Friday , April 23 2021

The lessons left by the death of the patient undergoing robotic heart surgery



Stephen Pettitt was a retired music teacher of 69 who had a heart problem.

The surgical operation I needed was 98 or 99 percent chance of success. This, assuming that the surgeons who would carry out the operation were human.

But the operation that Pettitt performed was performed by a robot and the patient died.

Pettitt, which was operated in 2015 at Freeman Hospital in Newcastle, England, was the first patient in the UK to pioneer cardiac robotic surgery.

And as the investigation into the causes of his death concluded, "there is a risk of other deaths occurring" with this type of procedure.

The robotic heart surgery program in England was suspended after the death of Stephen Pettitt.

Surgery with Robot

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In robotic surgery, miniaturized surgical instruments are used that can be inserted into several small incisions in the body.

Complications

In the verdict of the investigation, medical examiner Karen Dilks said that death was "a direct consequence of the operation and its complications."

"Mr. Pettitt died due to complications in an operation to treat mitral valve disease and partly because the operation was performed with robotic assistance."

These complications included discussions between surgeons operating the robot and deficiencies in the training of surgeons who performed the procedure.

The verdict raises important questions about the growing dependence of humans on robotic surgery.

Robot

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Robotic surgery has been used with high success rates since the early 2000s in thousands of hospitals around the world.

Robotic surgery is a type of minimally invasive surgery. That is, instead of operating the patient performing large incisions, miniaturized surgical instruments are used that can be inserted into several small incisions in the body.

What is done is to place these miniaturized surgical instruments in robotic arms so that The surgeon can perform a series of movements accurately.

These systems have been used with high success rates since the early 2000s in thousands of hospitals around the world, particularly for hysterectomies and prostate extractions.

In recent years, some hospitals have begun using it in cardiac surgery for valve repair, such as the operation to which the British patient was subjected.

Surgeons trained

As Dr. Patrick Finlay, president of the British Association of Biomedical Engineering, told the BBC, the use of robots has proved to be extremely safe over the years, provided that the hands they manipulate are trained.

"Putting a robot in a surgical procedure requires following a series of very strict measures, it is necessary to go through various regulations and tests to make sure the robot is safe," says the expert.

"It also requires that the hands that deal with it to be competent for this they need training"

"Training is very simple, but being able to use one of these robots safely requires training not only with the things you expect to happen, but also with what is not expected to happen, in addition to training for the specific procedure you will perform. "

Robot

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It requires a lot of training and practice from the surgeon before he can perform robotic surgery.

Professor Stephen Westaby, a cardiac surgeon at John Radcliffe Hospital in Oxford, England, and one of the country's most experienced experts, agrees.

"Robotic systems have been safely used in all types of surgeries for many years," he told the BBC.

"But in cardiac surgery there is one small difference: this is done against the clock, because to visualize the inside of the heart and operate the patient, you must stop the heart and connect the patient to a heart-lung machine to aid in blood circulation. "

"In addition, cardiac arrest is performed with a solution called cardioplegia, to protect the heart."

But, as the expert says, all this has the disadvantage of time. Because the longer you are connected to a machine, the more damage your heart can suffer, and the longer the blood circulation is interrupted, the harder it will be to restart the heart.

"So the use of robotics in heart surgery has advantages only because of the small incisions required by the procedure and because of the supposed rapid recovery," says Professor Westaby.

"But this rapid recovery will depend on all the factors I mentioned earlier," he adds.

Robotic Surgery

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He is asking to establish guidelines that include the use of specialized medical supervisors – who offer advice during surgical procedures.

Human error

What has caused the greatest controversy in the case of the British patient who died is that it has been revealed that they do not exist in this country established guidelines for the use of robots in the operating room.

As forensic research has indicated, a policy should be established that includes the use of specialized medical supervisors – who offer advice during the new procedures.

Medical examiner Karen Dilks said in her research findings that "there are no benchmarks" in training new treatments and interventions.

The investigation indicated that the surgeon who directed the operation of Pettitt He had no personal training to use the robot.

He added that it is likely that the patient would have survived if he had undergone open heart surgery, with which he would have only 1% or 2% chance of dying.

But does this mean that robots should not be used in cardiac surgeries?

"No, not at all," says Professor Westaby. "There are many colleagues in this country and abroad who are experts in these operations. To get there, it takes a lot of training. "

"If we are going to introduce a new and innovative way of performing cardiac operations, we need to do a lot of practice," says the specialist.


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