Technology used in surgery is becoming increasingly complex. While in some cases these advances may reduce the risk of technical error, in other cases unfamiliarity or confusion with the new and ever expanding technologic devices may increase the risk for technical error.

The introduction of laparoscopic surgery was a revolutionary change in surgical technology [10]. Along with clear advantages, this technology also brought a series of new technical errors [11, 12]. The rate of common bile duct injury increased shortly after the introduction of laparoscopic cholecystectomy. These injuries were also more commonly reported early in the surgeon’s laparoscopic experience [13].

Robotic surgical systems are increasingly being used for general surgical, cardiothoracic, and urologic procedures [14]. Since most facilities will only have one of these costly systems, system failure may require surgeons to abort the planned surgical procedure. In a review of 725 robot-assisted laparoscopic radical prostatectomies, robotic system failure that lead to case abortion occurred in only four cases (0.5 %), while other reports have cited a 2–5 % system failure rate [15–17]. In order to avoid surgical cancelation and unnecessary anesthesia, the system should be completely set up and its operational status confirmed prior to bringing the patient into the operating room [15, 18].

In another review of the da Vinci S robotic system (Intuitive Surgical Sunnyvale, CA, USA), authors reported a 10.9 % overall device failure rate during 340 consecutive robot-assisted urologic operations [18]. The most frequent technical problems were related to the robotic instruments and included broken tension wires, wires dislodged in the working pulleys, non-recognition of the instruments, locked instruments, and limited range of movement. Most of the problems, 76 %, were successfully corrected or overcome during the course of the surgery but required additional surgical time. Technical problems requiring conversion to standard open or laparoscopic procedure was required in only two cases.

Zorn and colleagues reported only a 0.4 % rate of technical errors resulting in their series of 725 robot-assisted laparoscopic radical prostatectomies [15]. In two cases this was a camera problem that resulted in a loss of 3-D vision and one case in which there was a robotic arm failure. Despite these problems the surgeon was able to complete the operation, although with difficulty.

The introduction of any new technology invariably results in a learning curve as surgeons become increasingly adept with the technology [10, 19]. New technology also creates training and credentialing challenges [10, 20]. Education and training must be offered to ensure that users are proficient in the standard skills and procedural tasks of the new technology. Additional credentialing may be required, either through an independent agency or through the hospital to ensure patient safety.

The increasing time and cost constraints placed on physicians have been identified as increasing the risk for technical errors. In a report that identified three cases in which angled drill guides were inadvertently retained following locked plating of wrist fractures, the authors indicated that this error could have been prevented by making a postoperative radiograph prior to leaving the operating room. They note that, “This practice has become rare as operating room has become tighter and cost-control pressures on surgeons have increased” [21]. Prior teaching emphasized the importance of obtaining any necessary radiographs in the operating prior to the leaving in order to ensure that the outcome was satisfactory. Radiographs obtained in the recovery room have been referred to as “Discovery Room radiographs,” to emphasize the potential for discovering an unexpected finding which may necessitate returning the patient to the operating room for additional surgical intervention.