A Methodological Framework for the Definition of Patient Safety Measures in Robotic Surgery: The Experience of SAFROS Project

  • Angelica Morandi
  • Monica Verga
  • Elettra Oleari
  • Lorenza Gasperotti
  • Paolo Fiorini
Part of the Advances in Intelligent Systems and Computing book series (AISC, volume 194)


This paper describes an innovative methodological approach developed within the SAFROS European project (Patient Safety in Robotic Surgery, FP7) that allows to identify a set of metrics for the evaluation of patient safety during the pre- and intra-operative phase of robotic interventions. This methodology enlarges the focus of the evaluation: safety is assessed not only through the analysis of features and limitations of the technological solutions involved in the execution of target surgical interventions (product safety) but also in terms of the effects of their interaction within the surgical scenario (process safety). Moreover potentialities and obstacles emerging from the introduction of such technologies into the operating room and the hospital as systems (organizational safety) are evaluated. The proposed method has been applied to the analysis of one gold standard and two benchmark procedures. The output of the analysis is a complex set of key metrics addressing safety at the above described levels. This paper reports the most relevant and interesting subset of the obtained results. The extendibility of the method to the analysis of other interventions will be verified with suitable experiments in the next future.


patient safety robotic surgery safety metrics surgical workflow SAFROS project 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
  2. 2.
    Kohn, L.T., Corrigan, J.M., Donaldson, M.S.: To err is human: building a safer health system. Institute of Medicine Report, National Academy Press, Washington, DC (2000)Google Scholar
  3. 3.
    Edington, M. (ed.): Crossing the Quality Chasm: A New Health System for the 21st Century. Institute of Medicine Report, National Academy Press, Washington, DC (2001)Google Scholar
  4. 4.
    Quality Interagency Coordination Task Force, Doing what counts for patient safety: Federal actions to reduce medical errors and their impact. Agency for Healthcare Research and Quality, Washington, DC (2000)Google Scholar
  5. 5.
    Makary, M.A., Sexton, J.B., Freischlag, J.A., Millman, E.A., Pryor, D., Holzmueller, C., Pronovost, P.J.: Patient safety in surgery. Annals of Surgery 243(5), 628–635 (2006), doi:10.1097/01.sla.0000216410.74062.0fCrossRefGoogle Scholar
  6. 6.
    Gutt, C.N., Oniu, T., Mehrabi, A., Kashfi, A., Schemmer, P., Büchler, M.W.: Robot-assisted abdominal surgery. British Journal of Surgery 91(11), 1390–1397 (2004), doi:10.1002/bjs.4700CrossRefGoogle Scholar
  7. 7.
    Herron, D.M., Marohn, M.: The SAGES-MIRA Robotic Surgery Consensus Group. A consensus document on robotic surgery. Surgical Endoscopy 22(2), 313–325 (2008), doi:10.1007/s00464-007-9727-5.CrossRefGoogle Scholar
  8. 8.
    Nio, D., Diks, J., Bemelman, W.A., Wisselink, W., Legemate, D.A.: Vascular Surgery: A Systematic Review. Eur. J. Vasc. Endovasc. Surg. 33, 263–271 (2007), doi:10.1016/j.ejvs.2006.10.004CrossRefGoogle Scholar
  9. 9.
    Martinie, J.B., Smeaton, S.M.: Laparoscopic Approaches to Pancreatic Endocrine Tumors. In: Greene, F.L., Heniford, B.T. (eds.) Minimally Invasive Cancer Management, Part 3, pp. 145–157 (2010)Google Scholar
  10. 10.
    Yuh, B.E., Hussain, A., Chandrasekhar, R., Bienko, M., Piacente, P., Wilding, G., Menon, M., Peabody, J., Guru, K.A.: Comparative analysis of global practice patterns in urologic robot assisted surgery. J. Endourol. 24(10), 1637–1644 (2010), doi:10.1089/end.2010.0024CrossRefGoogle Scholar
  11. 11.
    Borden Jr., L.S., Kozlowski, P.M., Porter, C.R., Corman, J.M.: Mechanical failure rate of da Vinci robotic system. Canadian Journal of Urology 14, 3499–3501 (2007)Google Scholar
  12. 12.
  13. 13.
    Murphy, D.G., Bjartell, A., Ficarra, V., Graefen, M., Haese, A., Montironi, R., Montorsi, F., Moul, J.W., Novara, G., Sauter, G., Sulser, T., van der Poel, H.: Downsides of Robot-assisted Laparoscopic Radical Prostatectomy: Limitations and Complications. European Urology 57(5), 735–746 (2010), doi:10.1016/j.eururo.2009.12.021CrossRefGoogle Scholar
  14. 14.
    Antoniou, G.A., Riga, C.V., Mayer, E.K., Cheshire, N.J.W., Bicknell, C.D.: Clinical applications of robotic technology in vascular and endovascular surgery. Journal of Vascular Surgery 53(2), 493–499 (2011), doi:10.1016/j.jvs.2010.06.154CrossRefGoogle Scholar
  15. 15.
    Zureikat, A.H., Nguyen, K.T., Bartlett, D.L., Zeh, H.J., Moser, A.J.: Robotic-Assisted Major Pancreatic Resection and Reconstruction. Archives of Surgery 146(3), 256–261 (2011), doi:10.1001/archsurg.2010.246CrossRefGoogle Scholar
  16. 16.
    Kaushik, D., High, R., Clark, C.J., LaGrange, C.A.: Malfunction of the da Vinci Robotic System During Robot-Assisted Laparoscopic Prostatectomy: An International Survey. Journal of Endourology 24(4), 571–575 (2010), doi: 10.1089=end.2009.0489Google Scholar
  17. 17.
    Basili, V.R., Caldiera, G., Rombach, H.D.: The Goal Question Metric Approach. In: Encyclopedia of Software Engineering, Wiley (1994)Google Scholar
  18. 18.
    Thammarak, K., Intakosum, S.: OPI model: A methodology for development metric based on outcome oriented. In: 8th International Joint Conference on Computer Science and Software Engineering, JCSSE (2011), doi:10.1109/JCSSE.2011.5930144Google Scholar
  19. 19.
    Joint Commission on Accreditation of Healthcare Organizations, Robot-assisted abdominal surgery. Comprehensive Accreditation Manual for Hospitals: The Official Handbook (CAMH) Oakbrook Terrace, IL (2002)Google Scholar
  20. 20.
    Vincent, C., Moorthy, K., Sarker, S.K., Chang, A., Darzi, A.W.: System approaches to surgical quality and safety – From concept to measurements. Annals of Surgery 239(4), 475–482 (2004), doi:10.1097/01.sla.0000118753.22830.41CrossRefGoogle Scholar
  21. 21.
    Pronovost, P.J., Berenholtz, S.M., Goeschel, C.A., et al.: High Reliability in Health Care Organizations. Serv. Res. 41(4 Pt 2), 1599–1617 (2006), doi:10.1111/j.1475-6773.2006.00567.xGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Angelica Morandi
    • 1
  • Monica Verga
    • 1
  • Elettra Oleari
    • 1
  • Lorenza Gasperotti
    • 2
  • Paolo Fiorini
    • 2
  1. 1.e-Services for Life & HealthFondazione Centro San Raffaele del Monte Tabor MilanMilanItaly
  2. 2.Altair Robotics Laboratory, Department of Computer ScienceUniversity of VeronaVeronaItaly

Personalised recommendations