Critical appraisal of technical problems with robotic urological surgery

OBJECTIVE: To record the technical problems and complications associated with the use of da Vinci S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) and to review previous reports. METHODS: We analysed our records for all machine- or instrument-related errors during the course of 340 consecutive robot-assisted urological operations at our centre from July 2006 to March 2009, using one robotic machine. The cause of the error (machine or human), troubleshooting methods and consequences of the errors were evaluated. RESULTS: The overall device failure rate was 10.9% (37/340). The most frequent technical problems were related to robotic instruments (23/37). Other failures included colour/hue changes in the console image, intermittent double vision, fused illuminator bulb and problems with the master tool-manipulator device (hand-piece unit), patient cart circuitry, patient-side manipulator arm, closed-circuit camera unit or camera cable. Of 37 problems, 28 (76%) were surmountable during the course of surgery. The overall conversions to standard open/laparoscopic procedure attributable to mechanical failures of the robot were 0.6% (2/340). There were no complications or direct harm to the patient in any case. Most faults could be corrected or bypassed with some addition to operating room time. CONCLUSIONS: Despite an association of various types of new technical problems with robotic surgery, it provides a safe mode of minimally invasive surgery with very low conversion rates attributable to it, and no direct patient injury.