back to article Robot surgeons kill 144 patients, hurt 1,391, malfunction 8,061 times

Surgery on humans using robots has been touted by some as a safer way to get your innards repaired – and now the figures are in for you to judge. A team of university eggheads have counted up the number of medical cockups in America reported to the US Food and Drug Administration (FDA) from 2000 to 2013, and found there were …

  1. Anonymous Coward
    Anonymous Coward

    Wot?

    How on earth can bits fall off a surgical standard robot? Hmmm, what standards?

    I can't remember the term for leaving bits of equipment inside a patient but I'd imagine that bits of surgeon are unlikely to be included. I've certainly never heard of a surgeon's syrup or falsies being found later amongst the scissors, scalpels, swabs and whatever else is lying around that drops into the poor patient.

    Sparks burning the patient? Mad.

    1. iLuddite

      Re: Wot?

      "...the term for leaving bits of equipment inside a patient..."

      Found some:

      Unretrieved Device Fragments(UDF)

      Retained surgical instruments

      Retained foreign objects

      Unintentionally retained foreign bodies

      Gossypiboma(sponge)

      Medical malpractice (from legal site)

      I have not found one specific to robots, so I propose URF - Unretrieved Robot Fragment, because it sounds only a little painful.

      1. Anonymous Coward
        Pint

        Re: Wot?

        I've just tried: "medical term for foreign objects left inside patient" and got the same WP page as you 8)

        I'm sure I remember a more snappy industrial euphemism that was mentioned in an article (probably New Scientist) I read a few years back.

        I quite like URF: it emphasises "stupid mistake" in an onomatopoeic (blimey, five pints and two glasses of plonk and no wiggly red line) way.

        In the aerospace (at least) world FOD or Foreign Object Debris is the equivalent term. What about extending it to this? No maybe not, that would be silly and deprive another cant* of an exclusive word.

        Cheers

        Jon

        * https://en.wikipedia.org/wiki/Cant_(language)

        1. AndyS

          Re: Wot?

          Why not try to fit in, or contrast, with UDF?

          I propose Illicit Robotic Abandonment.

    2. Dr Patrick J R Harkin

      Re: Wot?

      "Sparks burning the patient? Mad." Not TOO mad - surgical diathermy is (vast oversimplification) a deliberate burn intended either to cauterise or cut. I was once on the receiving end of some (non-surgical) low-frequency diathermy when the machine caught fire...

      I smiled at the machines powering down until I remembered that it's not unknown for human surgeons to power down (permanently) during operations.

      These figures are really interesting but I don't know with what to compare them.

      1. Muscleguy
        Boffin

        Re: Wot?

        In Science, rather than medicine I have used and seen/smelt the use of a good old soldering iron to cauterise and remove when doing animal surgery. Usually the non survival type, but male mice getting the snip usually have their vas deferens snipped out and the ends cauterised. That was certainly how I was shown to do it.

    3. Simon Harris
      Alert

      Re: Wot?

      "I can't remember the term for leaving bits of equipment inside a patient but I'd imagine that bits of surgeon are unlikely to be included"

      I'm not sure that they ended up inside the patient, but body parts of members of the surgical team have been known to fall off during surgery. Consider the case of Robert Liston, a Georgian/Victorian surgeon reputed to be 'the fastest knife in the West End'. In his most famous case:

      "Amputated the leg in under 2 1⁄2 minutes (the patient died afterwards in the ward from hospital gangrene; they usually did in those pre-Listerian days). He amputated in addition the fingers of his young assistant (who died afterwards in the ward from hospital gangrene). He also slashed through the coat tails of a distinguished surgical spectator, who was so terrified that the knife had pierced his vitals he dropped dead from fright.

      That was the only operation in history with a 300 percent mortality."

      Edit: I just noticed Allan George Dyer got there first with the story of Robert Liston, but I'll leave this one here to keep the context of bits of surgeons dropping off. Send any upvotes to Allan for being first!

  2. Anonymous Coward
    Anonymous Coward

    Cats

    I wonder if the researchers looked into the operations that had malfunctions to see if the remote doctor owned a cat. I've been fragged many a time due to my feline overlord jumping on my keyboard while <cough> working <cough> from home

  3. Vector
    WTF?

    There is so much wrong with this article! It's a real headline grabber, but do the numbers really hold up? It quotes the study as saying "a non-negligible number of technical difficulties and complications are still being experienced during procedures" yet 10 deaths and 100 injuries in about 288000 surgeries sound like fairly low numbers. How does this compare with humans performing the same procedures? Yes, some of the issues seem astoundingly stupid, but then, so does leaving surgical instruments in patients and that seems to happen as well.

    ...And, no, I don't want to be the one under the knife when something goes wrong, but then, I also don't want to be in the car when the brakes fail, but I still drive.

  4. king_tut

    How does it compare to human-only surgery?

    The report (or certainly the article - haven't read the source material) doesn't really analyse the % stats, and neither does it compare the robotic rates vs human only. In any surgery, there will be problems. Yes, the malfunctions suck, and many are inexcusable. However, are the results worth it? Are robots better than humans for certain types of surgery?

    1. Martin Gregorie

      Re: How does it compare to human-only surgery?

      Are robots better than humans for certain types of surgery? is the prime question that should have been asked and answered. The rest is nice-to-now but irrelevant by comparision.

      IMO if the robots vs. humans surgical failure rate wasn't measured, then the source material is garbage and the El Reg article is scarely better because it apparently didn't address this point.

      1. bozoid

        Re: How does it compare to human-only surgery?

        Typically, a surgical "robot" isn't some autonomous knife-wielding monster. Instead, a "robot surgeon" (like the Da Vinci) is what the rest of us would call a "waldo" -- a way for a human surgeon to see and manipulate things that are too small or too inaccessible for his/her hands. I'll bet there are some common human errors included in these "robot" statistics.

        1. Thorne

          Re: How does it compare to human-only surgery?

          You also need to compare against robot surgery when it was human error at fault. Not all robot failures are the fault of the robot.

    2. diodesign (Written by Reg staff) Silver badge

      Re: How does it compare to human-only surgery?

      Comparing the error rate to human surgeons did cross our minds. It would be good to compare, we're still trying to get a number, it's non-trivial.

      Edit: Added a bootnote.

      C.

      1. Doctor Syntax Silver badge

        Re: How does it compare to human-only surgery?

        "we're still trying to get a number, it's non-trivial"

        I'd have thought more or less impossible. How do you put together a set of control events with which to compare? That's a problem which is plaguing surgeon league tables.

        What's really concerning is the fact that they seem to have had problems in getting adequate accounts, a problem clearly exacerbated by liability questions: it's going to impede improvement. Where life is clearly at risk - something which would apply to medical devices more generally - there needs to be a mandatory report/analyse/modify feedback loop.

      2. batfink
        FAIL

        Re: How does it compare to human-only surgery?

        The bootnote only says "sorry we can't figure out the error rate for humans".

        So, combining that with the lack of clarity about what exactly constitutes "Robot Surgery" (is it actually a robot performing the surgery or a person using a remote tool, which would just make it an extra-long scalpel, for example?), this is a pretty poor article.

        It doesn't even address the question of whether these figures are good or bad.

      3. Tom 13
        Devil

        Re: Edit: Added a bootnote.

        So, assuming each of the reported numbers is unique (that is a malfunction that leads to a death was counted only as death and not both) that give the robots an error rate of 0.5% compared to Between two and four per cent of operations in the US suffer from complications or somewhere between 4 and 8 times safer than a fleshie. And that's assuming the 2-4% isn't underestimating issues for unreported recoveries (or what the rest of us would probably call coverups). Yet no change in the headline. Isn't that rather, (oh what was that usual derogatory comparison I see in the comments oh yes) Daily Mail like?

    3. Jason Bloomberg Silver badge

      Re: How does it compare to human-only surgery?

      There is also that rather complex issue that some surgery is baseline lower risk with a robot than with a human surgeon, a lot less risk in sliding a robot arm in there than their slamming a fist in and/or cutting a huge hole to get access.

      If human surgery carried a 10% risk, robotic surgery carried a 5% risk, there's a whole lot of leeway for robotic surgery to go wrong before the risk approaches that of the human surgery.

      Probably the only meaningful comparison is how many avoidable errors are made and of what severity.

  5. John Smith 19 Gold badge
    Unhappy

    "119 injuries were caused by pieces of the robot falling off into the patient,"

    You can bet this stuff is not cheap.

    Sounds like a case of premium pricing, sub grade manufacture.

    1. Charles Manning

      Re: "119 injuries were caused by pieces of the robot falling off into the patient,"

      "Sounds like a case of premium pricing, sub grade manufacture."

      More likely the technician/surgeon didn't clip something in properly.

      These devices have modular removable bits so they can be used for different purposes or fit different size patients. They have blades and sterile covers which must be replaced on every use. Likely one of these was not clipped on properly and just fell off.

  6. Filippo Silver badge

    It doesn't have to be perfect. It has to be better than humans.

    1. Charles Manning

      "It doesn't have to be perfect. It has to be better than humans."

      Except in the court rooms.

      1. Tom 13

        Re: Except in the court rooms.

        Sad isn't it?

        You've got people who are 95%+ intent on doing something good for somebody who would otherwise likely (again in the 95%+ range):

        - die

        - constantly suffer great pain

        - be crippled

        - or some combination of all of the above

        and unless everything goes as perfectly as it does for the forensic investigators in a CSI tv show, somebody is out to sue the living day lights out of them.

    2. TReko

      Doctors can bury their mistakes - "unexpected complications"

      1. Thorne
        Terminator

        "Doctors can bury their mistakes - unexpected complications"

        So can robots. They send a terminator back in time and..........

  7. Richard 12 Silver badge

    Sparks and bits falling off?

    That is totally inexcusable, especially in such low-power devices.

    It takes either serious incompetence or deliberate action to create sparks with enough heat to burn a patient, and a device with such design flaws wouldn't even meet normal CE requirements for a household appliance, let alone be sane to use in surgery.

    Normally I'd presume that bits falling off was probably poor maintenance or assembly, but in this case, perhaps not.

    1. Alan Brown Silver badge

      Re: Sparks and bits falling off?

      "Normally I'd presume that bits falling off was probably poor maintenance or assembly, "

      You should presume.

      You can also presume that a good chunk of the reported issues are operator cockup, not mechanical issues.

      Unlike aviation, the medical field routinely covers up as much as possible to avoid ambulance chasers.

      1. MondoMan

        Re: medical coverups

        It's important to realize that while the "medical field routinely covers up as much as possible to avoid ambulance chasers", that's aimed at the *external* world. Hospitals also run (monthly?) morbidity and mortality review sessions for internal staff only, without recording names, where staffers review morbidity/mortality caused by preventable errors/circumstances. The purpose is for all to learn and to prevent repeats or similar errors in the future. These frank discussions are not made available to patients/lawyers/regulators.

        An article on a version of the process: http://www.aaos.org/news/aaosnow/may09/research8.asp

  8. harmjschoonhoven

    More risks

    Most minimally invasive surgery or "robo-operations" are performed under general anesthesia with a 1:400 risk of (minimal) brain damage. This and the general risk of an operation are not evaluated by Alemzadeh et al. Which does not mean there is no room for improvement since surgeons started in the 19th century to wash their hands before surgery.

  9. Paul 129
    Happy

    Actually sounds good.

    0.5% Cockup

    0.08% Injury

    0.008% Death

    Sounds like, with a little better reporting, and a few more generations of these things, they sould be able to do the job nicely.

    Given the stupod souding nature of the problems, you would assume that they're easy to correct/design around.

    1. 100113.1537

      Re: Actually sounds good.

      I agree, but the important quote in the article said the rates had been pretty constant over the 10 year period studied - suggesting that the 'stupid' mistakes are not all that easy to correct. Needs a follow-up with yearly numbers to see what is (and is not) improving.

  10. Boris the Cockroach Silver badge
    Terminator

    I wonder

    if they looked at the risk involved to the patient during said surgeries

    EG a bypass done on a otherwise fit and healthy middle aged male has a 1 in 100 chance of killing said patient anyway..... and as for letting a robot do it..... no way in hell am I consenting to that next time.

    I prefer my surgeons to the human (and leave forceps/sissors/swabs/gloves/ and the piece of metal that holds the chest open inside me) themselves

    1. Anonymous Coward
      Anonymous Coward

      Re: I wonder

      "and as for letting a robot do it..... no way in hell am I consenting to that next time."

      In my case I decided it was best to let the surgeon do it how they wanted it done. Giving them the best chance of success gives me the best chance of success. If they tell me there is less chance of death when a robot does it then why would I choose the riskier route?

    2. Chris 244
      Paris Hilton

      Re: I wonder

      I wonder, would you reconsider your position knowing that the robotic approach lowers your risk of urinary incontinence and erectile dysfunction after prostatectomy?

  11. Allan George Dyer

    A long way behind Robert Liston...

    He achieved a 300% mortality rate in one operation: the patient, an assistant and a bystander all died!

    ​The Legend Of The Surgery With The 300% Mortality Rate.

  12. Turtle

    Dr Careful Hands...

    I don't know who decided on that picture but it was an inspired choice.

  13. Destroy All Monsters Silver badge
    Holmes

    This sounds pretty good to me!

    And these are not autonomous robots / autodocs. They are remote manipulators.

  14. Anonymous Coward
    Anonymous Coward

    Wrong metrics

    The number of deaths due to robotic surgery have to be weighed against the number of lives saved by robotic surgery, where a human doctor either couldn't have saved the life or one who could was not available in time.

    This headline is good for working the Luddites into a frenzy, nothing more. Once self-driving cars are a reality, some of them will be involved in fatal accidents. Some of those accidents will be the car's fault. But if self-driving cars were to have 1 death (caused by the car) per 100 million miles driven and human-driven cars have 1 death (caused by the human driver) per 20 million miles driven, then self-driving cars would still be superior.

  15. DropBear
    Facepalm

    ...so the over-privileged class of charlatans that enjoy a level of unaccountability the NSA can only dream of has found yet another way to indifferently shrug off the consequences of whatever they do. Neat...

  16. Christoph

    "Robot surgeons kill 144 patients

    "there were 144 deaths during robot-assisted surgery

    The second statement does not imply the first. If someone dies during surgery that may be because the surgeon is unable to save them, not because the surgeon made an error. Hopefully that's the reason for the great majority of deaths during surgery.

  17. TRT Silver badge

    I think you ought to know...

    I'm feeling very depressed.

    1. Chris 239

      Re: I think you ought to know...

      The diodes down the left side giving you trouble are they?

      Have an upvote Marvin, hope it makes you feel better!

      1. TRT Silver badge

        Re: I think you ought to know...

        I would give you a thumbs up, but there's this terrible pain...

    2. Sgt_Oddball

      Re: I think you ought to know...

      I've calculated your chance of survival, but I don't think you'll like it...

  18. bigtimehustler

    I always found it amusing when surgeons themselves refer to surgical implements ending up inside a patient as "the patient retained the scalpel", as though it was in some way the patients body that chose to keep this item, as opposed to the careless surgeon leaving it in there.

  19. Ugotta B. Kiddingme
    Joke

    matter of semantics...

    Surely a botched robotic prostate surgery would be the OPPOSITE of a "cock up", would it not?

  20. sisk

    Actually that sounds better the human doctor error rate to me. 144 deaths out of 1.7 million surgeries? Human surgeons don't even come close to that level of patient survival.

  21. Anonymous Coward
    Anonymous Coward

    My brother is a pediatric anesthesiologist.

    You should see what his malpractice insurance costs. The children he works on already have critical diseases that could kill them and he has to anesthetize them so the surgeon can work on them. Only reduces their already lowered chances of survivability and some of these surgeries can take 10 to12 hours. Sometimes it is a lose/lose proposition to be in the Healthcare business at all the way lawyers work. The odds do not favor him and robots wouldn't help them.

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