Why you want the Terminator to be your next surgeon

Introduction to autonomous robotic surgery

Significant advancements in Artificial intelligence have had an enormous impact on our lives in every aspect. Health and medical procedures are no exception. While it hopefully won’t be needed, you or someone close to you might require surgery at some point in the future. Soon a robot might play a significant role. Not only as an exact tool for the surgeon, but at least in parts as the surgeon itself. Looking back at the history of medicine, robotic surgery will be the next revolution. Many surgical procedures are done with the assistance of AI. The rate of adoption is growing very fast in this critical highly salient area as it directly relates to human lives. Sooner rather than later, robots will help make surgeries less invasive, quicker in recovery and execution, less prone to errors, and likely more affordable. Though valid concerns exist, robots in medicine and surgery are beneficial.

A brief history of surgery

Surgery has a long history. There is evidence of trepanation in 6500 BCE using the most simple tools. From there, development took a while to modern scientific surgery and the emergence of antiseptic surgery and X-rays in the 19th century. All indeed revolutions and can be counted towards humanity’s achievements. Laparoscopic surgery is what leads us to where robotic surgery is today. Here, instead of giving full access by creating a large incision as in open surgery, operations are performed through a small incision through which instruments are inserted. Laparoscopic surgery is, therefore, associated with reduced pain, faster recovery and shorter hospital stay. The ability to use sophisticated instruments and cameras makes the laparoscopic approach the standard for surgical procedures. Operations performed in this manner are referred to as minimally invasive. Laparoscopic techniques have evolved, making it possible to perform more advanced surgical procedures with the same minimally invasive approach. The development of endoscopic techniques and the introduction of robotics were the key developments in the evolution of laparoscopic surgery. Recovery times and stress on the patient during surgery drastically decrease, making this a highly valuable technique in modern surgery. This technique was popularised in the ’80s, at the same time, robotic-assisted surgery emerged and is now firmly established in many routine procedures.  

Robots in medicine

According to new research from the University of California, Berkeley team, an automated robot performing the test can match or exceed a human’s skill, precision, and speed. The project is a part of a much broader effort to bring AI into the operating room. Researchers are also working on automating surgical robots by using many of the same technologies used in self-driving cars. Although these methods still have a long path from everyday use in OR, further developments are accelerating.

Intuitive is an AI technology leader in minimally invasive care and the pioneer of robotic-assisted surgery. Their work is based on minimally invasive life-enhancing care through ingenuity and intelligent technology. Their pioneer product, the Da Vinci, is designed to help surgeons perform minimally invasive surgery. It offers surgeons different facilities such as 3D vision, a magnified view, and robotic assistance. They use specialized instrumentation to help the operator precisely cut through and reconstruct inside the body.

Approved by the FDA in 2000, there are more than 6,500 da Vinci surgical systems installed in 67 countries, and more than 55,000 surgeons worldwide have trained on the use of da Vinci systems. Furthermore, there are nearly 70 representative clinical uses for da Vinci systems, spanning different clinical specialties, including urology, gynecology, thoracic surgery, general surgery, and transoral surgery.

Researchers at Boston Children’s Hospital in Massachusetts have shown how AI can better navigate a leaking heart valve than human surgeons with years of experience and training. The procedure is done so that the assembly is inserted into the base of the heart. From there, it propels itself using a motorized drive system along the pulsating ventricular wall to a damaged valve near the top of the ventricle, guided by vision and touch sensors. The robot wedges itself into position near the leaking valve. A surgeon then launches an occluder from the robot that plugs the leak. This operation was done on a pig and has not yet been into the human phase. The researchers claim that it’ll be years before their robot masterminds valve repairs in humans heart. But its abilities hint at the dawning of a new era of surgery. Intelligent surgical robots with varying degrees of autonomy are proving in early tests to be the equals of surgeons at some technical tasks.

Research shows that robotic surgery has grown significantly from 2012 to 2018. However, it expanded across all procedures, for certain operations, such as inguinal hernia repair, practice patterns increased by order of magnitude toward greater use of robotics. Moreover, the use of robotic surgery diffused widely across numerous procedures in the years after hospitals began performing robotic surgery due to more trust in this surgery method. This trend was associated with a decrease in the use of open and laparoscopic minimally invasive procedures, which was already considered a safe and effective approach when clinically feasible for most surgeons.

Aside from robotics, more rising technologies such as machine learning, deep learning, and natural language processing can vastly improve surgical decision-making before and after surgical operation by analysing the substantial wealth of existing information. Machine learning and its derivatives have enormous potential to enhance human surgeons’ decision-making and also to help train robotic surgeons with data to perform surgery.

The Concerns

While most operations are completed using just the robot, surgeons switch to manual open surgery as soon as serious complications arise. The same holds for laparoscopic surgery which accounts for over 50% of all operations, while robot-assisted surgery is used in over 15% of cases in the US. These procedures are most comparable among current techniques, and the use of robots resulted in one percent less serious complications for the same process in a meta-study of randomized trials. Another study focused on complex minimally invasive surgeries found that while robotic-assisted surgery was on average longer in duration, recovery times and time in the hospital were significantly reduced over laparoscopic surgery. While this does not constitute a clear advantage, the use of robots seems to improve safety.

Human surgical performance is defined by physical, mental, and situation variables, making surgical performance consistency challenging to obtain in terms of functional outcomes, complication rates, and survival observed across institutions and geographies. Surgical robots have certain advantages over humans, such as insusceptibility to fatigue and more significant range movement, which have been shown to produce enhanced performance and less need for large cuts for specific procedures. The combination of AI algorithms, training with large data sets, and sophisticated surgical robots enhance surgeries by reducing technical errors and operation time, easing the access to hard-to-reach body parts by mitigating or even eliminating the chance of human error. Altogether, this makes robotic surgery a very safe procedure that can substitute human surgeons.

Supervised Robotic Surgery

Maria Fiazza, writing her Ph.D. thesis on safety in autonomous surgical robots, suggests a three-pronged approach in an interview on the topic: Robots are carefully designed and extensively tested. Secondly, whenever these robots are deployed there is still a human supervising the robot’s actions ready to intervene. Lastly, there is an alternative plan to safely complete or end the surgery as trained professionals are nearby.

As the technology grows and more automation becomes feasible, more questions are being asked about how the human surgeon’s role would change if autonomous robots take over most of the tasks in the OR. Most in the field still see a place for surgeons and most surgeons appreciate the robot as a tool. There would always be a human surgeon and expert present and supervising the surgery. Robots that can act autonomously might be able to compensate for delays during remote surgery and reduce fatigue by largely automating simple tasks. Already modern medicine without the use of robots is unthinkable. An optometrist’s office is filled with robots aiding and improving various tasks.

Even if a technology is proven safe, it must significantly improve over current methods. Cost is one of the main factors in determining this Technology as a viable alternative. When used enough and for the right operations robotic surgery can be the most cost effective option. While currently, robotic surgery remains the most expensive choice, it is still profitable and frequently results in the reduced hospital stay. Widespread adoption is thus continuous.

The future

While teleoperated systems are bought in more and more hospitals, supervised autonomous robots are being developed, for example, the ARS project, and prepared for widespread adoption. This next stage of robotics in surgery is meant to assist a surgeon more actively. As surgeries can easily take more than four hours a robot that can execute simple tasks autonomously and detect abnormalities would give valuable rest-time to the operator.

Initially, surgical robots were designed for remote operations such as a highly-skilled neurologist operating in a war-zone while being in New York or Astronauts needing urgent surgery. Currently, AI is being developed to assess and understand a medical situation and incorporate medical literature as the situation requires. Further robotic surgery simply allows for more fine tuned movement, getting into deep areas of the lung without ever making an incision is something not thinkable otherwise. While a surgeon can examine a tumour and decide what to remove, the robot keeps the the camera stable and dynamically moves a thin needle through the tissue with movements too fine to be controlled by a human.

In the future, AI is likely to continue to play a key role in the assessment of injuries. This will likely involve the use of the patient’s own health data and electronic health records. AI will also be able to work alongside humans to assist with complex medical situations. As AI becomes more intelligent, it will be able to perform many of the routine and simple tasks that we humans currently do often using autonomous robots.

Further, nanorobots may be used to conduct surgery from within the body or to act as remotely controlled microscopic vehicles for drug delivery and other purposes. One day there might be an army of nano robots aiding our immune system and detecting cancer in its earliest stages. As we consider the possibilities, we must recognise that the potential for new technologies is vast. A robot might help diagnose you as you enter the hospital and be send bak with you for care and help in rehabilitation.

Scientists and doctors hope that autonomous surgery will make specialized surgical procedures available to more and more people in the future. The distribution of surgeons’ availability to patients worldwide is not uniform. There are multitudes of people around the world that don’t have access to professional surgical care. Autonomous-robots assistance can help surgical expertise more evenly.

At the forefront of what’s possible today is STAR the smart tissue autonomous robot. This device recently was able to reconnect two ends of the intestine with minimal human intervention, a task certainly impressive to any surgeon. While robots have been known to execute planned motions with superhuman accuracy in solid materials, the soft and varied tissue of the body requires adaptation and a degree of understanding the situation.

While Technology and methods take time to adapt, robots in surgery are the next revolution in this field. Medical interventions leave you vulnerable and require trust and due diligence. A future in which robots perform surgery on you is a good one and not an emotionless dystopia. For robots to autonomously operate on humans a shift in public perception will have to occur. As robotic assistance in the operating room become more the norm than exception the wave is paved for even deeper involvement in surgery. While AI and robotics show great promise in surgical applications it will not be suitable for every operation and not replace consultation and comfort provided by a human physician.

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