If you’ve ever seen Ridley Scott’s Prometheus, you’ll likely remember the scene where the main character has surgery performed on her by an automated robot. We’re not there – yet. For right now, researchers at Penn State and other medical universities are training the next generation of surgeons to perform robotic-assisted surgery with the new da Vinci laparoscopic system.
An important distinction is that, at this point, surgery is assisted by robots – never directed. While some companies are developing robotic systems that can perform surgery with little to no assistance, the technology isn’t presently in use. It’s not just enough to say, “this is the future – we need more robots.”
There are serious considerations made by both surgeons, healthcare facilities, insurers and even the FDA itself before a second set of robotic arms can go into the OR. Below are three of those considerations:
1. Cost Savings
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Hospitals and medical centers that routinely perform surgeries have very high costs. Surgeries can typically last four or more hours of continuous work. There are a lot of
Hospitals and medical centers that routinely perform surgeries have very high costs. Surgeries can typically last four or more hours of continuous work. There are a lot of people that need to be in a traditional operating room to ensure that the operation goes smoothly. All of these things have costs associated with them. If one surgeon is able to perform with minimal staff and do the same – if not better – work, that’s a cost-added feature for the medical center.
2.Everybody’s hands shake at least a little.
And when someone is making an incision that’s measured in millimeters, there is a lot of emphasis put on manual dexterity. For systems like the da Vinci Surgical System, the motor controls already compensate for the natural shakiness of a surgeon’s hands. This means that the surgeon can instead focus on suturing up a duodenum instead of wondering if that second shot of espresso was a bad idea.
3. Robots Don’t Sleep
Unlike humans, robots don’t need sleep. That means that after one surgery has taken place, the room can be reset and a new surgeon can come in and operate that same machine. This has the added benefit of a quicker turnaround for surgery and frees up more surgeons to rest. A well-rested surgeon is the best surgeon.
What makes robotic-assisted surgery unique is it is a minimally invasive surgical option. Instruments and cameras are slid in by small incisions very similar to current endoscopy practices. The biggest difference is that the surgeon isn’t standing over the patient – he or she is sitting at a nearby console. At his computer station, the surgeon directs the tiniest movements of the robot’s arms. The arms are equipped with various tools and equipment for whatever procedure the surgeon is doing. For those wary about seeing a new machine in the OR – it’s actually nothing new. The Puma 560 – used for taking out small pieces of a brain for biopsy – was first employed in 1985 with great results. The reason it was so successful was partially due to the steadiness of a machine. It’s able to work in scales (think micrometers) that are nearly impossible for humans. For laparoscopy – this is exactly what’s required.
Overview of Robot-Assisted Surgery
Right now, most robotic-assisted surgeries performed in the United States are laparoscopic in scope. That means for any operation where a long, thin filament can be inserted to probe or address an internal problem – there’s a good chance robots are important tools in the OR.
The basic process for a Da Vinci robotic surgical operation:
• Usually the surgeon personally makes the first incision to get the operation started. For the Da Vinci and other automated systems coming out, that step isn’t necessary.
• He (or she) inserts a 3-D camera to feed live images and video back to his station.
• At the console, he directs the robotic arms through very finely tuned actuated controls.
• Surgical nurses or assistants can switch out tools as necessary while the surgeon maintains his concentration on the patient.
Special Risks with Robotic Assisted Laparoscopic Surgery?
The biggest risk associated with this type of surgery has statistically been operator error. That means a surgeon or technicians who may not have been familiar with the machine may have directed it erroneously. Surgeon assisting robotic systems typically cost millions of dollars to procure and hundreds of thousands of dollars a year to maintain. As technology is constantly improving and being finely tuned, this means there may be robotic surgical systems who either missed a service update or need a firmware upgrade.
And because the technology is changing so rapidly, there’s a real risk of the surgeon being trained on one particular style of system and then having to rapidly learn another when he gets to his core practice site. In conclusion, as the technology for robotically-assisted laparoscopic surgery becomes more affordable and standardized, expect to see a rapid increase in its usage in the operating room. The good news? This cost savings will likely trickle down to the consumer – meaning more affordable surgery done at a fraction of the risk.
