• 02
  • Sep

Rise of the Machines?

A certain pharmaceutical giant had been trying – operative word, trying – to sell a robot that can put patients to sleep for simple procedures like colonoscopies. Who did not like this? Human anaesthesiologists, ofcourse, whose jobs would be on the line. Professional groups lobbied hard against the device, questioning its safety. Even after the food and Drug Administration approved the device, hospitals were wary. Soon, the aforementioned giant quietly stopped selling its anaesthesiology robot.

However, the robots are coming – they’re just not coming for any doctors’ jobs yet. To get hospitals to trust robots, their makers have realized, you can’t make doctors obsolete – you have to make them feel like Iron Man. Hence the popularity of Intuitive Surgical’s da Vinci system for minimally invasive surgery, whose insect- like arms are operated by a surgeon sitting at a control booth.

Another tack is automating repetitive tasks that can stretch surgeries into 16 - hour marathons. A new device, unveiled by surgeons and engineers at Children’s National Medical Center and Johns Hopkins, could automate surgical tasks on floppy soft tissue. In a proof of concept, the team had the machine suture together two ends of a pig’s bowel. The Smart Tissue Autonomous Robot (STAR) could sew more evenly and consis- tently than even an experienced surgeon.

However, STAR was still  dependent on a surgeon to make the initial incision, take out  the bowel, and line up the pieces before it fired up its autonomous suturing algorithm, similar to the cruise control function on cars. STAR has also been programmed to do other things like cut and cauterize, and soon enough will be doing an entire surgery under supervision. Unlike Google’s autonomous car, which doesn’t even have a steering wheel, nobody is talking about a surgery robot without human supervision.

If the technology behind STAR is going to make it into the hospital any time soon, it’ll probably be integrated into an existing platform, for example, adding automated tasks to something like da Vinci, where the doctor still has final control. It makes sense, because the real advance behind STAR is software, not hardware. What makes STAR unique is its ability to “see” Inside the 3-D folds of soft tissue by using a 3-D lightfield camera – similar in concept to Lytro’s camera- that looks for fluorescent biomarkers injected inside the tissue.

Technical capability isn’t the only barrier to acceptance among surgeons. Mazor Robotics makes a robotic system that identifies where surgeons should insert bone screws into the spine. Their machine could have easily done the drilling too, but Mazor found that surgeons preferred to give the go ahead and hold the drill themselves.

It’s the same with cars. No one is trying to sell you a fully autonomous car yet. But the cars we do drive are already becoming increasingly automated, first with cruise control and now with lane change and parking assist. You’ll be lulled into trusting the robot driver and robot surgeon and the lulling will be slow and incremental.

Bottom line is, the role of robotics in surgery is and always will be to add value to the quality of surgery. Nobody, or shall I say nothing, is going to swoop in and push the surgeon out of the scene anytime in the foreseeable future.