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Robots in the Operating Room

Posted on Jan 10, 2013 by Ailee Slater ()  | Tags: Healthcare, United States

The patient lies on the operating table, eyes closed, body covered in thick blue plastic. If he were awake, he would be hearing the strangest sound right now - a rustling, clicking sound; a sound of steel fingers softly rubbing together. If the patient were awake, his eyes might fly open in surprise, and before him he would see it: A machine as tall as he, four thick white arms, long slim fingers made of rods and knives, a robot towering over him.

If this sounds like a scene from a science fiction movie, well, it's not. Welcome to the future. Surgical robotic technology has been in development for some time, and in the past decade, it's become more and more common. Take the da Vinci system. Made by Intuitive Surgical, the world leader in medical robotic technologies, the da Vinci is basically a large upright structure with four robotic arms. While the robot stands next to the patient, poking away while wielding surgical tools and a small video lens, the actual surgeon sits at an ergonomic console a few feet away. But not to fear - the robot is not technically performing the surgery. Every movement made by the da Vinci is controlled by the nearby surgeon, using a video monitor and set of joy sticks to move her hand as though she were truly performing the surgery. The robot then moves its own tools in real time with the surgeon's motions.

Thanks to 3-D viewing through optical channels in the robot, the surgeon has a high definition, close up understanding of what is happening inside the patient. Intuitive Surgical has reported great success as a company. The da Vinci system has been approved by the FDA of the United States, and more than 2,462 of these surgical machines have been installed around the world. With annual growth of more than 25 percent, Intuitive Surgical seems to have proved the point that hospitals want and will pay for robotic surgical technology. And, speaking of payment, robotic surgeons are not cheap - Stanford Hospital in California recently bought a da Vinci for upwards of $1.3 million dollars. So, why invest millions in a robot? It's a valid question, seeing as the da Vinci can only do as much as the conventional surgeon seated beside it. But Intuitive Surgeon and other proponents of robotic surgical technologies have plenty of arguments for why robotics are better.

A robot like da Vinci can enter a patient with very small tools, meaning that the initial incision does not need to be as large as with traditional surgery; this should mean less blood loss, less scarring, less risk of infection, and shorter healing time. Plus, with a robot to help, non-specialist surgeons are more able to perform procedures previously requiring a dedicated expert. Even though the robot is little more than a physical translation of the actual surgeon sitting in a console a few feet away, robotic surgical technology is specifically designed to reduce or eliminate a doctor's hand tremors, leading to more precise movements and less chance of damage to the patient. This, along with the unsurpassed view of a patient's insides thanks to optical viewing technology, gives the surgeon the ability to perform above and beyond what would be possible during a traditional surgery.

Unfortunately for Intuitive Surgical and similar medical developers, a growing group of medical professionals is dead set against the use of surgical robotics. One of the most vocal of that group is Dr. Marty Makary, a surgeon at John Hopkins University of Medicine in Baltimore. Search for Dr. Makary on Google, and you'll find journalist after journalist quoting the doctor as expert witness on the failings of robotic surgery. According to Dr. Makary, robotic surgery is first and foremost unnecessary - Makary told the L.A. times that when it comes to being operated on by a surgeon or a robot, "for the patient, clearly there is no difference." In a study and successive paper he headed for the Journal of Healthcare Quality, Makary expands upon this point, arguing that surgical robots are more marketing ploy than medical advance. Tech companies say that robots are making surgery better, but Makary argues that there is no scientific evidence to confirm this claim, and that not nearly enough randomized, controlled studies have been conducted. Even scarier, as more and more hospitals purchase and publicize robotic surgical technology, patient education and medical industry norms are being handed over to device manufacturers rather than doctors.

Robotic surgery has other detractors, too. In 2010, the Wall Street Journal published an article detailing cases of robots gone wrong - a patient who experienced major complications after robotic surgery, two women who came away from gynecological surgeries with lacerated bladders, and more. The article was clearly designed to shock with tales of a futuristic medical nightmare, but still: it is telling that in its detailing of these cases, the Wall Street Journal mentioned again and again a lack of clear cut evidence. There was no way to say if the robotic technology itself  (rather than a pre-existing condition or doctor's error) had actually led to later complications. What's more, there are plenty of medical researchers who have found definitive advantages to robotic surgical systems.

A study published just this month by the Research and Training Center of the Boston Children's Hospital found that using robot surgeons in pediatric urologic surgery is well tolerated by patients and overall advantageous when compared to other surgical methods. Likewise, a study published last year in the Journal of Gastric Cancer found that gastric surgery conducted with a robotic surgeon caused less blood loss and hemorrhaging as compared to the conventional procedure. With more studies on the way, and more development sure to come from companies like Intuitive Surgical, it seems a certainty that robotics will have an influence on the surgical industry for some time to come. Still, with the hefty financial hurdle and the ongoing question of how much good a machine like the da Vinci can actually achieve, it's unlikely that medical professionals need to worry just yet about losing their jobs to robots.

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