A perspective on autonomous surgeries

Today’s Robotic Surgery Turns Surgical Trainees Into Spectators – IEEE Spectrum

I began researching the impact of surgical robots on surgical technique and education in 2013. My studies have found that hospitals that adopted the technology have most often turned trainees into optional assistants in the OR, meaning that they begin practicing as “real” surgeons without enough skill. Reversing this trend would require sweeping institutional change, which I don’t expect to happen anytime soon. So, I’m working with collaborators on an alternate solution for surgical skill learning. The platform we create could turn out to be broadly useful, perhaps even turning into a blueprint for 21st-century apprenticeship.

This is an interesting perspective. Robotic surgeries may not offer the learning experiences of open surgeries. The author then self-promotes the Github type of learning platform with a commercial angle. I am only including the relevant learning points.

My bigger concern is the gradual shift towards autonomous “self-aware” systems. 5G and AI will hasten the impact (through data collection), but I can foresee commercial applications through 6G and beyond. This isn’t futuristic, but VC’s are pushing through this because they are pitching ideas of “human cost centres” to healthcare enterprises. The cost of healthcare delivery will become astronomical through cloud based AI delivery (object recognition) and having autonomous systems. Robotic systems are being trumpeted by marketing as “technological advancements”, even though the empirical evidence to suggest robotic surgeries as superior is flimsy.

Here’s something more:

Autonomous Robot Surgeon Bests Humans in World First – IEEE Spectrum

For this study, published today in the journal Science Translational Medicine, researchers programmed their robot to carry out a procedure called intestinal anastomosis, in which a piece of intestine that’s been cut through is stitched back together. It’s like repairing a garden hose, said Ryan Decker, the senior engineer on the team, in that the sutures must be tight and regularly spaced to prevent leaks. STAR performed this task both on ex vivo tissue in the lab and on in vivo tissue in an anesthetized pig, and experienced human surgeons were given the same tasks. When the resulting sutures were compared, STAR’s stitches were more consistent and more resistant to leaks.  

The researchers don’t think these assists invalidate their claim of autonomy; instead they see the setup as representative of shared control setups that would be appropriate for real ORs. Human surgeons could supervise procedures or even trade off tasks with the robot, letting the machine do more routine or tedious parts of an operation. “You can imagine that if something critical is happening, that would be a point where the surgeon is going to be closely monitoring the robot,” Decker said. “I’m sure they wouldn’t feel comfortable just letting it run and going to take a coffee break.” 

So autonomous robots are being developed, and it is a matter of “when”. While the tone and tenor are to suggest that it won’t replace surgeons, but “offer a helping hand for more tedious parts of the operation”, it is only a matter of time.

The policy challenges involved are ample-should you outright ban them from being developed (and borrow an euphemism) “halt the march of progress” or embrace them and adapt them to your needs? The arguments around this adoption will be around infection rates, lowering rates of “medical/surgical errors” and stupid statistics from “research organisations” and potentially pushing insurance companies to pay for these procedures too. Brace for the onslaught and publications in “respected medical journals”, never mind the retractions.

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