Robotic Surgery, Is It the Future?

Will robots replace the surgeons?

Robotic surgery involves the surgeon sitting at a console in the corner of the room remotely operating a $2.5 million machine that in turn handles the skinny instruments that are introduced through small incision to perform surgery.

Remote Robotic surgery- also known as Tele-surgery is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location.

The Lindbergh Operation

The first true and complete remote surgery was conducted on 7 September 2001 across the Atlantic Ocean, with French surgeon Dr. Jacques Marescaux in New York City performing a cholecystectomy on a 68-year-old female patient 6,230 km away in Strasbourg,

Unassisted robotic surgery

As the techniques of expert surgeons are studied and stored in special computer systems, robots might one day be able to perform surgeries with little or no human input. Carlo Pappone, an Italian surgeon, has developed a software program that uses data collected from several surgeons and thousands of operations to perform the surgery without human intervention.

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The robot was introduced in 2000. Unlike the cell phone, it has not evolved into a better, sleeker technology and it isn’t cheaper. Back then, the robot costed one million dollars, not the 2.5 million it costs today. And the technology has not accelerated at the rate of Moore’s law. It remains a bulky, cumbersome technology.

1990s have witnessed the so-called laparoscopic revolution in which many operations were adapted from the traditional open surgery to the minimal access technique. Robotic surgery effectively addresses the limitations of laparoscopic and thoraco-scopic procedures, thus revolutionizing minimal access surgery. It is envisaged that “almost all surgery can and will be performed by robotic surgery in the future.

Hospitals and the robot companies tout the benefits, but there are concerns about the number of casualties. The number of robotic procedures, from delicate head and neck surgery to routine hysterectomies, has soared by 30 percent each year. Experts attribute the surge to aggressive marketing that plays up the robot’s ‘wow’ factor. Many claims of superior safety and effectiveness are misleading.

Robotic surgery is considered generally safe. While the robot provides a benefit in some operations, most uses are for procedures where there are no advantages and there may be potential risks. And adverse events involving the robot increased 34 percent between 2013 and 2014 alone, prompting the FDA to launch an inquiry. Furthermore, a new Johns Hopkins study shows that such problems are likely underreported.

People have come to assume that robotic surgery is better simply because of their increased precision and accessibility to small spaces. Advantages may or may not be earth-shattering.

Laparoscopy is hard on a surgeon’s body, but all surgery, in general, is hard on a surgeon’s body. Robotic surgery is easy on the surgeon. And until we come up with some better ergonomic solutions, surgeons will continue to accumulate back, neck, shoulder, elbow and hip injuries at alarming rates. It is estimated that more than 60 percent of surgeons are nursing a chronic skeletal injury by 50 years of age. The robot represents an attempt to address the ergonomic crisis in surgery.

surgeons see many advantages in performing procedures with a robot. A computer screen magnifies everything in 3-D, greatly improving the surgeon’s field of vision; the robot’s “hands” can reach into tighter spots and move in ways that human hands cannot; and the machine’s software corrects for a surgeon’s hand tremors. The robot may also reduce physician fatigue because surgeons work the robot’s controls while sitting at a console instead of standing over the patient for hours. Minimally invasive robotic surgeries usually result in less blood loss and faster recoveries, since there’s a smaller incision to heal.

All technologies have to start somewhere. Remember the first mobile phones and how bulky they were and how much they would cost?”. “The costs will go down as the technology improves and is more widely used, it has not happened in case of robotic surgical units.

We assume that the robot will result in better outcomes. And the JAMA data demonstrates that this assumption is incorrect. Robotic surgery companies have sold the health care organizations on the “sexy” and sleek nature of Robots without any evidence of increased benefit proportional to cost.

One little thing that does not get mentioned is that in addition to the initial cost of purchase, hospitals pay an annual six-figure maintenance fee to the company. So after ten years, the initial cost of the purchase has doubled.in addition there is Instrument amortization. Break an arm or an attachment, add $40K or a couple of Lakhs of rupees to your six-figure bill for the year.

Patients may be surprised to learn that there are no national training standards for robotic surgery. The training provided to surgeons new to the technique typically consists of online instructions, a few one-day sessions at the workshops and few supervised surgeries. It’s up to the individual hospitals to decide when doctors can perform robotic operations on their own. It takes a long time to master this technology.

Health care is entirely about outcomes. In the rapidly evolving environment of value-based medicine- outcome per cost the robot loses. To conclude the Robots must demonstrate value by improving results and reducing cost.

Are we moving towards more automation during these types of surgeries?

Yes, robots will become more automated in doing certain things, like real-time imaging. But, will a surgery be performed completely by AI without a surgeon? I think right now we are too far away from this.

Artificial intelligence will definitely help guide our hands and eyes while we are performing the procedure using overlapped imaging or other detection methods.

A range of competing robotic surgical systems is expected to enter the market in the next 5 years. The new technology offered has the potential to improve surgical ergonomics. With the market dominated by the high-performing but expensive generations of the da Vinci for almost 20 years, newer, economic machines may make robotic surgery accessible to wider populations.

Will Robots Replace Doctors?

Artificial intelligence and humans are the most potent when they work together. Collectively wise, individually otherwise!

Collaboration between humans and technology is the ultimate. The consistent and constant enemy image building should stop once and for all. It has never been technology versus humans — since technological innovations always serve the purpose to help people. No matter whether it’s A.I., robotics, augmented or virtual reality, we should accept that they have a massive influence on the way healthcare operates, and then start utilizing their power.

There are now a group of engineers coming to be known as “clinical engineers,” who have a technical background but are also educated in clinical applications. They may serve as the intermediary between surgeons and other engineers. This educational cross-pollination must continue, preferably at an increased rate and in a more structured manner.

Technology will help bring medical professionals towards a more efficient, less error-prone and more seamless healthcare.

Former director of Sri Jayadeva Institute of Cardiology, Former VC of Bangalore University and former chairman of the Karnataka State Health Commission

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Dr Prabhu Dev

Dr Prabhu Dev

Former director of Sri Jayadeva Institute of Cardiology, Former VC of Bangalore University and former chairman of the Karnataka State Health Commission

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