Brett T Starr, MD, Danielle S Walsh, MD, FACS, FAAP. East Carolina University Brody School of Medicine
Background: The ergonomic benefits or robotic surgery for the health of the surgeon are widely touted as benefits of this technique, though concern remains over a perception of increased risk of injury to patients, particularly in the novice robotic surgeon. Injury to the bedside surgeon and assistants due to robotic movement can also occur, though not previously reported. We describe a finger fracture to the bedside surgeon due to entrapment between robotic arms and discuss potential risks to the surgeon in robotic procedures.
Procedure: A distal pancreatectomy and splenectomy was performed utilizing the DaVinci SI system (Intuitive Surgical, Inc., Sunnyvale, CA). During the operation, hemorrhage was encountered which required an instrument exchange that was delayed by self-testing failures. After the instrument was validated and advanced into the field by the bedside surgeon, the operator abruptly took control of the device to reposition. The external portion of the active arm was then rapidly and forcefully propelled laterally toward a stationary retracting arm. The bedside surgeon’s hand was still engaged on the instrument being inserted and became trapped between the two arms, leading to a right middle finger crush injury.
Results: The bedside surgeon sustained a fracture to the distal phalanx at the insertion of the flexor tendon with significant hyperextension of the joint. There was temporary paresthesia of the fingertip. While flexor tendon function was preserved and surgery was not required, the surgeon was required to maintain continuous splinting and was unable to return to full duty for a total of 13 weeks. The surgeon has mild residual hyperextension.
Conclusions: While complications to the patient have previously been attributed to the robotic platform, this case demonstrates that there are other inherent hazards to members of the operative team. As is natural with all indirect visual surgical techniques, the operator becomes intensely focused on the internal view and instruments in the field. This spatial separation is accentuated on the robotic platform as the isolated console provides a complete visual field immersion, no tactile feedback, and a disconnect between the rapid, sizeable outward arm motions need to produce small internal movements. Given the need for maximum dexterity internally, the device doesn’t have external proximity sensors to prevent arm-arm or arm-operator collisions. While many bedside operators report anecdotes of collisions with the device, this case reveals the forces involved at the human-machine interface can lead to more significant injuries.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87442
Program Number: P783
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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