Can You Sue a Robot? Part 2 Minimally-Invasive Surgery, Minimally-Invasive
Surgery, Robotically-Assisted Microsurgery, and Cybersurgery
In the first part of “Can You Sue a Robot?” we looked at some
of the liability issues that could arise if the current enthusiasm toward
adoption of “autonomous vehicle technology” (“driverless”
cars and trucks) continues to exceed the availability of technology that
can reliably convert today’s “dumb” vehicles into a
reliable, 100% artificial intelligence-guided vehicle.
In today’s installment, our personal injury lawyer will look at how
the art and science of surgery has been transformed by digital technology
and the development of surgical instruments so delicate that they cannot
be used without computer-assisted guidance. Finally, we will a brief look
at the potential of cybersurgery.
Minimally-Invasive Surgery (1970s)
Minimally-invasive surgery describes surgical techniques that make use
of special instruments that are inserted into specially-fabricated tubes
(“endoscopes”) that are, in turn, inserted into different
body cavities or spaces between the body’s organs. Since minimally-invasive
surgery involves small incisions and less anesthesia, these techniques
can reduce post-surgical recovery times by as much as 50%.
The first successful applications to employ minimally-invasive techniques
were in orthopedics (knee, ankle, and elbow surgeries) and abdominal surgeries,
such as gallbladder or appendix removal. Today, minimally-invasive surgical
technology has progressed to the point that such surgical instruments
are now in routine use in many types of brain and spinal surgery.
Minimally-Invasive, Robotically-Assisted Microsurgery (2000s)
A major drawback to the use of minimally-invasive surgical technology is
the fact that very small instruments require the surgeon to use very slight
changes in finger and / or hand position to make effective use of this
technology. In fact, such delicate movements are all but impossible for
even the most gifted of surgeons. This problem was not solved until the
first decade of our current century.
The first true robotically-assisted microsurgical unit was the da Vinci
Surgical System (Sunnyvale, USA), which received initial FDA approval
in 2001. Currently, the da Vinci system is approved for use in specific
types of urological, gynecological, and abdominal surgeries and is undergoing
clinical evaluation in certain cardiac and non-cardiac chest procedures.
In robotically-assisted surgery, the operating surgeon typically sits in
front of a bank of computer monitors that provide high-definition images
of the body’s interior. The tiny surgical instruments that are used
in the surgery itself are manipulated via a “box and joystick”
controller similar to those used every day by computer game enthusiasts.
These controllers are designed to “smooth out” or suppress
the natural tremor of the hands while still allowing precise movement
of the surgical instruments.
To many people, the words “cybersurgery” (cyber = “pertaining
to computers and/or virtual reality”) and “telesurgery”
(tele = “distant”) are one and the same: descriptions of a
technology that is the natural successor to the technological revolutions
brought about by minimally-invasive and minimally-invasive-robotically-assisted
Cybersurgery is seen by many medical device designers as a natural outgrowth
of technology now in use such as a specialist in one city being consulted
in “real time” regarding a complex diagnosis or, more commonly,
a radiologist who sits at a computer monitor to interprets x-rays taken
in a hospital hundreds of miles away.
Although there are many promising developments in technology, cybersurgery
is not expected to be in widespread use for at least another decade.
“State of the Art” and “State of the Art Problems”
Although this article has not dealt with specific shortcomings of “state
of the art” surgical technology, there is one problem that should
be obvious to everyone with more than a passing interest in this field:
no one has solved the “operator problem!” By this it is meant
that, no matter how sophisticated or delicate the instrumentation may
become, there is still a human being in control of the equipment because
no one has found a way to make any of these robotic systems completely
autonomous and thus independent of the many potential problems that may
arise with human control.
Another potential problem area that has yet to be fully explored is that
of “cyber-liability,” specifically:
- In robotically-assisted surgery, who is liable if the instruments in use
are not properly calibrated before each surgical procedure, the manufacturer
or the operating surgeon?
- What happens if a properly calibrated system loses its calibration during
- Suppose a surgeon is performing cybersurgery from a location that is in
a different city from the patient. If the surgeon commits medical malpractice,
where would the case be tried: the city from where the surgeon operated
or the city where the patient was injured by the malpractice?
- Who will certify that robotic surgical systems are safe to use: the manufacturer,
a government agency, or some other private organization?
In our next installment of “Can You Sue a Robot?” our personal
injury accident lawyer will take a very cautious look at the world of
drones, aka “autonomous aviation vehicles,” and how they have
already revolutionized warfare, and how they just might revolutionize
everything else from disaster relief to Oprah’s Book Club.