Manufacturer faces lawsuits after surgery robot arm breaks off in patient's butt

Surgeons in Aalst, Belgium were startled when part of the robot arm of a da Vinci surgery robot broke off inside a patient who was undergoing prostate surgery in 2007. According to New Scientist magazine, that incident and others have sparked a rash of lawsuits against Intuitive Surgical, Inc., the company that makes the surgical robots. This news comes after a recent study by Columbia University researchers found that robotic surgery has no real advantages over live surgeons with proper instruments and training.

Other alleged complications from the da Vinci machines include punctures to the liver and spleen during heart surgery, rectal damage during prostate surgery, unintended burns from the device's cauterizing tools and vaginal hernias following hysterectomies.

In the Belgian case, surgeons found themselves unable to remove the damaged robot part. The fracture of the robotic arm bent it so badly that it could not be pulled back out through the original keyhole incision. They ended up having to enlarge the wound to retrieve the damaged part.

In robotic surgery, a doctor sits at a console and operates robotic arms while looking at a detailed readout screen. Images are produced by a lighted camera inserted into the patient. Intuitive Surgical, Inc. is the sole manufacturer of the so-called da Vinci machines. There are more than 2,500 da Vinci machines operating in hospitals all over the world.

The $1.7 million machines have performed more than a million procedures in the last decade. Advocates say that they produce less scarring, minimize blood loss and contribute to shorter recovery periods. Some doctors who operate them say that its displays give them a better view or the surgical site and enable them to work with greater precision.

"The console has brilliant, unsurpassed 3D vision, unlike laparoscopic systems with 2D screens," said Ben Challacombe, a London urologist to New Scientist. "It also has fantastic control instruments that filter out hand tremors, whereas long laparoscopic tools only enhance tremor."

Challacombe and other advocates of robotic surgery argue that the accidents that spawned the lawsuits have more to do with human error than flaws in the machinery.

"Studies show there is a learning curve with new surgical technologies, during which there is an increased complication rate," said James Breeden of the American Congress of Obstetricians and Gynecologists.

The Columbia study found, however, that the main difference between robotic surgery and conventional laparoscopic surgery was price. A robotic hysterectomy costs an average of $8,868, compared with $6,679 for a regular laparoscopic procedure. Complications occurred at roughly the same rate (5 percent) and hospital stays were shorter in less than 5 percent of cases than with conventional surgeries.

Similarly, a 2009 study published in the Journal of the American Medical Association found that in prostate surgeries, da Vinci surgeries provided some small benefits, but in order to become proficient with the device, doctors needed more than 250 hours of operating time.

New Scientist said that, on average, doctors get less than two days of orientation on the da Vinci machines before they are pressed into service.

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