FDA Probes AI Surgical Tool Malfunctions in TruDi System

The U.S. Food and Drug Administration (FDA) is facing increased pressure to tighten oversight of artificial intelligence in healthcare following a Reuters investigation into the TruDi Navigation System. Since integrating machine-learning algorithms in 2021, the surgical tool has been associated with a significant increase in adverse events, raising urgent questions about the safety of “adaptive” medical technologies. The fallout highlights a growing gap between the rapid deployment of AI and the regulatory frameworks designed to protect patients in the operating room.

The TruDi Investigation: From Precision to Malfunction

The TruDi Navigation System, currently owned by Integra LifeSciences, was designed to provide real-time 3D guidance for ear, nose, and throat (ENT) and skull base surgeries. However, investigative data reveals a troubling trend following its AI upgrade.

Before the machine-learning transition, the system had only seven unconfirmed malfunction reports over three years. Since 2021, that number has surged to over 100 documented malfunctions and injuries. Reports indicate that the AI frequently “hallucinated,” misidentifying anatomical structures or showing tools inside the brain when they were positioned elsewhere.

Real-Life Impact: When Data Fails the Patient

The inaccuracies have resulted in severe, life-altering surgical errors. Documented cases include:

Cerebrospinal Fluid (CSF) Leaks: Critical breaches in the brain’s protective barrier leading to infection risks.
Carotid Artery Dissections: In one instance, a misplaced tool guided by faulty AI visualization caused a life-threatening arterial tear.
Misidentified Fetal Anatomy: Beyond TruDi, other AI tools like ultrasound systems have allegedly misidentified fetal body parts, leading to incorrect prenatal diagnoses.

A Systemic Issue: Beyond a Single Device

The TruDi case is symptomatic of a broader industry-wide surge. At least 1,357 AI-authorized medical devices are currently cleared by the FDA, double the amount allowed through 2022. This rapid expansion has outpaced the agency’s ability to monitor long-term performance.

A landmark study published in the JAMA Health Forum in August 2025 by researchers from Johns Hopkins, Georgetown, and Yale universities found that 60 FDA-authorized AI devices were linked to 182 product recalls. The study revealed that 43% of these recalls occurred less than a year after the devices were greenlighted, twice the rate of non-AI devices authorized under the same rules.

Common Malfunctions in the AI MedTech Landscape:

Heart Monitors: Cases where AI missed abnormal heartbeats entirely.
Diagnostic Imaging: Algorithms failing to detect critical anomalies while maintaining a “high-confidence” display for the clinician.
Functional Delays: Significant lags in processing that can be critical during time-sensitive procedures.

Regulatory Gaps in Adaptive AI Frameworks

The core of the controversy lies in the FDA’s current approval pathways. Most AI-enabled medical devices are cleared via the 510(k) pathway, which allows tools to hit the market by demonstrating they are “substantially equivalent” to existing products, often without new clinical trial data.

Global Policy Shifts and African Context

This issue is not confined to the United States. Regulators worldwide, including the South African Health Products Regulatory Authority (SAHPRA), are refining guiding principles for AI/ML-enabled devices. SAHPRA’s 2025 guidelines emphasize transparency and “human-in-the-loop” requirements to prevent clinicians from developing a false sense of security when relying on algorithmic guidance.

Impact and What’s Next for MedTech AI

The legal and financial repercussions for manufacturers have been immediate. Integra LifeSciences is currently defending multiple lawsuits while its stock has faced volatility. In late 2025, the FDA issued a Class 2 recall for specific software versions of the TruDi system, citing defects that compromised visualization accuracy.

Moving forward, the industry expects a shift toward Total Product Lifecycle (TPLC) oversight. Regulators are likely to mandate continuous performance reporting and stricter re-validation requirements. For surgeons, the takeaway is clear: while AI offers immense potential, it cannot yet replace traditional clinical intuition and manual verification.