Robotic Surgeons Coming to Hospitals Near You—Pros & Cons

Introduction

While new technology is generally a good thing, we sometimes forget that with the benefits derived therefrom may also come challenges, risks and potentially harmful repercussions.  For every new form of technology, therefore, it’s important that we conduct carefully-coordinated risks and benefits analyses.  

This is especially true for new devices for the healthcare arena. 

One such device is something called a “surgical robot”--that is, an electro-mechanical apparatus that can help surgeons do their jobs in a myriad of interesting, but potentially challenging ways.  Although this technology is in its infancy stage, it is already being used.  

More importantly, it’s a technology that will soon be deployed (if not already) at hospitals near you.  As a matter of fact, these robots are being used in the UK (e.g., the da Vinci line of surgical robots), although the overall technology has a long way to go.

Already credited with bringing simplification and workload reduction to the surgery theatre, these machines are eventually expected to also help reduce mistakes, reduce the time required for each procedure, and do more than merely support but, rather, greatly enhance a surgeon’s motor skills. 

At any rate, that’s what innovative British companies like CMR Surgical (the makers of the newer, more advanced Versius line) predict or would like to see.

The Benefits & Advantages Of Using Robot Surgeons

--THESE DEVICES WILL OR CAN allow surgeons to operate on patients remotely, even from locations that may be very far away.  

The potential sub-benefits of this “benefit” are numerous, multi-faceted and rather comprehensive.  For example, this can reduce fatigue and costs associated with surgeons having to travel from destination to destination.  

--As they are improved over time, provide spot-checking and monitoring tools for surgeons, in essence helping surgeons make fewer mistakes

Let’s say, for example, that a surgeon makes ready to cut a particular section of the patient’s body, the robotic system, if it determines that the surgeon is about to cut into a non-specified section, can sound an alarm or give the surgeon reason to double-check the targeted tissue/organ to be cut.

 --Make it possible for surgeons to perform more surgeries per day, if only by introducing more efficiency into the system.

--Lower, in the long-run, operating and functional costs, thus helping to reduce over-all healthcare costs.  

--Reduce over-all surgeon fatigue.

--Make it possible for low-income patients in urban areas to possibly receive services from surgeons stationed in hospitals catering mostly (if not exclusively) to high-end, wealthy patients.

--Make it possible for surgeons in developed countries to operate on patients in developing nations hundreds of miles away on a reduced-charge or humanitarian basis

--Allow surgeons, without fear for their lives, to perform procedures on patients located in war or civil unrest-torn locations.

--Make it possible for military surgeons to treat soldiers in the field during military conflicts, if robotic surgeons can somehow be parachuted or, using some other means, transported into or near the battlefield. 

--As they are improved over time through AI and other forms of technology, eventually function independently or autonomously.   

The avenues of benefits that would become available through such a development can literally be said to be “mind-boggling!”  Robots that can perform on their own without human control isn’t merely a Sci-Fi pipe dream—it’s something that will eventually be possible. 

--Help reduce the extensive stress that is often placed on many surgeons because of long work schedules, the almost unavoidable fear of being sued (when things go wrong), and the impetus to always perform flawlessly.  

--These devices can help extend the career spans of most surgeons.

--These devices may allow doctors with certain physical disabilities and shortcominsg to perform (or continue to perform, if the disability is maybe the result of a tragic accident or mishap) surgery.  

A good example would be a surgeon that lost his/her ability to stand and move about with ease.  Surgeons that have lost use of their legs (but have retained use of their hands) would be able (in theory) to continue to function in their profession. 

Even loss of hands may still allow a surgeon to keep practicing his/her craft once we develop the technology to control these robotic devices with eye movement, foot action, voice commands, etc. Actually, this technology already exists—it just has to be enhanced somewhat to meet the complicated, meticulous demands of medical surgery.

--May help expand programs (e.g., “Doctors without Borders”) that depend at least partly (if not exclusively) on physicians willing and able to donate some of their expertise in order to serve the indigent, uninsured and underinsured all over the world.  

--Make it easier and more convenient to teach surgery classes.  

Surgeons in big cities, for example, can demonstrate techniques to medical students living in small towns, rural communities and even the boondocks.     

--Ameliorate accessibility to minimally invasive techniques and procedures, which, in turn, reduces the trauma induced by operations, thus cutting recovery times significantly.

--Continuously inspire surgical robots that are more portable, less & less expensive, and much more versatile.

As these devices are improved over time, for example, they will become easier to move from room to room, hospital to hospital and even from one geographic location to another, regardless of the distance. As their cost is brought down, even poor countries may be able to afford them. 

The Risks & Caveats

--Such devices may complicate, if not negatively affect, personal injury and malpractice cases

Some attorneys may successfully argue, for example, that doctors operating on patients using these devices cannot be held to the same standards of liability and accountability that would be applied to surgeons merely using their own hands.  What if, it might be argued, these mechanical devices were the cause of any mistakes or mishaps?

Unless attorneys and experts on the other side of the case can successfully prove that the mechanical device was not to blame, this might throw enough “reasonable doubt” into a case as to basically auto-exonerate surgeons, even if they did indeed make a mistake or perpetrate an act of malfeasance (e.g., operating on someone that didn’t really need the operation in question for the sake of monetary gain).  

--What if the device begins to malfunction, possibly beyond the capacity of the supervising surgeon to stop or control?  

For obvious reasons, such impossible-to-always-prevent possibilities could have extensive and rather complicated ramifications both legally and medically. 

--Surgeons may be tempted to abuse these devices by attempting to cater to more patients than is medically safe or reasonable

--Surgeons would have to depend on the limited physical “view” or visual perspective provided by these devices.  

What if, to use just one simple, albeit imperfect, example of what could go wrong, the “view” (if using a monitor or cameras from another location) the device provides turns out to be the wrong patient—i.e., a patient that is also being operated on at the facility but not the one the surgeon intended to be operating on at this time?

Or what if the quality of the projected image is compromised by, say, a loss of power or imperfections in the optics or digital processing of the images being transmitted? 

--It’s possible that, once these devices are connected to online connections, someone may hack into the system and thereby possibly take over or sabotage a surgical procedure

This new type of crime might be labeled as “robotic surgery hacking.” Like other forms of cybercrimes, this possibility would be difficult (if at all possible) to safeguard against with 100% certainty.

--Yet another hair-raising, horrific possibility is that these devices could also, in time, be used for evil or unethical purposes, such as to sterilize people, implant things inside them (e.g., location-tracking chips), or force people to donate one of their organs against their will.  

--An even more horrific possibility worth considering is the fact that these devices may also be used to torture people, euthanize them (by the many powerful people that think that there are too many people on this planet), or to subject them to acts of medical/surgical forms of terrorism or unethical experimentation

In general, it may be easier, one may theorize, to be cruel using robotic arms than it would be to use your own two hands directly. 

--Some researchers attest that these devices, at least in their present limited-scope technological form/status, don’t significantly ameliorate medical outcome or cost concerns of standard surgical procedures. 

--These devices are, as most machines tend to be when they are first being manufactured and marketed, relatively expensive

 Conclusion

Although the technology that has produced these surgical robots has much to offer, it still has a long way to go, especially in terms of ever becoming autonomous medical devices.  Meanwhile, though, the technology appears to be good enough to pass the preliminary tests for effectiveness and efficiency. 

As proof of such is the fact that the da Vinci models (launched in the year 2000) have already been deployed in over 70 hospitals across the UK, with 2500 robotic units performing over 200,000 procedures per year.  Other, more advanced models are close on this line’s heels. 

Is this something for you to get excited (or at the very least open-minded) about? Let’s just say that the technology is simply too new and too untried in the global medical market to give it a complete seal of approval at this time. 

As has been demonstrated, there are many cons (only some of which were presented here) to consider and to pit against the many benefits.  

One thing you can be sure of is that this technology is here to stay.  Hopefully, it will be improved quickly and efficiently, to the point that it will become easier to endorse on a wide scale as time goes by.  

But like any other new technology, these devices come with potential problems that the average healthcare consumer can’t just ignore. 

What you need to hope for is that, by the time this technology reaches hospitals near you (which is only a matter of time), it will have been tried and improved to the point of making the cons almost negligible and the benefits, well, too promising and valuable to turn down. 

Copyright, 2018.  Fred Fletcher.  All rights reserved. 

References & Resources   

https://www.uclahealth.org/robotic-surgery/what-is-robotic-surgery

https://medlineplus.gov/ency/article/007339.htm

https://internetofbusiness.com/versius-robot-for-minimal-access-surgery/

https://gixtools.net/2018/09/health-tech-versius-the-robot-surgeon-arrives-in-the-nhs/

https://www.theguardian.com/society/2018/jul/04/robots-nhs-surgeons-keyhole-surgery-versius

https://www.telegraph.co.uk/business/2018/01/27/nhs-publishes-300m-contract-new-surgery-robots/

https://guttenberghospital.org/2016/11/robotic-surgery-arrives-in-guttenberg/

https://internetofbusiness.com/mako-robot-assisted-joint-replacement-orthopedics/

https://www.economist.com/science-and-technology/2017/11/16/new-surgical-robots-are-about-to-enter-the-operating-theatre

https://www.popularmechanics.com/science/health/a8798/the-robotic-doctor-is-in-15204883/

https://www.ecnmag.com/article/2015/08/complexities-designing-surgical-robots

https://www.unitypoint.org/cedarrapids/services-how-does-it-work.aspx

https://www.nsf.gov/news/special_reports/science_nation/surgicalrobotics.jsp

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356187/

10/12/2018 7:00:00 AM
Fred Fletcher
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Fred Fletcher is a hard working Consumer Advocacy Health Reporter. Education: HT-CNA; DT-ATA; MS/PhD Post-Graduate Certificates/Certifications: • Project Management • Food Safety • HIPAA Compliance • Bio-statistical Analysis & Reporting • Regulatory Medical Writing • Life Science Programs Theses & Dis...
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Comments
AI is coming & it's bringing both good & bad things. Soon you may be explaining your symptoms to an automaton of some kind next time you visit the ER. As usual Fred you're forcing people to think more deeply. Good job!
Posted by Dr. Dario Herrera
The scary part is when the autonomous surgical robots come out. Thanks to AI it's no longer farfetched. They already have cars that fit the "ticket." How long before the robots start slicing into us? And if you think that some surgeons are cold-hearted wait until the mechanical ones hit the ward. Of course it's poor folks, people in jail and the elderly that will probably be used as guinea pigs in perfecting their AI techniques but since most of these people will be anesthetized by maybe a robot Nurse Anesthetist at least they won't feel any pain. Does this mean I need to be looking for another job?
Posted by Susan Blakely

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