Recently, my colleague Amy Foust made some really good points about a subject that is rarely discussed. Over the years, a number of patients have claimed that they were injured by surgical robots defective by design or manufacture. A recent study from Johns Hopkins University may now allow some to argue that surgical robots are also injuring surgeons. Of 432 clinicians using robotic surgical systems who participated in a survey, 78% self-reported pain in the fingers; 74% in the neck; 53% in the upper back; and 33% or more reported pain in each of the lower back, eyes, and wrists. The lead researcher attributes pain in the fingers and neck, especially, to certain features of robotic system consoles.
The Occupational Safety and Health Administration (“OSHA”) describes musculoskeletal disorders (“MSDs”) as affecting “the muscles, nerves, blood vessels, ligaments and tendons.” They are associated with, among other things, awkward body postures and repetitive tasks. OSHA cites a 2013 Bureau of Labor Statistics report for the astounding estimate that 33% of all worker injury and illness cases are MSDs. The ergonomics researcher at Johns Hopkins, Dr. Gyusung Lee, believes that a lack of tactile feedback and locking mechanisms may cause surgeons to grip console elements more tightly or for longer than is ideal. Similarly, a surgeon may hold her neck in a fixed position to view a console screen during extended surgeries.
For an industry already wary of potential product liability claims, this study highlights yet another area of allegedly defective design. Courts have entertained claims of injury from poor ergonomic design for keyboards for telephone operators, mail sorting machines, and personal computers. Repetitive strain injury claims related to keyboards largely failed due to inadmissible or insufficient evidence of a causal link between the keyboard designs and the injuries. Academic attention to surgeon discomfort, however, suggests that manufacturers should remain attentive to the developing evidence of ergonomic design factors as contributing to or preventing various injuries. While hypotheses without prospective data seem unlikely to provide evidentiary support for a design defect claim, more robust studies might. It would be wise to inquire about user comfort during procedures of at least normal duration, and to implement improvements in user comfort and ergonomics where the trade-offs (e.g., ease of cleaning, avoidance of unintentional activation of other controls, accessibility of critical or emergency controls, etc.) are acceptable. User comfort features may contribute to a legal defense if the data ultimately does suggest a causal link between certain user interface features and persistent repetitive stress injuries. In any event, improving user comfort should make the system more attractive to frequent users.