MEDICO LEGAL M A G A Z I N E
ROBOTICS AND ARTIFICIAL INTELLIGENCE IN HEALTHCARE By Greg McEwen, Partner, BLM Law BLM is a leading insurance and risk law firm, instructed on a broad spectrum of legal issues and acting for customers in key sectors such as healthcare, insurance and indemnity, leisure, technology, and public sector. With robotics and AI playing an ever-increasing part in the way healthcare is managed and conducted, Greg McEwen, partner at insurance law specialist BLM, explores the potential for the technology and how the ‘friend or foe?’ equation will affect medical claims.
The idea of ‘robotic surgery’ is not a new one. The first robot assistant for surgery, the Arthrobot, was developed in the early 1980s and first used in 1984, in an orthopaedic procedure. Since then, robots have been developed and deployed in increasing numbers, to perform all types of surgery from bowel and bladder procedures to eye operations and neurosurgery. One of the most well known systems is the da Vinci Surgical System, approved since 2000 by the US FDA. The system accepts a variety of different surgical instruments, allowing it to be used in different surgical settings. It’s not just the US however that has led the charge in the field of robotic surgery. The PROBOT, developed at Imperial College London, was used in a world-first to perform robotic prostate surgery at Guy’s & St Thomas’s Hospital in 1992. As AI has progressed, so too have we in its adoption into ever more complicated procedures – you need only look at the first ophthalmic surgery carried out by a miniature robot within the eye, which took place just a few months ago, here in the UK. However, with the greater ubiquity of robots have come greater concerns and reports of errors. Researchers from the University of Illinois, Michigan Institute of Technology and Rush Medical Center published a manuscript in 2015 entitled Adverse Events in Robotic Surgery: A Retrospective Study of 14 Years of FDA Data, utilising data from the Manufacturer and
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User Facility Device Experience (MAUDE). The study noted that, from 2007 to 2013, 1.74 million robotic surgical procedures were performed in the US - the majority of which were urological or gynaecological. In the thirteen years preceding, the data recorded 8,061 ‘device malfunctions’, 1,391 patient injuries and 144 patient deaths. Adverse incidents included electrical arcing, sparking or charring of instruments and the falling of broken or burnt pieces into the patient’s body. Such incidents were said to have contributed to 119 injuries and one patient death. Clearly, operations utilising robotics are not without their risk. However, it should be noted that incidents relating to broken and/or retained instrumentation are by no means exclusive to robotic surgery, and herein lies one of the difficulties in interpreting the data. It cannot tell us whether a complication is solely or partly attributable to the use of a robot, whether it is patient related, or whether it represents a complication of the surgery itself. As a result, there remains a debate amongst medical professionals over whether the perceived advantages of robotic surgery outweigh the costs, both financial and otherwise. Some studies have suggested that surgical outcomes for robotic procedures are as good as the nonrobotic alternative, but is “as good as” good enough? In fact, there have in recent years been reports of a decline in the sale of surgical robots. Amongst the disadvantages sometimes cited are longer setup times as well as the time that may be required during surgery to change instruments. Surprisingly perhaps, some surgical procedures may therefore take longer to perform with robot assistance, with the knock on effect of longer periods under anaesthesia. On a practical level, robots also lack the sensation or
