In the Hands of a Robot, From the Operating Room to the Courtroom: The Medicolegal Considerations of Robotic Surgery

How effective and sustainable is proctoring in robotic surgery? A retrospective analysis based on interviews with surgeons

BACKGROUND

Robot-assisted surgery is one of several minimally invasive techniques which have become increasingly important in recent years. Education and training are key factors of sustainable success, and surgical tutoring by an experienced external surgeon (proctoring) has emerged as a very useful method of training surgeons. Proctoring enables surgeons to train their respective skills and eventually improve the overall quality of surgical care.

METHODS

To evaluate the sustainability of proctoring, we conducted telephone interviews with colleagues who participated in a single-center surgical proctoring program. The aim was to analyze the feasibility of the concept for being established in the future, how well it suits the surgeons (depending on their individual work experience), and which areas of clinical practice would benefit from proctoring. Furthermore, the surgeons provided free-text comments to the questions on a feedback form handed out after the proctoring.

RESULTS

Surgical skills were significantly enhanced and operating times were reduced after proctoring. Given favorable structural conditions, the number of cases and the case-mix index were also significantly increased. It was found that the learning needs of surgeons differ, depending on their medical function, work experience, and the frequency of robotic surgery. On the feedback forms, proctoring was consistently rated as a positive and supportive measure.

CONCLUSIONS

Proctoring is an important aspect of the individual development of surgeons. Depending on learning needs, a structured curriculum is crucial and should be established for the future. Regular feedback modules should be a part of any surgical training concept.

Malpractice or masterful practice? Navigating vicarious liability in healthcare

In the intricate landscape of healthcare, vicarious liability looms large, shaping the responsibilities and actions of healthcare practitioners and administrators alike. Illustrated by a poignant scenario of a medication error, this article navigates the complexities of vicarious liability in healthcare. It explains the legal basis and ramifications of this theory, emphasizing its importance in fostering responsibility, protecting patient welfare, and easing access to justice. The paper explores the practical effects of vicarious responsibility on day-to-day operations, leadership practices, and decision-making processes via the eyes of senior consultants, junior doctors, and hospital administrators. Through comprehensive insights and real-world examples, it underscores the imperative of fostering a culture of accountability, communication, and quality care to navigate the intricate web of liabilities inherent in modern healthcare.

The AI Orthopedician will see you now - But who is Liable if it's Wrong?

Artificial intelligence (AI) is revolutionizing various sectors, including health care, with orthopedics being no exception. Orthopedic practice, already familiar with technological advancements such as robotic surgery, is rapidly integrating AI into clinical workflows, enhancing precision in surgical planning, diagnostics, and patient care. However, this evolution raises critical questions, particularly regarding liability when AI systems fail and cause harm. This article delves into the role of AI in orthopedics, exploring its current applications and the potential legal implications that come with its adoption. It examines the global landscape, highlighting the lack of clear regulations around AI liability, especially in India, where the topic remains underexplored in medical literature. With insights into how AI is transforming orthopedic practice, the article addresses the pressing concern of who bears responsibility when AI errors occur. This timely discussion serves as an exploration of a unique and recent topic, urging Indian orthopedic surgeons to balance the benefits of AI with the responsibility they hold, as the legal framework surrounding AI in health care continues to evolve.

Online videos of robotic-assisted cholecystectomies: more harm than good?

BACKGROUND

Many surgeons use online videos to learn. However, these videos vary in content, quality, and educational value. In the setting of recent work questioning the safety of robotic-assisted cholecystectomies, we aimed (1) to identify highly watched online videos of robotic-assisted cholecystectomies, (2) to determine whether these videos demonstrate suboptimal techniques, and (3) to compare videos based on platform.

METHODS

Two authors searched YouTube and a members-only Facebook group to identify highly watched videos of robotic-assisted cholecystectomies. Three members of the Society of American Gastrointestinal and Endoscopic Surgeons Safe Cholecystectomy Task Force then reviewed videos in random order. These three members rated each video using Sanford and Strasberg's six-point criteria for critical view of safety (CVS) scoring and the Parkland grading scale for cholecystitis. We performed regression to determine any association between Parkland grade and CVS score. We also compared scores between the YouTube and Facebook videos using a t test.

RESULTS

We identified 50 videos of robotic-assisted cholecystectomies, including 25 from YouTube and 25 from Facebook. Of the 50 videos, six demonstrated a top-down approach. The remaining 44 videos received a mean of 2.4 of 6 points for the CVS score (SD = 1.8). Overall, 4 of the 50 videos (8%) received a passing CVS score of 5 or 6. Videos received a mean of 2.4 of 5 points for the Parkland grade (SD = 0.9). Videos on YouTube had lower CVS scores than videos on Facebook (1.9 vs. 2.8, respectively), though this difference was not significant (p = 0.09). By regression, there was no association between Parkland grade and CVS score (p = 0.13).

CONCLUSION

Publicly available and closed-group online videos of robotic-assisted cholecystectomy demonstrated inadequate dissection and may be of limited educational value. Future work should center on introducing measures to identify and feature videos with high-quality techniques most useful to surgeons.

Doctor, Bot, or Both: Questioning the Medicolegal Liability of Artificial Intelligence in Indian Healthcare

Artificial intelligence (AI) is rapidly transforming the landscape of healthcare, with its applications ranging from diagnostics to robotic surgery. As India swiftly integrates AI into its healthcare system, a critical question arises: who bears the liability when AI-driven medical decisions go wrong? This article explores the complexities of assigning legal responsibility for AI in healthcare, particularly within the Indian context. While India's legal framework, including the Information Technology Act, intersects with AI usage, it lacks specific provisions addressing AI liability. The National Strategy for AI, although a step forward, does not resolve the ambiguities surrounding accountability. The article also examines how other countries, particularly the European Union and the United States, are beginning to tackle these challenges through proposed directives and regulations. However, the absence of clear, comprehensive laws worldwide reflects the inherent difficulties in legislating AI stemming from its autonomous nature, the "black box" problem, and the multifaceted roles of stakeholders. Until robust legal frameworks are established, the article cautions healthcare professionals to exercise vigilance when using AI tools, recognizing that they may still bear significant liability. This evolving legal landscape underscores the need for continued deliberations in AI regulations.

Robotic colorectal surgery training: Portsmouth perspective

This study aims to discuss the principles and pillars of robotic colorectal surgery training and share the training pathway at Portsmouth Hospitals University NHS Trust. A narrative review is presented to discuss all the relevant and critical steps in robotic surgical training. Robotic training requires a stepwise approach, including theoretical knowledge, case observation, simulation, dry lab, wet lab, tutored programs, proctoring (in person or telementoring), procedure-specific training, and follow-up. Portsmouth Colorectal has an established robotic training model with a safe stepwise approach that has been demonstrated through perioperative and oncological results. Robotic surgery training should enable a trainee to use the robotic platform safely and effectively, minimize errors, and enhance performance with improved outcomes. Portsmouth Colorectal has provided such a stepwise training program since 2015 and continues to promote and augment safe robotic training in its field. Safe and efficient training programs are essential to upholding the optimal standard of care.

Beyond Blame: Is India Ready for No-Fault Liability in Healthcare?

In contemporary healthcare systems, the pursuit of justice intertwines with fault attribution and liability determination. The exploration of no-fault liability as a potential alternative within India's healthcare landscape delves into its feasibility and implications. Drawing from international experiences, regulatory frameworks, and societal readiness, the complexities and potential benefits of adopting a no-fault liability system are elucidated. Perspectives from patients, healthcare providers, and broader societal stakeholders are considered, highlighting both the advantages and challenges associated with such a transition. Addressing disparities in access, legal reforms, and logistical hurdles underscores the groundwork necessary for potential adoption, signaling a potential paradigm shift toward equitable compensation and accountability within India's healthcare system.

Exploring the Evolution of Robotic Surgery in Obstetrics and Gynecology: Past, Present, and Future Perspectives

Robotic surgery has emerged as a transformative technology in obstetrics and gynecology, offering enhanced precision and minimally invasive techniques for various procedures. This paper explores the evolution of robotic surgery in obstetrics and gynecology, examining its historical development, current applications, and prospects. Through a comprehensive review of the literature and case studies, we highlight the benefits of robotic surgery, including reduced trauma, improved patient outcomes, and increased surgeon capabilities. However, cost, training requirements, and regulatory concerns hinder widespread adoption. Continuing technological innovation is expected to enhance the efficacy and applicability of robotic-assisted procedures. Collaboration between healthcare professionals, researchers, and industry stakeholders is essential to address these challenges and ensure optimal patient care. By embracing the opportunities presented by robotic surgery while addressing associated challenges, practitioners and researchers can contribute to the continued advancement of this transformative technology in obstetrics and gynecology.

Autonomous Robotic Surgery: Has the Future Arrived?

Autonomous robotic surgery represents a pioneering field dedicated to the integration of robotic systems with varying degrees of autonomy for the execution of surgical procedures. This paradigm shift is made possible by the progressive integration of artificial intelligence (AI) and machine learning (ML) into the realm of surgical interventions. While the majority of autonomous robotic systems remain in the experimental phase, a notable subset has successfully transitioned into clinical applications. Noteworthy procedures, such as venipuncture, hair implantations, intestinal anastomosis, total knee replacement, cochlear implant, radiosurgery, and knot tying, among others, exemplify the current capabilities of autonomous surgical systems. This review endeavors to comprehensively address facets of autonomous robotic surgery, commencing with a concise elucidation of fundamental concepts and traversing the pivotal milestones in the historical evolution of robotic surgery. This historical trajectory underscores the incremental assimilation of autonomous systems into surgical practices. This review aims to address topics related to autonomous robotic surgery, starting with a description of fundamental concepts and going through the milestones in robotic surgery history that also show the gradual incorporations of autonomous systems. It also includes a discussion of the key benefits and risks of this technology, the degrees of autonomy in surgical robots, their limitations, the current legal regulations governing their usage, and the main ethical concerns inherent to their nature.

The Era of Digital Orthopedics: A Bone or Bane?

Orthopedics, the medical specialty dedicated to diagnosing, treating, and preventing disorders of the musculoskeletal system, has long been a cornerstone of healthcare. With an aging population and an increasing emphasis on maintaining an active lifestyle, the demand for orthopedic care is on the rise. However, the field of orthopedics is rapidly evolving, and one of the most significant developments in recent years is the emergence of digital orthopedics [1, 2]. This transformation is reshaping the way orthopedic care is delivered, from diagnosis and treatment to patient outcomes and beyond. In this editorial, we explore the concept of digital orthopedics, its implications, and the potential benefits it offers to both patients and health-care professionals.