Is this the end of the surgeon as we know it?

In recent times there has certainly been a buzz around the emergence of robotic surgery. However, many people don’t realise how long robotics have been around, for they are nothing new; the most famous surgical robot, the Da Vinci robot, was FDA approved over 15 years ago. The machine was developed to enhance conventional laparoscopic surgery, which usually involves the surgeons utilising long instruments lacking the manoeuvrability of a human hand; in fact with its 7 arms and numerous joints, it has a greater degree of mobility than a surgeon’s hands. This allows for minimally invasive procedures, such as prostatectomies and  hysterectomies, to be performed with precision. Despite this, by the end of 2015, there were still only 52 of these robots in the UK. In contrast, the uptake in America has been much better,  where nearly 180,000 procedures were Da Vinci assisted in the first quarter of 2015.These machines have resulted in robot-assisted surgeries becoming more common. In the future as this technology develops and evolves, it may eventually become the mainstay option.

Last month a paper published by Dr. Peter Kim and his team, from Children’s National Health System in Washington DC, described the revolutionary use of an autonomous robot for surgery. Why revolutionary? Well, almost all robots used prior to this were controlled by the surgeon, including the Da Vinci; where the surgeon sat on a console to control the robot’s arms. Therefore robotic techniques were hugely reliant on a surgeon’s dexterity, even though they offered improved manoeuvrability. The autonomous robot, as the name suggests; can function on its own, make decisions on its own, adjust to a new situation on its own. During the study, the machine was supervised so mistakes could be corrected but at a nearly 60% error-free rate, the surgeon was only needed to make the rare adjustment. The hope is that the machine will only get better at the job; and since the study was published the robot has operated completely unaided.

For the study the robot operated on an exposed pig intestine both within and outside of the body, to anastomose the soft tissues. The robot visualises specific operating sites using near-infrared fluorescent technology. Following the robot analyses its route using 3D quantitative plenoptic imaging and its decisions rely on an autonomous algorithm. Dr. Kim’s team tested the robots against a group of expert surgeons comparing a range of factors including; suture spacing, the leak pressure, number of mistakes, lumen reduction and completion time. For most of these variables, the robot performed better than humans and there were no further complications, but it did take a significantly longer time. However, just as the operability of the robots improved to carry out the procedures unaided, time taken also reduced. In the 4 test runs carried out, the completion time decreased dramatically from 57 mins to 35 mins. Thus, it won’t take long for the robot to match the human time of 8 mins.

While this may be the future of surgery, is it the future we want?

Can we really trust robots to carry out the intricate procedures which can take expert surgeons many hours to complete, and that too, only after years and years of practice? The medical profession is built on a foundation which fosters patient confidence and many doctors take pride in this. Ultimately the public has the final say so until these robots can make a patient feel safe, reassured and confident in its hands, machines will not be operating autonomously at a hospital near you, anytime soon. But rather these studies should be taken as learning opportunities so that we can identify points to incorporate into current practice to improve patient safety.

By Pranay Balijepalli

Reference:

Supervised autonomous robotic soft tissue surgery

Azad Shademan, Ryan S. Decker, Justin D. Opfermann, Simon Leonard, Axel Krieger and

Peter C. W. Kim (May 4, 2016) Science Translational Medicine 8 (337), 337ra64. [doi:10.1126/scitranslmed.aad9398]