Damage rate in knee operations bolsters case for more robotics

Jamie Walker | Associate Editor | The Australian

Original article is here.

Surgeons make mistakes and -inflict “unintended damage” in at least one in 10 knee arthroscopic operations, a benchmark university study shows.

The finding has surprised the research team, headed by robotics expert Jonathan Roberts and top Brisbane joint surgeon Ross Crawford, and will be used to build the case for widening the role of medical robots in the operating theatre.

The 93 orthopedic surgeons surveyed in the Queensland University of Technology project amounted to almost 10 per cent of those likely to be operating on any given day in Australia. Half said inadvertent damage to cartilage tissue happened in at least 10 per cent of arthroscopic knee procedures, a common day surgery.

A third of respondents said the damage rate was at least one in five procedures. And, astonishingly, seven surgeons — 15 per cent of the sample — admitted damage happened in every knee operation.

“We didn’t expect such high numbers,” said Professor Roberts, of QUT’s Australian Centre for Robotic Vision. “Of course, we really had no other data to go on — nobody seems to have asked the surgeons before or measured it. Our gut feeling was that (the mistake rate) would be a bit less than that, so we were surprised.”

Professor Crawford, who holds a chair in orthopedic research at QUT and has a busy surgical practice, said the survey aimed to establish the frequency of errors so surgeons could grasp how robotic help might improve patient outcomes.

“People didn’t seem to be uncomfortable answering it, which was interesting. I think they were being pretty honest … the sense was, ‘we are good, but we could be better’,” he said.

The research, published in the Journal of Orthopaedic Surgery, taps into a hot issue as smart machines intrude increasingly on Australian work, even in the most skilled occupations.

There is no suggestion, however, that orthopedic surgeons could ultimately be replaced in the operating theatre by a robot. Professor Roberts said his team was working on robotic tools to assist surgeons, not take over.

Tens of thousands of knee operations are performed each year in Australia, mostly arthroscopic procedures using remote-control instruments inserted through small incisions.

The issue for surgeons is that they not only have to work in the tight confines of the knee joint, -visualised by the limited field of a camera prong, but must also contend with the challenge of manipulating a heavy limb while using arthroscopic tools.

“Holding a leg is heavy when it comes down to it,” Professor Roberts said. “Some surgeons have reported that they actually get hurt lifting and holding limbs.”

To establish a baseline for the mistake rate, the QUT team asked surgeons how often unintended damage happened to the knee joint. This typically involved a “scrape or nick” to articular cartilage, the tissue that cushions the bone ends inside a joint. Professor Roberts said because this was not usually a “life or death” concern, “the honesty was there” from survey respondents.

Professor Crawford, 55, said less invasive arthroscopic procedures had been introduced in the face of entrenched scepticism while he was training as an orthopedic surgeon and now were regarded as best practice.

“We continue to innovate in medicine and surgery, and we see this as the next logical step of robots being able to help us with different parts of procedures,” he said. “And it’s not just with orthopedics. It’s really with any intervention where we are putting devices into the body. Some automation and robotic control will ultimately make us better.”

Professor Crawford said his operating suite at Brisbane’s Holy Spirit hospital was equipped with a $1 million medical robot, one of 20 in the country, used to precision cut and mill bone for hip and knee replacements.

The next generation of robotic systems would provide mechanical muscle to manipulate patients during hip and knee replacements and “imaged-based machines that can accurately access difficult-to-get places”.