Wednesday , April 14 2021

The lessons left by the death of a patient with a robotic cardiac surgery

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

The surgery that I needed was having a chance of 98 or 99% of being successful. This was, assuming that the surgeons who would perform the operation were human.

But Pettitt's operation was carried out by a robot and the patient died.

Pettitt, which was implemented in 2015 at Freeman Hospital in Newcastle, England, was The first patient in the United Kingdom receives the innovative treatment of the robotic heart surgery.

And when an investigation into the causes of his death came to the conclusion, "there is a danger that other deaths happen" with this type of procedure.

The robotic cardiac surgery program in England was banned after Stephen Pettitt's death.

Surgery with a robot

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In robotic surgery, small surgical equipment is used that can be inserted into a number of small body incisions.


In the ruling of the investigation, the forensic doctor, Karen Dilks, said that the death had been a "direct result of the operation and its complications."

"Mr. Pettitt died because of complications in surgery to treat linear valve disease and, in part, because the surgery was performed with robotic support."

These complications included discussions among the surgeons operating the robot and Shortcomings in training surgeons who did the procedure.

The ruling raises important questions about the increasing dependence of people on robotic surgery.


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

Robotic surgery is a form of minimal invasive surgery. That is, instead of acting on the patient who performs large incisions, small surgical equipment can be used that can be inserted into a number of small body incisions.

What is being done is to install the ancient surgical instruments in robotic arms, so The surgeon can perform a series of movements with rigor.

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

In recent years, some hospitals have begun to use it in cardiac surgery for valve repairs, such as the surgery they had received from the British patient.

Trained surgeons

As Dr. The president of the British Biomedical Engineering Society, Patrick Finlay, has been experiencing the use of robots over the years to be extremely safe, as long as handled hands are trained.

"You need to put a robot in a surgical procedure following a series of strict measures, many regulations and tests need to be passed to ensure that the robot is safe," said the expert.

"It also requires the hands that are handled bod competent and for that they need them training"

"The training is very simple, but the ability to use one of these robots safely requires training not only with the things that you expect them to happen but also with & # 39; What is not expected to happen, in addition to training for the specific procedure that you will perform "


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He needs a lot of training and exercise of 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 most experienced specialists in the country, agrees.

"Robotic systems have been used safely in all types of surgery for many years," the expert tells the BBC.

"But in cardiac surgery there is a small difference: This is against the clock, Because you have to imagine inside the heart and act on the patient, you must give the best to the heart and connect the patient with a lung machine to help circulate blood. "

"In addition, a cardiac arrest with an answer of the cardioplegia name is performed, to protect the heart."

But as the expert says, all of this has a disadvantage of time. As long as you are connected to a machine, the more harm the heart can suffer, and the longer period the circulation of the blood circulation is, the more difficult is to restart the heart.

"The use of robotics in cardiac surgery is only beneficial because of the small incisions that are required by the procedure and due to the rapid recovery," said Professor Westaby.

"But fast recovery will depend on all the factors that I mentioned earlier," he added.

Robotic Surgery

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He asks to establish guidelines that include the use of specialist doctors-supervisors-who offer advice during surgical procedures.

Human error

What has caused the most controversial in the case of a British patient who died has been revealed that they do not exist in this country Guides set up for the use of robots in the operating room.

As the forensic investigation said, a policy should be established that includes the use of specialist doctors-supervisors-who offer advice during the new procedures.

The coroner, Karen Dilks, stated in his research's conclusions that there was a "lack of point of reference" in the training for new treatments and interventions.

The investigation noted that the surgeon who instructed the operation of Pettitt He did not have personal training to use the robot.

He added that it was likely that the patient would have survived if he had had an open heart surgery, and would have had only 1% or 2% chance of death.

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

"No, no," said Professor Westaby. "There are many colleagues in this country and abroad who are experts in these operations. To get there, much training is needed. "

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

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