Safe design of surgical robots - a systematic approach to comprehensive hazard identification

OBJECTIVES

Since the 1980s, robotic arms have been transferred from industrial applications to orthopaedic surgical robotics. Adverse events are frequent and often associated with the adopted powerful and oversized anthropomorphic arms. The FDA's 510(k) pathway encourages building on such systems, leading to the adoption of hazards, which is known as "predicate creep". Additionally, the methodology of hazard identification for medical device development needs improvement.

METHODS

We present an approach to enhance general hazard identification and prevent hazards of predicate creep by using the integrative, scenario-based and multi-perspective Point-of-View (PoV) approach. We also present the Catalogue of Hazards (CoH) as an approach for collecting and systematising hazards for future risk analysis and robot development.

RESULTS

We applied seven predefined PoVs to the use case of robotic laminectomy and identified 133 hazards, mainly coming from HMI analysis and literature. By analysing the MAUDE and recalls databases of the FDA, we were able to classify historical hazards and adopt them into the use case.

CONCLUSIONS

The combination of PoV approach and CoH is suitable for integrating multiple established hazard identification methods, increasing comprehensiveness, and supporting the systematic and hazard-based development of surgical robots.

Current Capabilities and Development Potential in Surgical Robotics

Commercial surgical robots have been in clinical use since the mid-1990s, supporting surgeons in various tasks. In the past decades, many systems emerged as research platforms, and a few entered the global market. This paper summarizes the currently available surgical systems and research directions in the broader field of surgical robotics. The widely deployed teleoperated manipulators aim to enhance human cognitive and physical skills and provide smart tools for surgeons, while image-guided robotics focus on surpassing human limitations by introducing automated targeting and treatment delivery methods. Both concepts are discussed based on prototypes and commercial systems. Through concrete examples the possible future development paths of surgical robots are illustrated. While research efforts are taking different approaches to improve the capacity of such systems, the aim of this survey is to assess their maturity from the commercialization point of view.