Medical liability in paediatric robotic surgery - a current concept and a literature review

Robotic-assisted surgery offers significant technical advantages in pediatric procedures but presents complex, unresolved medico-legal challenges regarding liability. We retrospectively reviewed our ten-year experience comprising 205 pediatric robotic procedures. Technical issues related to the robot were encountered in 7 cases (3.4%). These included joystick latency (3/7), coagulation/cutting pedal malfunctions (2/7), and accidental power cable disconnections causing system shutdowns (2/7). A literature review was conducted to assess the current international state of the art regarding robotic medical liability. Although the technical events at our center did not result in clinical complications, they highlighted significant potential risks. The literature shows that specific guidelines governing human, product, and algorithm-related liability are still lacking. Robotic surgery shifts the focus from an exclusively fault-based liability of the surgeon to a network-based system involving multiple stakeholders: the surgeon, the healthcare institution, and the manufacturer. Determining whether an adverse event stems from human error, algorithmic malfunction, or a combination of both remains a critical challenge. Unlike open or laparoscopic surgery where liability is primarily attributed to the operator, robotic surgery involves a complex interaction between the surgeon's console inputs and the manufacturer's technology. Consequently, from a medico-legal standpoint, responsibility for complications should be shared among the surgeon, the hospital, and the device manufacturer.