Expert Witness Journal Issue 64 December 2025 - Flipbook - Page 15
Remote Robot-assisted Surgery
Raises Liability Questions
by Jill Paterson, Partner & Philippa Wheeler, Associate Solicitor at Leigh Day
In a world-昀椀rst, surgeons in Dundee and Florida
have successfully performed remote stroke
surgery using robotic technology: a signi昀椀cant
development that could rede昀椀ne emergency care
for millions.
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The remote surgeon uses instruments in
their hospital, and the robot replicates those
movements precisely in real time on the patient
at the other hospital.
The procedure is monitored via live imaging,
allowing the remote surgeon to guide the
catheter and remove the clot as if they were
physically present.
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Professor Iris Grunwald, consultant diagnostic
and interventional neuroradiologist, performed a
mechanical thrombectomy on a human body which
had been donated to science. The procedure uses
catheters and wires to remove blood clots on the
brain after a stroke. Traditionally, a surgeon would
be situated in the operating theatre with the patient,
but in this procedure Professor Grunwald operated
from Ninewells Hospital in Dundee on the cadaver
located in a university facility across the city.
This innovation could greatly improve access to
stroke care, especially in rural or under-served
areas where there may be fewer specialists. Further,
every minute counts in stroke treatment, and this
technology could eliminate delays that can cost lives.
It could also reduce the burden on overstretched
healthcare systems.
Legal questions in a robotic world
Hours later, neurosurgeon Dr Ricardo Hanel used
the same technology to perform a similar procedure
from his location over 4,000 miles away in Florida.
Professor Grunwald described the procedure as
“the 昀椀rst glimpse of the future”. But it brings with it
a series of legal and ethical questions.
The procedures used robotics from Lithuanian 昀椀rm,
Sentante, to mimic the surgeons’ movements, who
were guided by live X-ray imaging and ultra-low
latency connectivity supported by tech companies,
Nvidia and Ericsson.
As we move toward clinical trials and live patient
procedures, key concerns will include:
1. If something goes wrong, who will be liable?
How robotic stroke surgery works
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An ischaemic stroke occurs when a blood clot blocks
an artery supplying the brain. A common treatment
is a thrombectomy, where a specialist threads a
catheter through an artery (often from the groin)
up to the brain to physically remove the clot.
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2. How do we prove causation?
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In the robotic setup:
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A patient is admitted to a local hospital for
surgery.
At the local hospital, a robotic arm is connected
to the same catheters and wires a surgeon would
normally use.
A local medic attaches the wires to the patient.
The hospital is connected to the remote surgeon
at another location.
EXPERT WITNESS JOURNAL
Is it the remote surgeon, the local team, the
hospital, or the robot manufacturer?
What if harm results from a connectivity
issue, software glitch or mechanical fault?
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In traditional surgery, causation is linked to a
surgeon’s direct action or inaction.
In robotic procedures, responsibility may be
distributed across multiple actors, including
hardware, software, and network providers.
If a patient su昀昀ers harm, how do we trace the
source of the error in a system involving realtime data transmission, robotics, and human
oversight?
DECEMBER/JANUARY 2025-2026
