Robotic Surgery and Reported Adverse Events
Medscape: What are some of the most common and avoidable AERs that occur with robotic surgery? And do they tend to be due to surgeon or machine errors?
Dr. Colella: I'll take the answer to your last one first. Any time that you introduce a technology, it has to be employed correctly by appropriately trained people who know how to use it. I was trained in the open era, and in the last few years of my training we began using laparoscopy. I went through the entire laparoscopic evolution from 0 to 100 miles an hour, and now I am living through and helping to lead the robotic evolution and seeing the same events. But, because robots are involved, we now seem to be chasing events that have been occurring all along throughout the course of laparoscopic surgery.
As I mentioned, the adverse events with laparoscopy and robotic surgery are almost identical. For instance, one of the more commonly reported ones with both is inappropriate arcing of a coagulation device, where it injures a piece of intestine and is not witnessed or recognized at the time of the event. Everyone is trying to capture and report this with robotic surgery, and it's appropriate to do so, However, those same events happened and still happen with laparoscopic surgery, and you don't see the FDA investigating laparoscopic technology independently, as they do now with robotics.
Medscape: Robotic surgery adds the complexity of the machinery, however. Are there many errors that can be attributed to the technology itself?
Dr. Colella: In my experience, I have never had the robot malfunction in any way. The adverse events that I have heard about can almost universally be attributed to surgeon error, to user error, or to some other event that is related to either personnel in the operating room or a distracting event that may involve the robot but is not in fact the fault of the robot. The complexity of the machinery actually makes most operations easier.
Medscape: Of course, these are all relatively new machines. No one knows how they're going to behave over time or at what point they will begin to break down.
Dr. Colella: There is definitely some truth to that. I've had the privilege of using a brand new machine for 1 year at one hospital and then moving to another hospital where they also had a brand new machine. I've had a unique experience in that I haven't had to use the same machine for 5 years, so I can't tell you personally what those 5 years would look like. However, I can tell you that the company has built a very intense support system that we haven't had to use very often. On those rare occasions when there has been a problem with the robot, for example as part of its setup or after an operation when someone notices a fault light, the engineering teams have been very good about responding.
Medscape General Surgery © 2013 WebMD, LLC
Cite this: Is Robotic Surgery Worth Its Price? An Interview With Dr. Joseph Colella - Medscape - Jun 20, 2013.