UVA team working to improve robotic surgery outcomes

Robot-assisted surgery has become standard of care in many specialties. According to the Intuitive Surgical Annual report, 877,000 robot-assisted procedures of various types were performed across the United States in 2017 – but a University of Virginia (UVA) study based on reports made to the U.S. Food and Drug Administration databases from 2000 to 2013 revealed surgical robots were involved in more than 10,000 adverse events, with 1,391 cases resulting in patient injury and 144 cases resulting in death.

Homa Alemzadeh, a UVA assistant professor of electrical and computer engineering and systems and information engineering and four of her UVA colleagues were awarded a UVA Graduate Medical Education grant to tackle two critical issues for ensuring safety in robotics surgery. Now, Alemzadeh and her colleagues Dr. Leigh Cantrell (obstetrics and gynecology), Dr. Jose Oberholzer (surgery), Dr. Noah Schenkman (urology) and Inki Kim (assistant professor of systems and information engineering) are working to improve the safety of robot-assisted surgery systems and improve the training of the next generation of surgeons.

First, Alemzadeh and other team members: – are collecting information on and analyzing robot-assisted surgery errors to characterize the causes of adverse events and model and simulate them in virtual environments. Then, they will work on developing new simulation-based training methods for robot-assisted surgery that will help prepare surgeons to deal with adverse events.

The da Vinci Surgical System, the main system Alemzadeh and her team studied, and what the team says is the top-selling system used in robot assisted surgeries across the country, “works well,” Schenkman said, “but has safety issues” – and there are humans behind the machines who can make mistakes, too.

“A surgical team is actually controlling it,” Alemzadeh said. “So there are a lot of failures that are not just due to hardware or software bugs or mechanical defects, but a combination of those with unintentional operator errors and a complex underlying context, including various surgical tasks and patient dynamics.”

Alemzadeh and her colleagues are on a mission io help decrease the number of those adverse events during procedures. “My passion for research in health care safety and security comes from the significant impact that it can have on people’s lives,” she said.

Alemzadeh works on the engineering aspect of the robots, and Schenkman and the other doctors provide the clinical expertise.

“The current simulation system is very simplistic,” Schenkman explained. “It’s mostly focused on understanding how to do the technical moves – how to move your hands and feet (to manipulate the robot) at the same time. It’s not focused on higher-level problem-solving that you might actually encounter in the operating room,” such as if a patient is bleeding, where do you put the needle? If a major blood vessel is cut, how do you get through the situation safely?

“We are really looking at situations that we call ‘high-risk,’ but with very rare occurrence,” Schenkman said. “That’s where you are really tested with something you’ve never seen before, but that has very high stakes if you make a mistake.”

The team want to give trainees the chance to solve problems before they present themselves in real life – because you don’t want the first time you encounter something to be in the operating room, Schenkman says, adding that their ultimate goal is to help make better surgeons.