Scalpel, called Dr. Fox, focused and serene as he performed the operation. The surgery so far was going extremely well.
Thelma, a seasoned operating room nurse, reached for the tray and grabbed the requested item. She turned around, advancing briskly towards the doctor. But, before the scalpel could reach the doctor's hands, Thelma tripped over the extensive wiring near the operating room table. As she fell to the ground, she knocked over the tray, and it too loudly fell to the floor, its metallic contents splattering noisily.
The sudden commotion panicked Dr. Fox, whose usually steady hand trembled, opening the patient's wound up. The patient was now losing blood fast, Thelma was on the floor in pain and Dr. Fox was sweating profusely. The rest of the medical team quickly sprang into action to remedy the situation.
Observing through the glass surrounding the operating room, a medical student could not help but envision a perfect scenario in which none of this would have happened a scenario where robots ran the show.
Imagine an operating room filled with the beeping and whizzing sounds of robots performing various roles with minimal direct human intervention. What would be the task-division of such robots and are companies already taking steps to realize such a goal?
The first task that comes to mind is patient diagnosis based on a series of inputs gathered intelligently by a robotic system. The advantages of such a system would be many, including a robot that is incapable of forgetting signs and symptoms, a robot that is able to keep up-to-date on very recent advancements in medicine and a robot with the ability to collect and analyze patient records rapidly. An example of the development of such (albeit nascent) technology is IBM's Watson, which is a collection of 90 IBM servers that the Memorial Sloan-Kettering Cancer Center in New York put at the disposal of a team of physicians for training to help deliver individualized cancer diagnostics in 2012. Although such training may take more years until a usable system is put in place, the promise is tantalizing and worth following. For more information, check out IBM's 2013 press release
on the matter.
Second, enter robonurse. Despite the hype with surgical robotics (discussed more thoroughly below), physicians are not likely to be replaced any time soon. But, there is a potential for robots that have increased dexterity, speed and precision that could assist in avoiding operating room mishaps. In fact, there was a system made by Robotic Systems and Technologies Inc (previously Robotic Surgical Tech) called the Penelope Surgical Instrument Server. This system was able to count surgical instruments, pack and unpack them and hand them to the surgeon. Although this system did not gain much traction, it did offer a glimpse at a possible role for robots in the less technical aspects of medicine, which brings us to another role already being fulfilled by robots: sterilization.
Robotic Systems and Technologies Inc decided that Penelope is more suited for a behind-the-scenes role. The Penelope CS is able to clean, inspect and perform quantitative counts of hospital equipment before packing them for OR use. This kind of technology might reduce costs for hospitals and allow them to invest more heavily in the highly innovative field of cameras and high tech devices. This in turn might translate positively to the overall patient experience.
Finally, we get to the actual surgical robots. Intuitive Surgical, the famed da Vinci systems manufacturer, was recently in the news for all the wrong reasons. Most notable of these was the 6% decline in their system sales for Q2 2013. A number of reasons come to mind here, which are important to consider when thinking about whether this technology, and other kinds of medical robotics, are actually a realizable dream. First, there have recently been some high profile expressions of doubt within the medical community over the marketed procedural advantages and cost-effectiveness of these robots. One very notable example to highlight this was a statement
written and published online by the President of the American Congress of Obstetrics and Gynecology (ACOG) and released in March, 2013. Another reason was likely to be the continued decline in prostatectomy procedures. In their 2012 report
, Intuitive Surgical already outlined that they witnessed a procedural decline of 15% in 2012 for these procedures, which is significant because these kinds of procedures form 24% of those using robotics. All of that was probably exacerbated by negative press for the company overall, both in terms of the lack of regulated training
programs for robotic use and the lawsuits being filed for surgical mistakes/deaths.
But is this the end of robots? Certainly not! Even more than diagnostic robots, robonurses or sterilizer robots, there is still a lot of space for procedure-type branching, especially in general surgical procedures, cardiothoracic surgeries and head and neck procedures. There is also a lot of space for technological innovation in this field, especially when it comes to accessories. For example, the Firefly Fluorescence Imaging System, FDA approved in 2011, allows physicians to better visualize critical anatomy during surgery. And most importantly, Intuitive Surgical is not likely to remain the only competitor over time. Already, companies are establishing niches for robotic surgery in other surgical procedures. For example, a UK company called Stanmore Implants has recently received 510(K) FDA approval (2013) for its Sculptor Robotic Guidance Arm (Sculptor RGATM) which is to be used for unicompartmental knee surgery. All of this is bound to keep interest going as the company deals with its 2013 hiccup.
At the end of the day, robots have a huge potential for revolutionizing the way medicine is practiced. Such potential is not a far-off reality and is already starting to have ramifications worldwide, with over 450,000
surgeries being performed robotically. One note of caution should be said, however: robots are not likely to replace the surgeons as rapidly as they might in other less critical aspects of medical practice (for sterilization for example). Despite Will Smith's best efforts to demonize the poor things, they're likely to be complementary to the betterment of medical practice.