Robot surgeon heart op went tragically wrong
I’d foolishly turned down extra training on new machine, consultant tells inquest
PIONEERING robot heart surgery went tragically wrong when the surgeon operating the machine made a string of errors, an inquest heard.
The Da Vinci robot began stitching the patient’s heart incorrectly and it was only removed when the robotic camera became ‘blinded by blood’.
Surgeon Sukumaran Nair yesterday told Newcastle coroner’s court he had turned down extra training on the use of the robot, and admitted he was ‘running before he could walk’ by performing the operation in February 2015.
Stephen Pettitt, 69, suffered multiple organ failure days after undergoing the UK’s first robotic heart surgery to repair a leak in the mitral valve – which lets blood flow around the heart.
The inquest heard that atmosphere in the operating theatre at Freeman Hospital in Newcastle became tense after robot experts, known as proctors, left part-way through the procedure.
It was later found that sutures inside the heart had criss-crossed and needed to be repaired.
An assistant surgeon had shouted, ‘We have a problem’, but Mr Nair struggled to hear him because his head was enclosed in a robotic console.
Mr Nair told the inquest: ‘There was an atrium tear and the blood from the right atrium blinded the robotic camera. We could not see anything.’
Mr Pettitt, a married father-ofthree from Whitley Bay, Tyne and Wear, then had his chest opened and repaired using conventional surgery, but he died days later on March 3 2015.
Mr Nair, who has now left his post in Newcastle, said he had ‘made it clear’ to Mr Pettitt that he would be the first robotic mitral valve repair patient, but did not tell him that he ran a higher risk. He agreed with an official report by a professor that ‘advancing to robotic surgery was a premature step and you were running before you could walk’.
The surgeon also agreed with coroner Karen Dilks that it was ‘more likely than not’ that Mr Pettitt would have survived had conventional, open heart surgery been used.
After the operation went disastrously wrong and led to Mr Pettitt’s death, Mr Nair told a colleague that he ‘could have done with some more dry-run training’, the inquest heard.
Mr Nair said he was not aware that the proctors, who were supposed to assist the surgical team with the robots, were going to leave the surgery and that the operation had been ‘progressing well’ at the time.
He said he did not attend a training session provided by the robot’s manufacturers, Intuitive Surgical, at Freeman Hospital because he was too busy with other surgery.
The inquest also heard Mr Nair had shadowed US surgeons carrying out four robotic mitral valve repairs, and one in Holland, and that he practised alone on a simulator.
The inquest continues.