Who Wins Your Preference: A Robot or Surgeon?

Place yourself in the shoes of a patient about to undergo hip replacement.

Medical personnel usher you into a room and solace your nerves with masked smiles. A buzz of energy surrounds you, but you feel lost in the haze of chaos. Your thoughts are nested in your life after surgery; more specifically, your ability to walk in comfort granted the procedure's success. Concerns from all pockets of life appear to be tangent to this present moment. And while these thoughts swarm in your head, the words coming from the doctor, now bent over you with wary eyes, are unintelligible. They won't string together. All you want, you tell yourself, is an everyday life after surgery.

Now, sitting comfortably in your chair, imagine how much grief a patient would suffer atop their pre-surgery nerves if the hip replacement procedure went against clinical expectations. Whether a mishap occurred while cutting the femur, reaming the acetabulum, or placing the implant components, one human error could permanently detriment the patient's wellbeing.

To put into perspective, 0.35% of patients that undergo hip replacement surgery die within 90 days of their procedure. While the stated misfortune appears trivial because of its ramifications on a mere margin of patients, the statistic doesn't account for the many degrees between success and mortality.

Fortunately for emergency patients, such events are dwindling with the rise of surgical robotics.

Table of Contents

• Surgical Robotics
• Timeline of Robots Entering the Surgical Scene
• Case Study: da Vinci Surgical System
• Projections of the Future
• Robotics: The Bigger Picture
• Closing Thoughts

Surgical Robotics

Surgical robotics, emerging in the late 20th century into the early 21st century, has become a vibrant focus in the medical sector and significantly reduced medical errors. 94% of human mistakes are prevented — just in hip replacement surgeries — because of the adoption of robotics in the surgery room. On a larger scale, medical errors are the third leading cause of death in the United States. Many of these medical errors come from human mistakes. Robots represent a pressing solution and fundamental notion in advancing medical procedures while mitigating errors in the surgery room and ensuring larger margins of patient success. However far as surgical robotics has progressed, there's an expansive future awaiting much more.

Some procedures that robots have already become instrumental in aiding:

→ Robotic kidney surgery

→ Robotic prostate surgery

→ Robotic colorectal surgery

→ Robotic coronary artery bypass

→ Robot-assisted cancer surgery

→ Robotic cardiac surgery

→ Gallbladder removal

→ Hysterectomy

→ Kidney transplant

→ Kidney removal (total or partial)

→ Single-site robotic gallbladder surgery

→ Head-and-neck surgery

→ Joint replacement surgery

Timeline of Robots Entering the Surgical Scene

• The 1970s: NASA started to experiment with telesurgery as a potential aid for astronauts
• The 1980s: The first surgical robot, the PUMA 560, was introduced in a brain biopsy procedure to reduce movement from hand tremors
• The early 1990s: Integrated Surgical Solutions, Inc. and IBM developed ROBODOC to prepare the femur for hip replacement in human subjects
• The late 1990s: Three systems combining laparoscopic technology with surgical robots emerged: da Vinci Surgical System, the AESOP, and the Zeus surgical systems
• The 2000s: The Lindinburg surgery in 2001 proved to be a colossal telesurgery success; doctors performed a gallbladder surgery from NYC when the patient was in France
• The 2000s: The Zeus system also emerged around this time, owned by Computer Motion, and was purchased by Intuitive Surgical
• The 2010s: The da Vinci surgical system, since its creation, has quickly become a leading robotic surgery device; its popularity swelled after the Edward Hospital recorded the da Vinci system peeling a grape and published the video on the internet

The da Vinci system is still the most prominent surgical robot device today. Its latest iteration, the da Vinci Xi, was released in 2016.

Case Study: da Vinci Surgical System

The da Vinci surgical robot is a prime example of an optimal surgical robot with unmatched precision. The da Vinci surgical systems, coupled with surgeons across the globe, deliver the best surgical procedures possible. In a nutshell, the da Vinci surgical system allows surgeons to run operations on patients through the harmony of various components that have ideal latency time (i.e., the time it takes the robot to mimic the surgeon's behavior) and superior precision. For this overview, I will break down a few components to give a comprehensive run-through of the functions of modern surgical robots.

The three components that enable the effectiveness of the da Vinci robot include the patient cart, surgeon console, and vision cart:

1. Patient Cart

• The patient cart is where the patient is positioned and is thus the point of interaction with the patient. The cart comprises three or four robotic arms that pivot around a fixed point and carry out the surgeon's exact commands. Safety checks ensure no unwarranted movement of the robotic arms without the surgeon's consent.

Patient Cart

2. Surgeon Console

• The surgeon console is analogous to a control center– i.e., where the surgeon operates on the patient while comfortably seated at a distance. From the console, the surgeon is allowed a 3D view inside the patient's body and has master controls positioned under the display where the surgeon's hand, wrist, and finger movements translate into real-time actions of surgical instruments.

Surgeon Console

3. Vision Cart

• The vision cart harmonizes all da Vinci components on a single interface, allowing the operating room (OR) to view the procedure in real time with a single HD display that serves as the integration hub for power generation, image processing, and information systems. In addition, this system brings true-to-life pictures of a patient's anatomy on-screen through a high-definition, 3D endoscope.

Vision Cart

These components, though comprehensive, are far from the extensive catalog of instruments, software, and sensors that allow the da Vinci surgical system to carry out dextrous motions beyond the limits of humans. Nonetheless, they serve as inspiration for the endless capabilities of the partnership between robots and humans in the OR.

Projections of the Future

The market for surgical robots was $4.4 billion in 2020 and is projected to reach a whopping $14.4 billion by 2026 due to increased demand, funding, and research. However, the future of the field is an exciting and suspenseful venture that has yet to peak. While precision, control, and flexibility remain at the epicenter of surgical robotics, less invasive surgical robots, telesurgery, and intelligent robots can continue transforming the landscape and how we perceive surgery.

Robotics: The Bigger Picture

In light of surgery, robotics has many applications that compound and best human abilities. However, robots' competencies travel beyond medicine. Robots have become crucial allies across synthetic biology (Trilo Bio), self-driving (Cruise), warehouse automation (Amazon), and even lavish sectors (Cafe X).

Insight into Amazon's "robot-run" warehouse

Suppose the implied meaning wasn't illustrious enough. In that case, the accepted definition of robotics is "an autonomous machine capable of sensing its environment, carrying out computations to make decisions, and performing actions in the real world." Some have two legs, while some have none. Some are intelligent, while others are completely automated. Robotics is a field stretched far and wide with little variations but an application for every industrial sector. For example, surgical robots mostly emulate human behavior and act as extensions of human limbs, but with better precision and sensors, components, and instruments to guide their movement. Consequently, while not the most intelligent on their own, systems like the da Vinci robot have shaped thousands of lives and achieved remarkable milestones in robotics.

Closing Thoughts

While surgical robotics today has advanced beyond the sci-fi movies of the past, I'm sure that robots in ORs will become increasingly intelligent and better equipped for diagnosing and treating patients without an in-house surgeon.

I must express that the breadth of the robotics sector is too expansive to suggest in scope so limited as this article. Nevertheless, I encourage you to explore robotics' application to your discipline.

Want to explore the same rabbit holes?

• Robohub podcast (https://robohub.org/podcast/)
• The Robot Report podcast (https://www.therobotreport.com/category/podcast/)
• Stanford Robotics Lab: https://cs.stanford.edu/group/manips/#
• MIT Robotics Lab: https://robotics.mit.edu/
• Breakdown of Robot Operating System: https://admantium.medium.com/robot-operating-system-introduction-e1b97d387982