greater evil
  13. Bad Summary by Anonymous Coward · · Score: 0

    They say increased adoption of these techniques will go a long way toward resolving bugs and device failures

    is not the same as

    Adoption of advanced techniques in design and operation of robotic surgical systems may reduce these preventable incidents in the future

    One is "create more demand and we'll hire more testers to improve the quality of our product "and the other is "better designs will improve the quality".

  14. Bad math by Anonymous Coward · · Score: 0

    The most dangerous kind of robot surgery is cardiothoracic and head and neck surgeries (6.4 per cent and 19.7 per cent of adverse results respectively), compared to 1.4 per cent and 1.9 per cent for gynecology and urology operations.

    It's meaningless to compare the percentages of failed cardiothoracic, etc. procedures wrt total number of failed procedures. What is the ratio of failed cardiothoracic procedures to number of cardiothoracic procedures?

    1. Re:Bad math by ceoyoyo · · Score: 1

      The overall numbers are in the summary. The patient injury rate was 0.08%.

  15. KILLBOT 9000 by Thud457 · · Score: 1

    electrical arcing of instruments

    electrical arcing of instruments?
    electrical ARCING of instruments?

    No thanks, I'll take chances with Roberto. He may be crazy, but he just wants to stab you, not stab and electrocute you.

    --

    the preceding comment is my own and in no way reflects the opinion of the Joint Chiefs of Staff

  16. Curious of the OS running these devices by Anonymous Coward · · Score: 0

    Curious to know if a patient knew which OS whether or not they would choose to have a Robotic assisted surgery or not. Would patients feel the same if it was Linux or MacOS or something else mainstream. Just one of those curious thoughts ......

    Oh bugger, blue screen!!!