Incident 5: Collection of Robotic Surgery Malfunctions

Description: Study on database reports of robotic surgery malfunctions (8,061), including those ending in injury (1,391) and death (144), between 2000 and 2013.

Tools

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Alleged: Intuitive Surgical developed an AI system deployed by Hospitals and Doctors, which harmed Patients.

Incident Stats

Incident ID
5
Report Count
12
Incident Date
2015-07-13
Editors
Sean McGregor

CSET Taxonomy Classifications

Taxonomy Details

Full Description

Reports of robotic surgeries resulting in injury and death between 2000 and 2013 as found in the Manufacturer and User Facility Device Experience (MAUDE) database, a database of both voluntary and mandatory reports of mishaps. Within the 14 year span there are 8,091 recorded malfunctions resulting in 1,391 injuries and 144 deaths. Injuries range from burns from sparks emitted by the machines (n=193), robotic arms becoming dislodged in the patient (n=100), and instances of the surgeon losing control of the machine or the machine powering down unexpectedly (n=52). About 62% of injuries and deaths reported were due to system/hardware error, while the remainder were attributed to the inherent risk of surgery or human error.

Short Description

Study on database reports of robotic surgery malfunctions (8,061), including those ending in injury (1,391) and death (144), between 2000 and 2013.

Severity

Severe

Harm Type

Harm to physical health/safety

AI System Description

Robotic surgery tools

Sector of Deployment

Human health and social work activities

Relevant AI functions

Action

AI Techniques

Robotic surgery tools

AI Applications

Robotic Surgery

Location

United States of America

Named Entities

da Vinci Robot, FDA

Beginning Date

2000-01-01T00:00:00.000Z

Ending Date

2013-01-01T00:00:00.000Z

Near Miss

Harm caused

Intent

Accident

Lives Lost

Yes

Infrastructure Sectors

Healthcare and public health

Data Inputs

Surgeon's directions, medical procedures

Variants

A "variant" is an incident that shares the same causative factors, produces similar harms, and involves the same intelligent systems as a known AI incident. Rather than index variants as entirely separate incidents, we list variations of incidents under the first similar incident submitted to the database. Unlike other submission types to the incident database, variants are not required to have reporting in evidence external to the Incident Database. Learn more from the research paper.

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