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Patient dies in robot-aided surgery

Such robots are considered a major surgical breakthrough, but something went wrong.

By GRAHAM BRINK, Times Staff Writer

© St. Petersburg Times, published October 30, 2002

Such robots are considered a major surgical breakthrough, but something went wrong.

TAMPA -- The surgery at St. Joseph's Hospital earlier this month employed the latest in medical technology.

An experienced doctor looking at a three-dimensional computer screen manipulated a robot with three mechanical arms used to cut blood vessels and remove a cancerous kidney from Al Greenway, Plant High School teacher.

The procedure is considered less invasive than traditional surgery and is supposed to decrease a patient's bleeding, pain and recovery time.

But something went terribly wrong.

During the surgery, Greenway's aorta and another blood vessel supplying the kidney were accidentally cut. No one noticed for about 90 minutes. Two days later, on Oct. 13, Greenway died of complications from the surgery.

On Tuesday, hospital officials held a news conference to explain what happened. Hospital president Isaac Mallah called the incident a "tragic but isolated accident."

"We are devastated by this situation," he said. "We have apologized to the family, explained the details of the surgery and expressed our sympathy to them."

The hospital did not release Greenway's name, but his family later confirmed he was the patient.

Greenway's widow, Brenda Greenway, said she was confused by hospital officials' behavior regarding her husband's death.

She said they told her Oct. 13 that her husband had died of surgical complications. The officials then "scattered," in Brenda Greenway's words. She didn't hear from them until Tuesday, 16 days later, when they called to tell her they were holding a news conference.

The hospital and Intuitive Surgical Inc., which manufactures the da Vinci Surgical Systems robot, evaluated the machine and found no mechanical problems. Mallah said the robot did not cause the problem. It does not act without prompting and is always controlled by a trained surgeon.

"The systems have proved highly reliable and have performed very well," said Lonnie Smith, president of Intuitive Surgical Inc.

The hospital did not release the name of the doctor who operated the robot. The doctor was experienced and highly skilled and had used the robot in about 10 similar kidney removal operations and many more prostate removals without any trouble, hospital officials said.

The doctor was not suspended and is still operating at the hospital, Mallah said. Surgeons at St. Joseph's continue to use the robot, but not in kidney removals, at least for the time being. Also, all the surgeons who want to continue using the robot will have to undergo another round of training and assist in five more surgeries before operating the robot on their own again.

"The further training is just a precaution," said Dr. Mark Vaaler, vice president of medical affairs.

Greenway, 53, a Desert Storm veteran and a teacher since 1996, had planned to be out of work a week for the surgery to remove his kidney, in which a biopsy had recently shown cancerous tissue.

In the operating room, a doctor made several small incisions near his kidney. The robot, with its three arms that look like they belong to a giant, 6-foot-tall insect, was maneuvered into position.

The robots are considered a major surgical breakthrough and a harbinger of the technology to come. The arms mimic the movements of a surgeon and in many cases the robot can perform very fine movements in tight spaces without damaging surrounding tissue as much as traditional surgery. The robots are also tremor free.

Greenway's surgeon sat at a console about 10 feet from the operating table and moved the robot with sophisticated control sticks, similar to a very expensive video game. A tiny camera attached to the robot's middle arm allowed the surgeon to see into Greenway's body.

He controlled the two other arms to make the cuts to the necessary blood vessels to remove the kidney. At some point, the two other blood vessels were cut. Despite the damage, the patient's blood pressure and pulse remained the same and nothing immediately alerted the doctors to any trouble, Mallah said.

About 90 minutes later, they noticed the problem. A vascular surgeon was called immediately and repaired the site. The initial damage, however, was too significant, Mallah said.

"We have reported this situation to all of the appropriate regulatory agencies," he said.

Greenway was a radar controller with the U.S. Air Force from 1970 to 1996, according to his school personnel file. He retired as a senior master sergeant. A native of the Virgin Islands, he earned an associate's degree from Hillsborough Community College and a bachelor's degree from the University of Tampa.

He became a teacher at Bloomingdale High School, where he taught for two years before joining the Plant High faculty in 1998. Greenway was active in the Mount Olive Missionary Baptist Church, the Upward Bound program for high school students at the University of South Florida and the Troops to Teachers program.

Mallah said the hospital had not received any notice of legal action in this case.

"We are looking at this very carefully," he said. "It's important that it isn't repeated."

-- Times news researcher John Martin, the Associated Press, the Los Angeles Business Journal and WTSP-Ch. 10 contributed to this report.

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