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James Schow
Instructor Hatch
English 1010
14 November 2013
How to Prevent Injury to the Robot and the Patient in Urological Surgeries
In the last two decades, robot-assisted surgeries have become more prevalent, accounting
for 55% of all prostatectomies in the US. The da Vinci System is one of the most advanced and
widely used surgical robots, and is most effective in Urological Surgeries. This minimally
invasive, laparoscopic approach to surgery is highly successful, but complications may occur,
possibly damaging the robot or injuring the patient. To avoid this, the surgical team must be
trained to find potential complications before operation, and quickly fix complications if they
arise.
To better understand the da Vinci System, one should understand the change from open
surgery, to traditional laparoscopy, to robot-assisted laparoscopy. Open surgery is very invasive
and accessing the location of surgery often causes more problems than the procedure itself
(Mack). For this cause, a minimally invasive approach to surgery was required. Laparoscopy
allowed surgeons to perform surgeries without large incisions and disruptions to the body. In
more complicated surgeries, traditional laparoscopy’s shortcomings came forward, and the need
for a more precise and maneuverable way to perform surgery arose. Computer Integrated
Robotic Systems (CIRS) such as the da Vinci System has been the most successful response to
the need; providing a 3D camera, several maneuverable arms, and many tool options. This robot
reduced blood loss by ¾ and post operative stay by a day or more in comparison to open surgery.
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A CIRS surgery is very similar to a traditional laparoscopic surgery, as it is called robotassisted laparoscopy because it involves entering the body through small incisions without the
surgeon making direct contact with the location of surgery. It’s minimally invasive and has a
similar team of the surgeon, surgical technicians, and surgical nurses. But, a CIRS adds two
members to the team: the robot and the robot technician. They work together to provide the best
and safest care for the patient. Robot-assisted surgery is highly successful and the rate of
complication is small—between 2% and 11% (Giri; Mack; Nayyar). When complications do
occur, they are either error from the surgical team, the robot, or a combination of the two.
Complications caused by the surgeon are very rare, and those that occur generally injure
the robot, but have the potential to injure the patient. In one occurrence, a negligent surgeon hit
a tool on the table, damaging the tool but not the arm (Finan). In this case, the surgeon let the
arm leave the view of his camera, a mistake that luckily didn’t harm the patient. If a tool was to
leave the surgeon’s field of vision, he may damage and organ, nerve, or blood vessel. This could
cause the patient injury and unnecessary damage to the body. If the surgeon had been paying
attention, the tool wouldn’t have broken. Occurrences such as this must be noted and surgeons
need to be aware that if they are negligent in procedures, they may not have such a lucky
outcome.
Often, rather than an issue being the surgeon’s or robot’s fault, a negligent robot
technician may not see a potential complication, meaning it has to be fixed in surgery. Finan
relays an instance in which the left and right optic cables were switched so the console image
was inverted. The technician overlooked something as basic as matching left and right cables to
the appropriate ports. Fortunately, the surgeon realized the problem and it was fixed before any
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damage was done to the patient. The robot technician needs to see any issues that may occur in a
preoperative setting so it can be fixed before the patient is under anesthesia.
Often, the surgeon can’t control complications in a surgery because the robot
malfunctions. Most often, the complications with the robot are caused by the robotic arms.
They may stop moving which can usually be fixed by rebooting the system. Though it can
usually be fixed, the longer the patient is under anesthesia, there is a greater chance of injury and
complication. If the robotic arm isn’t moving, it shouldn’t do anything that could injure the
patient, but there is a possibility that the robot, rather than not moving at all, may move out of the
surgeon’s control, endangering the patient and potentially harming the robot. In urological
surgery especially, with the high concentration of important tissues, an out of control robot could
cause serious, potentially lethal damage to the patient.
To avoid complications, a surgical team needs to gain experience with the robot, learn to
find potential complications before the operation, and learn to troubleshoot when complications
occur. Studies have found that most recorded complications with the da Vinci System occur in
the first 100-150 procedures the team performs. This means that the problems aren’t all with the
robot itself, but with the surgical team. This learning curve can only be overcome by experience,
but may be reduced if the surgical team is trained with the da Vinci System before they are given
free reign with the robot. As experience is gained, so is the ability to spot problems before they
occur. The team may find a tool that’s not properly connected to the arm, or cables that aren’t in
the correct ports. Finding such problems can save, on average, 25 minutes in operation time and
reduce the chance of a patient’s injury because the problem will have never occurred (Giri). If a
problem does occur, the team should be trained in troubleshooting the robot, such as manually
releasing the tools, interoperatively resetting, or finding and fixing mechanical abnormalities.
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Since most complications occur with an inexperienced surgical team, a well trained
team—surgeon, surgical technicians, nurses, robot, and robot technician—will not have a very
high rate of complication. If the whole team has to become certified in the da Vinci System, they
will understand how the robot works, FAQ’s, and how to prevent complications, and how to fix
the robot quickly whether in or out of surgery. That is why a certification to use the CIRS and to
help in such surgeries will reduce the number of complications; the team will also be
knowledgeable in troubleshooting when error does occur. Even experienced teams see issues
with the robot, so they must remain vigilant in their preparation and procedure to stop
complications before they start.
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Works Cited
Chen, Cheng-Che, et al. “Malfunction of the da Vinci robotic system in urology.” International
Journal of Urology. 19.8 (2012): 736-740. Web. 27 October 2013.
Close, Andrew, et al. "Comparative Cost-Effectiveness Of Robot-Assisted And Standard
Laparoscopic Prostatectomy As Alternatives To Open Radical Prostatectomy For
Treatment Of Men With Localised Prostate Cancer: A Health Technology Assessment
From The Perspective Of The UK.." European Urology 64.3 (2013): 361-369. Academic
Search Premier. Web. 14 Nov. 2013.
Finan, Michael, and Rocconi, Rodney.“Overcoming technical challenges with robotic surgery in
gynecologic oncology.”Surgical Endoscopy. 24.6 (2010): 1256-1260. Web. 27 October
2013.
Giri, Subhasis, and Sarkar, Diptendra. “Current Status of Robotic Surgery.”Indian Journal of
Surgery. 74.3 (2012): 242-247. Web. 27 October 2013.
Mack, Michael. “Minimally Invasive and Robotic Surgery.”The Journal of the American
Medical Association. (2001): n. pag. Web. 27 October 2013.
Nayyar, Rishi, and Gupta, Narmada. "Critical Appraisal Of Technical Problems With Robotic
Urological Surgery." BJU International 105.12 (2010): 1710-1713. Academic Search
Premier. Web. 14 Nov. 2013.
Ren, Hongliang, and Meng, Max. “Investigation of the Essentials for Integrating Off-the-Shelf
Industrial Robotics in Precise Computer-Assisted Surgery.”Journal of Mechanics in
Medicine & Biology. 11.5 (2011): 1113-1123. Web. 27 October 2013.