Robotic Surgery: The New
Future of Surgery?
1.
Executive
Summary
Considering the presently known advantages of robotic
surgery, it clearly has the potential to become a revolutionary technology
which will bring about further colossal changes in the way surgical procedures
are performed. This paper serves to evaluate the potential success of this
technology, by first examining the history and initial development of
robotically-assisted surgery, together with the major achievements and
breakthroughs it has since contributed to the area of surgery. Subsequently,
this paper delves into the current application and reception of the technology
in the medical field, as well as its present advantages and limitations. The
paper also addresses whether those limitations can be overcome. Finally, the various
possibilities that await the development of robotic surgery, and the resulting
changes to the surgical field will be touched upon and explained in the future
considerations section of the paper.
2.
Introduction
Technology has impacted the world in numerous ways,
with technological advancement and innovation playing major parts in
diversifying and improving human activities and capabilities, including the
medical field. Over the years, technological advancements have continuously
shaped and changed the variety of medicine and medical procedures performed.
Currently, one of the most innovative and potentially revolutionary technology raging
in the medical field is: Surgical Robots.
Robotic surgery is a type of surgical procedure where
robotic systems are employed to carry out surgical procedures (Mayo Clinic,
n.d.). Generally, in robotically-assisted surgeries, a surgeon conducts an
operation through a computer which controls the movements of multiple minute
surgical tools attached to a robot. This innovative surgical method was
initially developed and introduced with the aim of replacing minimally-invasive
surgery, or laparoscopy, by making up for the latter’s limitations, as well as
to enhance surgeons’ capabilities in cases of open surgery. (AAGL, 2013) As
such, there are presently 2 types of surgical situations where these robotic
systems are used: i) robotically-assisted minimally-invasive surgery and ii)
enhanced open surgery.
For that of a robotic minimally-invasive surgery,
robotic systems were incorporated with the purpose of overcoming the
limitations of the popular minimally-invasive surgery. Laparoscopy was first
introduced in 1987, and has steadily gained the favour of surgeons and patients
alike, by bringing advantages such as smaller incisions and wounds, lower risk
of infections, shorter recuperation and resource employment period (The University of Chicago Medical Center,
2013). However, its limitations has hindered its successful application
in more serious and complex surgical procedures. These limitations are mostly
centred on the dexterity and coordination of its technical and mechanical
nature, such as hand-eye coordination and restricted degrees of motion, thereby
limiting its adoption in delicate and complex procedures. Surgical robots were hence
developed to overcome these limitations, and extend the scope of application of
conventional laparoscopy. As for enhanced open-surgery, traditional steel
surgical instruments are replaced by autonomous robotic instruments capable of
performing several procedures and actions much smoother and better-controlled
than the human hand. This effectively decreases tissue trauma.
The several advantages of using robotic systems in
surgical processes are just a few of the numerous benefits of the technology.
These other benefits will be further elaborated in the later sections of the
paper, along with the present limitations of the technology. However, before
the paper explores those areas, it will first introduce the historical
developments and progress of the technology, and well as the achievements that
have since been realized. This will then be followed by the estimation of the
potential of the said technology.
2.1.Limitations
of Report
One of the limitations of the report would be the
absence of statistical evidence of the success and adoption of robotic surgery
throughout the world. Furthermore, were it not for length constraints, this
paper could have examined the historical origins of laparoscopic and its
development in order to better explain the inspiration for the idea of
incorporating robots into the surgical process. Similarly, the paper could have
perhaps delve into the multiple types of robotic surgical systems that were
developed over the years, together with their corresponding achievements, to date,
in greater detail.
3.
Historical
Perspective
The Information Age has brought about numerous
additions to the range of human activities and capabilities. Just like how
technology has revolutionised various fields such as manufacturing and
production, it has similarly made significant contributions to the area of
medicine. As mentioned previously, the limitations of laparoscopic surgery
spurred the research and development of a better technology, i.e. robotic
surgery. Seeing how robots have been successfully introduced and incorporated into
other areas, in manufacturing for example, innovators have since sought to do
the same for the medical field.
The year of 1985 saw the very first documented use of
robotics in surgery, when the PUMA 560 surgical arm, an originally standard
industrial robotic arm was modified and used by Kwoh et al. in a neurosurgical
biopsy with the aid of a computed tomography (CT). The PUMA robotic arm is
conjoined to a 1980 series controller which uses a programming language, VALII,
to translate simple commands into electrical signals that drives the robot
(Rutherford, 2012). The
robotic arm was adapted to hold a fixture beside the head of a patient so
drills and biopsy needles could be implanted with greater precision into the
desired location during brain biopsies (Albani, 2007). Despite the successful
preliminary results which showed that the robot could perform brain biopsies
with greater precision, the company selling the PUMA 560 protested the usage of
the robot for surgical purposes, stating that it unsafe as it was originally intended
to be within a barrier preventing any human contact. (Gupta)
Nevertheless, the encouraging 1985 surgery results
eventually led to the first robotically-assisted laparoscopic surgery in 1987.
The following year, in 1988, the PUMA 560 was again employed, this time by
Davies et al. for a prostate surgery. This consequently spurred the development
of the PROBOT, a robotic surgical system specifically designed for prostate
surgery purposes, in 1992 at the Imperial College London. The PROBOT was the
world’s first pure robotic surgery, but it failed to gain the approval of the
Food and Drug Administration (FDA). In the meantime, another robot, ROBODOC,
was in the midst of development, carried out by Integrated Surgical Supplies
Ltd. for the purpose of performing hip replacement surgeries with greater
precision. This time, the FDA finally approved of the ROBODOC, and it thus became
the first certified surgical robot. (Mishra, 2011)
Amidst the continuous research and development of robots
for surgical purposes, from the middle to the late 1980s, a party of the
National Air and Space Administration (NASA)-Ames Research Center researchers,
who were then researching on virtual reality, were keen on using the
information on robotic surgery to invent tele-presence surgery, or tele-surgery
(Lanfranco et al 2004). Tele-surgery allows a surgeon to perform surgery from a
location that is geographically removed from the actual surgical site, by
manipulating a robotic surgical system at the remote site (Sherk, n.d.). Spurred
by the massive potential of tele-surgery, a few of the scientists from the
NASA-Ames team joined forces with researchers from the Stanford Research
Instistute (SRI), along other experts in robotics and virtual reality, to continue
the development of surgical robots. The
US Army subsequently became interested in this development, as it presented the
possibility of conducting surgeries on wounded soldiers without having to take
the risk of transporting surgeons over to the war-site. With the financing from
the US Army, a robotic machine which enabled a soldier to undergo an operation,
remotely performed by a doctor at a nearby Mobile Advanced Surgical Hospital
(MASH), was successfully developed. This system was expected to help decrease
the likelihood of wounded soldiers dying from blood loss before reaching the
hospital. (Lanfranco et al 2004)
Several members of the team who developed the robotic
system for the US Army saw that the system possessed great potential commercial
value, and thus through forming several commercial ventures, they pioneered the
introduction of robotics to the civilian medical society. Over time, the
numerous research and development carried out on the area of robotic surgery
led to 3 noteworthy inventions, namely, the AESOP, the Zeus system, as well as
the Da Vinci surgical system. The AESOP, or the Automated Endoscopic System for
Optimal, is a voice-commanded robotic arm that manipulates an endoscopic camera
that was developed by Computer Motion Inc. The Da Vinci and Zeus surgical
system, developed by Intuitive Surgical, Inc. and Computer Motion, Inc.
respectively, have similar capabilities whereby both are master-slave machine, i.e.
not a pure robot with incorporated intelligence, consisting of multiple robotic
arms that are manipulated from a removed computer-enhanced console consisting
of video-assisted visualization.
Out of the three, the Da Vinci surgical system is the
more frequently utilised to date, as it was officially approved by the FDA for
use in most types of laparoscopic surgery in July 2000 (Mishra, 2011). Examples
of its applications will be covered under the following section. The Da Vinci
system comprises of 4 interactive robotic arms, 3 for surgical tools and 1 for an
endoscopic camera, manipulated by the surgeon through a single master console. It
is presently the only commercially available robotic surgical system that gives
a surgeon the dexterity, control, and precision of conventional open surgery
while merely needing 1-2cm incisions. (Intuitive Surgical, 2013)
4.
Current
Situation
As seen from the previous section, these past few
decades have seen advancements in robotic surgery that has led to countless
breakthroughs and advancements in the surgical field. Likewise, the usage of
robotic surgery has also been steadily increasing vis-à-vis the development of
the procedure. The popularity and receptivity of this technology, among
surgeons and patients alike, has rapidly escalated over the years, especially
in the US. More and more surgeons recommend the use of robotic surgery to
patients due to the advantages over traditional procedures, and patients
themselves, too, often enquire and request for this option whenever possible. In
the US alone, the total number of robotically-assisted operation shot up from
80,000 in 2008 to 205,000 in 2010. (Lipschitz, 2010) Some of the surgeries
which employs robotic systems will explained in detail in the subsection
below.
4.1.Applications
of Robotic Surgery
Initially, robotic surgery was more commonly used for
the removal of gall bladders, but today, robots are employed in a variety of
operations, namely:
4.1.1. General
Surgery
The Da Vinci surgical robot has been employed in
several common general operations, such as in esophageal and pancreatic
surgery, and even in liver transplants. This robotically-assisted procedure
provides the advantages of laparoscopic surgery, for example decreased pain and
scarring, as well as make up for its limitations.
4.1.2. Cardiovascular
surgery
Figure 1: Full Da Vinci S surgical system. Reproduced from Intuitive
Surgical. (n.d.)
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At present, robotic surgery is frequently applied to these 3 types of
heart surgery: Coronary artery bypass, atrial septal defect repair, and Mitral
valve repair. An atrial septal defect repair is conducted to resolve a hole in
the middle of the 2 upper heart chambers, while a mitral valve repair involves
the restoration of the valve that serves to avert the backflow of blood into
the upper heart chambers in heart contractions. A coronary artery bypass is for
the removal of blockage in the coronary arteries.
4.1.3. Gastrointestinal
surgery
There are numerous types of gastrointestinal operations
where robotic systems are used, such as in gastric bypass surgeries, which
reduces the amount of food absorbed during the digestive process by stitching a
part of a patient’s stomach together to make it smaller. Robotic surgery is
also applied in operations for the treatment of gastroesophageal reflux (i.e.
acid reflux) and colon resection surgeries. The Da Vinci robot and ZEUS system
are typical used for these procedures, although the latter has been recently
phased out.
4.1.4. Gynaecology
One of the most common and rapidly growing application
of robotic surgery is in gyneocology, such as in gynecology and gynecologic
oncology. The Da Vinci surgical system is usually used for such surgeries. The
robotically-assisted procedure eliminates the need for large abdominal
incisions, and is applied to treat endometriosis, pelvic prolapse, abnormal
periods, fibroids, and even female cancers. Furthermore, gyneocologists are
able to use the system to perform hysterectomies, myomectomies, and lymph node
biopsies as well.
4.1.5. Neurosurgery
Several robotic systems for use in neurosurgery have
been developed and marketed in the past few years, beginning with the NeuroMate
in 1997, which has since been used in 8000 brain surgeries over the US, Europe,
and Japan, by 2009. Others include the Rosa, Renaissance, and NeuroArm, the
world’s 1st MRI-compatible robot to be commercialised
internationally.
4.1.6. Orthopaedics
The
Renaissance robot mentioned above is also employed in surgeries involving the
spine, such as spinal deformity corrections and fusion, in multiple countries. Other
orthopaedic operations with robotic assistance are hip and knee replacements,
as well as ligament reconstructions. The robotic surgical systems allow greater
precision in bone-cutting procedures for these surgeries.
4.1.7. Paediatrics
Surgical
robots have even been employed in various operations for children as well. The
Children’s Hospital in Boston was the 1st paediatric hospital to procure
a robotic surgical system back in 2001, and has since used the technology in
more operations compared to any other hospital in the world. The surgeons in
their Centre for Robotic Surgery possess high-level of expertise paediatric
robotic surgery, and even conduct trainings for surgeons from other countries
on the procedures.
4.1.8. Radiosurgery
Robotic
surgery has even been used in radiosurgery to treat cancers and tumours. One
example is the CyberKnife Robotic Radiosurgery System which enables the treatment
of tumours in any part of the body by sending numerous high-energy radiation
beams directly to the tumour (Accuray Incorporated,
n.d.). This robotic system allows the delivery of radiation beams
from multiple directions without having to move either the patient or the
radiation source, which is required in traditional procedures.
4.1.9. Urology
Urology
is another field in which robotically-assisted procedures have gained
popularity in usage, especially in the US. It is most commonly used in prostate
cancer operations, due to the difficult anatomical access in traditional open-surgery
methods. Robotic systems are used in kidney cancer and bladder operations too.
4.2.Advantages
The widespread application of this technology, as
shown above, is due to its abundant advantages, for both surgeons and patients,
over tradition open-surgery procedures. Each of the current advantages of
robotic surgery will be covered in detail in the respective subsections below:
4.2.1. Increased
precision & accuracy
One of the main benefits of robotically-assisted
surgery would be the greater level of precision and accuracy of the robotic
systems give to surgeons, compared to traditional surgical instruments. For
example, in the ZEUS as well as Da Vinci surgical systems, one of the robotic
arms is a 3D camera, or Automated Endoscopic System for Optimal Positioning
(AESOP). This gives surgeons a more real-life image, compared to 2D images
using normal endoscopic procedures. Furthermore, AESOP is conveniently adjusted
through voice command, by either zooming in or out. The magnifying capability
of the device is especially beneficial to surgeons with poor vision, or in
surgeries involving miniscule or microscopic parts, such as veins or nerves.
With this enlarging function, a millimetre-wide vein, for example, can be magnified
into as big as a pencil. Also, the motions of the other robotic arms wielding
surgical instruments can be scaled according to the desired scale, which means,
for example, that a surgeon’s 1cm movement can be adjusted to result in a 1mm
movement. (ThinkQuest, n.d.)
4.2.2. Greater dexterity
& accessibility
The 3D camera mentioned above is small and flexible, and thus enables
surgeons to see regions that are usually obstructed to the human eye in
open-surgeries. The other robotic arms are extremely thin, flexible, and
dexterous, thereby allowing greater accessibility and mobility in tight areas,
especially in children operations, that are traditionally only accessible by
making long incisions.
4.2.3. Minimally
invasive
Figure 2: Minimally Invasive Surgery. Reproduced from Mayo Clinic.
(n.d.)
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Additionally, due to the thinness and flexibility of the robotic arms,
only small incisions are needed. For example, in a traditional heart-surgery,
in order to get to the heart, the surgeon would have to make a very long
25-30cm cut, as well as splitting the breast bone and parting the rib cage. With
robotic surgery, these procedures are redundant, for heart-bypass surgery can
now be done on a closed and beating chest, which is an enormous achievement in
the medical field. This minimally invasive procedure are far less painful, and not
to mention, leave much smaller scars. (Cavayero, 2013)
4.2.4. Risk
reduction & faster recuperation
Furthermore, the smaller required incisions result in
decreased blood loss and fewer blood transfusion requirements. In addition,
robots can remain in a sterile environment and minimize bacteria exposure,
unlike humans, thereby decreasing the risk of infections. This not only
benefits the surgeons, but patients too, with regards to minimal pain, speedier
recovery, and rapider return to normal activities. The briefer hospital stays help
reduce the number of staff required for after-operation nursing care. By
freeing up hospital resources, more patients and surgeries can be handled
during a particular period. This likewise leads to lower hospital costs for
patients and hospital alike. (ThinkQuest, n.d.)
4.2.5. Human
error reduction
Another clear advantage in robotically-assisted
surgeries is in long operations, especially those involving miniscule or
microscopic parts, like tissue or nerve reconstruction, and long complex operations.
A typical coronary bypass lasts as long as 3-6 hours. Surgeons often get tired
during such lengthy surgeries, and this affects their concentration level,
judgment, stability and accuracy, which are all very vital in any surgery.
Conversely, the robotic systems do not tire like humans, and can therefore
operate within long periods of time without compromising precision and
stability, thereby reducing human error, risk, and increasing chances of success.
Furthermore, in robotic surgeries, surgeons can remain seated rather than stand,
and the magnifying capability of the telescopic camera decreases the strain on
their eyes as well.
4.3.Disadvantages
Despite the plentiful benefits of robotic surgery,
there are several drawbacks to the technology that limit its widespread
application and reception. These drawbacks will be explained below:
4.3.1. Higher
costs
One of the frequently cited disadvantages of robotic
surgery is the hefty additional costs incurred for both hospitals and patients.
The purchase cost of some robotic surgical systems can go up to as much as $1
million, with maintenance costs generally amounting up to $100,000 a year. In
2011, the latest Da Vinci surgical robot was selling for $1.8 million, with annual
maintenance costs at approximately $140,000. The replacement cost of each of
the four arms of the robot was around $1,000 (Smith, 2011). In addition, operating the robotic system require
surgeons to have a specific degree of expertise, in which they would have to go
for a series of rigorous specialized training before they can be fully
certified to use the equipment. Hospitals would have to bear these additional
training costs required, as well as the opportunity cost incurred in terms of
time lost that could have been better used to operate on patients. Often,
hospitals would then make up for these extra costs by increasing the cost of
hospital bills for patients. The higher cost of robotically-assisted operations
are also not usually covered by patients’ health insurance or Medicare. On this
basis, critics of robotic surgery often argue that in spite of the benefits
conferred by the technology, the higher medical costs involved limit its
benefit to the small group of affluent patients who can afford it. Whereas
patients who cannot afford to bear extra costs are not able to benefit from the
use of the technology.
However, although the initial
absolute costs of robotic surgery is higher than that of conventional
procedures, the major portion of these additional costs is due to the large
purchase cost of the equipment, and the annual maintenance costs. These factors
are attributed to the relatively new stage of the technology, and thus are
projected to decrease significantly as the technology advances further.
Moreover, the savings hospitals can obtain from reductions in operative time,
hospital stays, and personnel costs, will duly compensate the hospital for its
initial investment in the technology in the long run.
(Lanfranco et al 2004)
4.3.2. Steeper
& longer learning curve
As mentioned earlier, surgeons are required to possess
specialised skills to master the use of the technology and thereby qualified to
perform a robotically-assisted operation. Learning how to use the robotic
systems takes a long period of time, usually requiring at least hundreds of both
simulated and real operations before surgeons can honestly express that they
have mastered the technology. The benefits of robotic surgery cannot be fully
realised if surgeons have not truly mastered the procedure yet, as a result,
patients sometimes bear the consequences of the learning curve, as seen from the
slightly less-than-satisfactory successful robotic surgery results. Also, most
of the surgeons who are qualified to learn the skills required are well-experienced
and established in their surgical fields, which means that they generally have
very little time to undergo training. Not to mention, the opportunity costs incurred,
in terms of serving other patients or training to enhance a surgeon’s skill in
traditional surgeries, is very high. Additionally, as the technology is still
considered to be at its initial stages, proper training curricula have yet to
be optimally developed, thus at present, surgeons face a very steep learning
curve. (Satava, n.d.)
Nevertheless, like the preceding
argument, given the eventual further advancements and developments of the
technology, more effective and appropriate surgical curricula and simulations
are bound to be drawn up, which would ultimately offset this disadvantage.
4.3.3. Risk of system
malfunction
Just like any other technology or electronic device,
there is always a possibility of the robotic systems malfunctioning or
experiencing device-related complications in the midst of an operation. This is
especially so given the higher complexity of robotic surgeries compared to
traditional operations. Once again, just like any other technology, this risk
can be gradually reduced as further developments in the robotic systems are
made. (Johns Hopkins, 2013) Furthermore, hospitals can put in place back-up
procedures and policies in anticipation of any possible complication, by having
a secondary robot ready, or requiring surgeons to continue the surgery using
conventional procedures.
5.
Future
Considerations
Robotic surgery has just been
around for slightly more than 10 years, yet the advantages attached to it has
led to its rapidly gaining popularity over traditional open surgery in many
areas of surgery. The amazing part about this revolutionary technology is the
fact that it is just at its initial stages of development. It has massive
potential to completely change the way surgeries are performed, and there are
still so many possibilities just waiting to be discovered and explored.
5.1.Automated
surgical robots
It was said earlier on that presently employed robotic
systems are master-slave robots that are unable to make decisions
independently, like the Da Vinci system for example. These type of robots
require a surgeon to be present at the master console to give the system
commands that will accordingly dictate their actions. However, there is a possibility
that the developments of the technology will introduce a new generation of
robotic systems that are capable of making decisions and performing procedures
independently and automatically in the near future. Robotic surgeons might even
substitute human surgeons, thereby eliminating human error and increasing
efficiency. Their greater precision, sterility, and lower invasiveness will
increase the likelihood of success for simple and complex procedures alike.
The higher success rate would mean that less lives
will be lost due to human carelessness and mistake. Also, the greater degree of
sterility in surgeries would help to push the rate of infection down, and the
lower invasiveness would contribute by accelerating patients’ recuperation
periods. In short, automated surgical robots have the potential to raise the
standards of healthcare services even higher, increasing overall standard of
living. The consequent benefits are not just confined to patients alone, these
automated robotic robots will take over the manual jobs of surgeons, and reduce
or even eliminate the number of assistant medical personnel needed to standby
during surgeries. This thereby decreases the strain on surgeons and nurses
alike, and they can then focus their efforts on other critical tasks.
5.2.Tele-presence
surgery
One of the major anticipated
contributions that robotic surgery will bring to the area of medicine is the
development in tele-presence surgery, or tele-surgery. Earlier in the paper, it
was mentioned that the US Army invested heavily into the development of robotic
surgery, as they hoped that it would make tele-surgery possible, and allow them
to deliver timely medical assistance to wounded field soldiers. However, the
geographical distance between the place of actual surgery and the surgeon was
not very far in their case.
Now, as continuous improvements are
made over time, doctors are expecting the expansion of this geographical
distance, whereby surgeons could operate on a patient from a different city,
country, or even continent. Imagine the substantial benefits that would bring
to patients all around the world. There will be greater accessibility to
medical assistance and solutions for even the most rural and desolated of
villages. This would in turn help to significantly decrease world mortality
rates that are associated with the lack of timely or appropriate medical
solutions, and raise healthcare standards in less-developed countries.
In fact, a
long-distance surgery has already been conducted in 2001, between New York and
Strasbourg, France, for gallbladder removal. Although “Operation Lindbergh”, as
the surgery was dubbed, was successful, the delay caused by lag time due to
telecommunications made the surgery unfeasible (Polland, 2012). Nonetheless, given the rapid improvements of the
internet and wireless technology, this is but a small problem that can be
easily surmounted.
5.3.Single-incision
ports & Nanosurgery
A different surgical method that robots
are expected to bring about is the single-incision port. Currently, robotic
systems used in laparoscopic surgeries employ a minimally-invasive method where
only a few small incisions need to be made, through which the flexible robotic
arms are inserted. In the case of a single-incision port, as the name suggests,
only one incision is needed for the robotic arms to go through. That would definitely
reduce the risk of blood loss, infection, pain, and recovery time even more
significantly (Polland, 2012),
ultimately raising the quality of healthcare services to a whole new level for
patients.
Additionally, there
is the emerging research and development of nanosurgery which involves the use
of nanorobots, robots with sizes ranging from 0.1-10 micrometres with nanoscale
(10−9 metres) components that
have the thinness of human hair, in surgical procedures. This would introduce a
whole new level of precision and accessibility in the field of robotic surgery,
and likewise cause great advancements in the quality and standards of medical
solutions and services. For example, in cancer surgeries, according to
Associate mechanical and industrial engineering Professor, Nader Jalili, of
Northeastern University, Boston, in the areas within the body where traditional
surgical instruments are unable to access, say within a millimeter of a tumor,
a nanorobot can be precisely directed to the location and show images of the
tumor that could never be seen before. (Northeastern University, 2009)
5.4.Greater competition
& higher education standards
With
the development and implementation of tele-surgery, other than reducing the
distance between patients and doctors, it would similarly raise the degree of
competition between doctors who are competing for surgical bids and patients
worldwide. Patients will have the ability to choose from a whole range of
medical practitioners from all over the world and pick the best from the
market. Consequently, the standards and quality of medical services would inevitably
be pushed considerably up, and doctors have to continually improve their skills
in order to not get left behind.
Another area that will receive
potential improvement is in the standards of surgical education. As mentioned,
the learning curve of robotic surgery for surgeons is very steep. Besides the
complexity and uniqueness of the skills needed to operate the systems, there is
a lack of educational materials and medical curricula available as well, due
mainly to the newness of the technology. Nevertheless, as more medical
institutes come to realise the great potential of robotic surgery, more effort
will be put into developing the educational curriculum and training required to
carry out robotically-assisted surgeries for interested and qualified surgeons.
(Ryerson, 2013)
In
fact, robotic surgery could even improve the learning curve for surgeons for
all types of surgical procedures in the future. The technology could be used to
generate simulations or reconstructions that emulate real operations for
surgeons under training. Besides helping to shorten the learning time for
surgeons-in-training, it could also increase the effectiveness of training
exercises, thereby lessening surgical errors and improving patients’ safety. (Lanfranco et al 2004)
5.5.Possible social costs
However, although
the adoption of robots in surgery may be advantageous to the surgical training
process in the long term, the steep learning curve of the technology might
present some social costs in the near future. As mentioned previously, due to
the limited time and inadequate training curriculum available to surgeons who
are interested in learning the technology, most surgeons have yet to fully
master the technology before they perform actual robotically-assisted
operations. This poses a threat to the safety of the patients they operate on,
for their inexperience increases the risk of errors. The lack of knowledge on
the technology may also contribute to the poor safety management and monitoring
of robotic surgeries. Besides this, robotic systems are prone to occasional
malfunctions too, especially when the development of the technology is still
relatively new.
Consequently, patients’ safety are at a
higher stake than what would have been in a conventional procedure serving the
same purpose. To put it simply, patients have to bear the brunt of the development
process of robotic surgery. This is especially so with complicated surgeries,
like life-and-death emergency cases where the risk involved is much higher. It
would not be comforting to either the patient’s relatives or surgeons
themselves, to know that the results might have turned out better, or mistakes
avoided, had traditional procedures been used instead. Nonetheless, nothing is
perfect; even though 85 deaths and 245 Da Vinci-related injuries have been
reported since 2000, the figures correspond to 1.5million robotic procedures
that have been performed during the same period. The statistical insignificance
of the causality rate thereby presents an optimistic forecast of the future
contributions of robotic surgery. (Greenberg,
2013)
Another possible
social problem is that the high cost of robotically-assisted operations limits
its accessibility to patients with lower income. Robotic surgery costs around
$1,500-$2,000 more than conventional procedures, a hefty difference a lot of
patients may not be able to afford. (Andrews, 2013) And though the costs of
present robotic solutions will most likely decrease vis-à-vis its advancement
and improvements, the costs of the more advanced robotic systems developed
along the way will always remain high, given the general perception that new is
always better. The rate of increment in its price is likely to accelerate as
the systems gets more and more advanced with increasing technological
knowledge. This rise in the prices of surgical systems could very well raise
the overall costs of healthcare across the medical industry, as hospitals are
likely to compensate their higher expenses by increasing their medical fees.
Considering so, there is a high chance of a widening gap with regards to
society’s access to healthcare services. The lower income group in society would
continue to face increasing difficulty in affording medical solutions, whereas
the more affluent group will always be able to freely enjoy and benefit from
the increasing quality of medical services. This means that the unfair
distribution of healthcare in society can only henceforth become more difficult
to eradicate.
The relatively
new stage of the technology might also impede on its efficiency and scale of
contributions in the near future. As the robotic systems are far more
complicated to use than conventional equipment that surgeons are much
experienced and familiar in using, robotic procedures often take a longer time
than traditional operations, particularly for non-complex cases. (Schwitzer, 2011) Furthermore,
surgeries performed by inexperienced surgeons or those who are still undergoing
training require intensive surveillance and guidance from surgeons who are
experts on the use of robotic surgical equipment. Meaning that besides the
longer time involved, which necessarily increases the stake on patients’ lives,
more medical personnel might be required than in traditional operations.
Therefore instead of relieving the present strain on the medical
infrastructure, robotic surgery could very well double surgeons’ burdens.
5.6.Suggestions for minimising current drawbacks
As stated
previously, one of the major drawbacks of this promising technology which
presently fetters the scope of its beneficial contributions would be the high
purchase cost of the technology. However, there has been several suggestions
that increasing the number of manufacturers and investors of the technology
would be the key instigator of the eventual reduction in its price (Pietrabissa et al, 2013).Given so, the author suggests that government
authorities could consider offering more incentives to hospitals that wish to
purchase and invest in the technology, as well as to manufacturers that are
interested in innovating and producing robotic systems. This could help to
increase the scope of adoption and volume of robotic systems in the healthcare
market, which would accordingly help to push the cost of the technology down.
As to the limitation attributed to the substantial learning curve surgeons
face, the author likewise feels that the joint effort of government authorities
and health institutions in pushing for standardised robotic surgery training
and credential programs, as well as in developing more comprehensive and better
training curricula, could perhaps help to ease the learning curve. Lastly,
regarding the inevitable malfunction risk of the surgical systems, this author
believes that this risk would most likely decrease significantly with the
eventual advancements in and greater knowledge of the technology, therefore
making the incentives and investments from government authorities even more
necessary. Nevertheless, regardless of how safe the robotic systems may get,
medical institutions should never leave anything to chance and always put in
place back-up policies and plans for all robotic surgeries performed.
6.
Conclusion
In summary, as seen from the historical and current
situation of the technology, the substantial time and effort used in developing
robotic surgery has been duly recompensed by the countless benefits and
achievements it has brought to the world of surgery. The technology’s
employment in the various areas of surgery have not only reshaped the way
surgical procedures are performed, it has also made possible countless
breakthroughs in the realm of medicine and improved the overall quality of
medical services available to patients. Limitless possibilities await the
development of robotic surgery, and its further progress is set to completely
reshape the way surgeries are performed in the future. It would only be unwise
to ignore its massive potential.
7. References
Cavayero, C. (2013). A
practicality analysis pertaining to minimally invasive robot-assisted urologic
surgery.Undergraduate Research Journal, 6(2), 45-55. Retrieved from http://www.urj.ucf.edu/docs/cavayero.pdf
Lanfranco, A. R.,
Castellanos, A. E., Desai, J. P., & Meyers, W. C. (2004). Robotic surgery a
current perspective. Annals of
Surgery, 239(1),
14-21. doi: 10.1097/01.sla.0000103020.19595.7d
Pietrabissa, A., Vinci, A., Pugliese, L., &
Peri, A. (2013). Robotic surgery: Current controversies and future
expectations. Cirugía Española, 91(2), 67-71. doi:
10.1016/j.cireng.2012.07.002
