Robotic Instrument Failure—A Critical Analysis of Cause and Quality Improvement Strategies

To introduce a quality improvement initiative tracking robotic instrument failures on a per case basis. It is imperative to understand rates of failure, financial implications of failures, and identify factors suggesting common mechanisms of failure. Starting in January 1, 2014 a quality reporting system for failed robotic equipment began. Staff was instructed to submit an incident report when a robotic instrument failed and the instrument returned to central processing. Instruments were then returned to the manufacturer (Intuitive Surgical Inc, Sunnyvale, CA) for analysis and reimbursement. Results of failure analysis by the manufacturer, including reimbursement rates, were recorded and correlated with the procedure and surgical specialty. A total of 3935 robotic cases were performed during the study period with a reported instrument failure incidence of 6.2% (247 total instruments). Etiology of instrument failure was as follows: tip or wrist (46.9%), cable (30.0%), unknown (12.6%), control housing (5.3%), and shaft (3.2%). Highest instrument failure incidence was seen in colorectal surgery cases at 4.0%, Urology had the lowest at 2.7%. Manufacturer reimbursement rate was 57.9%; the most common reason for denial being mishandling/misuse of equipment, determined by manufacturer analysis. Herein, we have demonstrated that improved process flow of reporting is necessary to better track incidence and etiology of instrument failures. Cost savings comes from improved training of not only surgeons but operating room and central processing staff in handling equipment to prevent high rates of reimbursement denial.