Robot responsibility
Robotic surgery, twenty years after its debut: its possible impact on professional liability.
Twenty years have passed since a small company in Silicon Valley, Intuitive Surgical, introduced the “da Vinci” system, a tribute to the great Leonardo, the first application of robotics in surgery.
The history of robotic surgery stems from the combination of two very different technologies: telemanipulation, with the creation of the first mechanical arm for handling radioactive material in the 1950s and the development, in the 1980s, of microelectronics and computers.
Another impetus for the study and refinement of this new technology came at the end of the 1990s when the limitations of another minimally invasive technique still used today were perceived, keyhole surgery, which allows the abdominal and pelvic cavities to be accessed with a few mini incisions using a fibre optical camera and traditional surgical instruments.
The prototype of the da Vinci system was developed at the end of the 1990s in the United States for the American army which wanted to develop a system that would allow for remote surgical operations on the battlefield, but later would include even wider ranging commercial uses.
Intuitive Surgical was founded in 1995 with this aim and in January ‘99 the da Vinci system was launched to then become a year later the first robotic surgery system to be approved by the FDA (Federal Drug Agency) for generic laparoscopic procedures.
Over the following years, authorisation was extended to include surgical operations on the thorax, the heart, and its use in urology, gynaecology, paediatrics and otorhinolaryngology.
From then to the present day, over three million patients worldwide have undergone operations using the da Vinci system, but more importantly, new companies have entered this market, increasing the number of solutions and contributing to the spread of this technology.
But what are the real advantages of this new way of operating?
The most instantly perceived benefit lies in the reduced minimal invasiveness of operations, thus reducing the number of days for post surgical hospital stay and recovery.
But the main advantage is that robotic surgery provides the surgeon with amplified vision, thanks to the use of 3D, high definition screens, enabling him to use the mini mechanical articulations capable of performing far superior folds and rotations than the human hand. All this means better precision and control.
Today, a typical robotic surgery sees the surgeon operating remotely from behind a console and the theatre personnel working on the machine to adjust the settings of the surgical instruments (scalpel, graspers, etc.).
Of course, the financial cost of the machinery is extremely high, but if one thinks of the reason why it was originally created it is clear that the scope of application in a spatial sense could generate huge savings in the future and above all prompt intervention particularly in the presence of highly specific surgical skills.
In terms of insurance, it is still today difficult to establish the advantages and risks deriving from the use of robotic surgery with any great certainty.
Given that the robot does not act independently, but is the mechanical extension of the surgeon’s hand, we remember that accidents linked to surgical procedures derive principally from three main areas: surgeon malpractice, complications due to the patient’s state of health at the time of the operation, and post-surgical infections or complications.
In the case of robotic surgery, there is the added risk of the malfunction or break down of the machinery even such as to give rise to a human error (like in the case of a distorted image).
It must be said, however, that on the other hand there is greater attention adopted in the patient diagnostic and preparation phase, and in the learning curve of the surgeon himself in using the machinery, as proven by certain studies available on the American market.
Considering, lastly, that the use of this technology, given its cost, is mainly available in centres of excellence and of highly specialist skills, the statistical data, where available, would not be as fully representative as to generic average data.
It can nonetheless be presumed that even in surgery, technological progress can in itself represent a mitigating factor in the risk of human error.