Automisation of Robots in Medical Surgery

The advancement in robotic technology has made it possible to introduce robotic support systems in a surgical theatre in the aim to increase patient’s well being. The boundaries of professional responsibility and liability blurred with regards to patient safety, public opinion, obstacles associated with novel technologies and removal of human decision making with increased involvement of robots. This has resulted in an ethical problem: what level of involvement of robotic technology should be approved when undertaking medical surgery?


The main stakeholders involved in this issue are the government, surgeons, patients and engineers.

No involvement of robots should be allowed in medical surgery at all

Robotics has adversely affected some surgeries as it was discovered that they have caused injuries to patients. These injuries would not have occurred without the robots involvement. In these instances it would be better to exclude robots as they do not fulfil their function of improving patient well being, indeed robot assisted surgery (RAS) was linked to over 100 deaths and more than 1000 injuries in the US alone.

The American College of Obstetricians and Gynecologists states that: “there is no good data proving that robotic hysterectomy is even as good as – let alone better – than existing, and far less costly, minimally invasive alternatives” highlighting that a skilled surgeon could to perform the surgery without the associated risks of RAS. RAS failed in its implementation into cardiovascular and gynecological surgeries and was only successful in urological surgeries as it reduced bleeding from patients. Despite this success, on the basis of impotence and incontinence which are better indicators for success, RAS is no better than traditional surgery.

Surgeons through extensive training are capable of making intraoperative decisions which enables them to adapt to a changing scenario, a necessary skill that robotics in surgery do not yet possess. This presents the notion that this technology should be subjected to further investigation and testing by independent bodies without a vested interest in order to produce a safe product which will not negatively impact a patient’s well being. This would require government legislation to enforce predecided standards. Introducing further legislation would also prevent over enthusiasm, which sometimes occurs with technology causing a rush on a novel product which is unproven and thus possibly dangerous. These robots are vulnerable to hacking which clearly a surgeon would not be, as such RAS would potentially compromise patient safety where remote connection was involved.

Robotics of assistive nature and the prospect of fully autonomous medical robots should be allowed

Robotic technology is an integral part of modern medical practice. Bio-imaging processing and nanoscale robots in the bloodstream are a few examples where robotics assist medical personnel in making a judgement on the required treatment. This prompts engineers to push the boundaries in which robotics can contribute to medical care. This is an example of paternalism in which engineers are determined to advance RAS as far as possible for the usage of surgeons. There is evidence which shows that RAS has been successfully employed by Guy’s Hospital  and is actively being used to treat cancer. The benefit here is clear, improved treatment for those with life threatening illness reducing surgery time, recovery time and increased survival rates. Considering the life saving ability should the cost be factored into decisions on adopting the technology, would this not be akin to assigning a monetary value to a life?

There is future prospect for the implementation of RAS, but as with any novel technology, certain challenges will have to be overcome at the early stages. In this instance, there are two main issues to be addressed; the first being the learning curve in using these surgicals robots and the second which involves software and hardware problems with the robots.These issues have resulted in accidents and injuries, however it would be wrong to presume that surgery would be better off without RAS, the next building block in the future of surgical medicine. For example, laparoscopic surgery is considered a successful surgical method today experienced many patient complications in its infancy. Reports have shown that the proportion of accidents have reduced over time with increasing implementation of RAS which implies progress as surgeons are becoming more experienced with RAS. In addition, with the release of every new model of robot, it comes with several progressive improvements: less malfunctions with components parts, tightened security protocols against hacking and generally the hardware and software for the surgical robot have been optimised. Instead of focusing on the few negatives of RAS, we would serve ourselves better if we build on its many more merits. The focus should be on setting up proficient training schemes for surgeons and regulating the standard quality and requirements of these robots.

By taking advantage of the robotic advancement to full automatisation, we can take the stand of a utilitarian viewpoint to bring the greatest happiness to the greatest amount of people. In our context, this can be done by deploying autonomous robotic surgeon to hazardous environment where access to trained surgeons is not available such as the battlefield. In this way, personnel can have valuable medical access without worrying about the surgeon’s safety. Medical assets such as trained surgeons can be put to better use such as medical research. Autonomous robotic surgeons can also be stationed in rural areas where medical access is limited. This way, more people can have access to proper medicine care albeit by robot rather than having those access limited only to first-world country. Governments can then provide better medical coverage to the populace without regards to geographical obstacles. With availability to medical care, the waiting time of these essential services can also be reduced with robotics technology. Robots can be productive for a long period of time only subjected to maintenance compared to surgeons who are susceptible to fatigue which can subsequently result in error in judgement which is often fatal. Patients can be reassured that emergency care is always available at its best regardless of the demand.Undeniably, the medical robotic application hasn’t been perfected yet and accidents do occur. However, compared to the inevitable benefits that the global community can reap from this, the sacrifices along the way is all well worth it.

54: Jeffrey Bong, Obi Ossai, James Browne, Matthew King

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20 thoughts on “Automisation of Robots in Medical Surgery

  1. Congratulations on a well written article that poses some excellent ethical questions.

    I find myself agreeing with the final sentiment: As the field of robotics steadily increases in capability and robust control, the involvement of engineers children in the operating theatre will be a positive to the practise of medicine.

    It would be good to see the true cost of robotic implementation assessed in greater detail. It may be cruel to give human life a value but the sad truth is that it happens everyday and I wonder how the expense will affect their deployment. How long can we expect them to remain in the private health sector alone?

    However, a good read!

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  2. Good article highlighting the key arguments of both sides of the story. It identifies the main areas that need to be improved moving forward. I think that having robots involved in surgery is going to be part of the future of medicine, however, I think that it will always be necessary for a human element with assists from robots. I also think that before these robots could be brought to market, the consumer perception of the technology would need to be improved

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  3. This is well-written. I have benefited from reading your discussion on the positive and negative aspects of RAS. Thank you.

    I agree that assistive robotic technology should be integrated as part of medical practice. RAS allows doctors to perform complex procedures that are otherwise impossible with conventional techniques. One of the benefits of these RAS technology I find very amazing is the smaller incisions.. It means less pain and reduced scarring!

    I think it’s still early for RAS to be applied at “rural areas where medical access is limited”, as that would need more advanced robotic technology, training for skilled surgeons, and also high expenses for such extensive research and development. That will cost a lot. Who is going to pay for the maintenance of the facility and medical treatments?

    Even with progressive improvements, there are always risks in every technology, undeniably. There are still hurdles to clear, but I believe that RAS has a great potential in saving many lives.

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  4. Definitely pro robotics here. While there is the high possibility of occasional malfunctions in treatment due to the use of robot technology in health treatment , like most any other technology this will only improve exponentially with time.
    In the long run , I strongly believe that medical care will be far more efficient with robot technology than without . it greatly simplifies the treatment process and allows for desired medical results to be achieved that much faster. It would allow humans live longer and more productive lives. It’s simply foolish to ignore the possibly infinite benefits of robot technology due to the dangers it poses as humans are also prone to error which is significantly more difficult to anticipate or rectify on a long term basis. .
    That being said, the danger of human life posed by robot technology can still not be ignored. I propose that more stringent tests should be used before launching new robot technology e.g. high levels of supervision by skilled medical professions, taking into account extenuating circumstances in robot design etc. If this done efficiently, this will keep the dangers to human life to a bare minimum.

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  5. Interesting article giving the pro and cons on the use of robotics in medical surgery. My personal opinion is that there needs to be further development in the technology before it becomes utilised on a commercial scale. A key consideration in the application of robotic technology will be how it affects the accesibility to affordable medical surgery

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  6. Interesting article providing strong cases for either side of the argument. With most advances in technology, the subtle introduction is key and clearly for this progression to occur it is imperative that the changeover is not abrupt. I can see some procedures being conducted entirely by robotics however believe it would take years of ‘human participation’ in order to gain patients trust.

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  7. After reading the argument in favour of robots, I strongly believe it is the future. Although a number of deaths and injuries have been recorded, improvements keep occurring yearly at an exponential rate. I believe the introducation of robots will aid rational decision making in surgery especially in unpleasant circumstances.
    However I have concerns about what the world will be with almost everything autonomized.

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  8. Firstly the article in my opinion is an informative and eye opening one. This is because it is a topic I have not considered giving a thought about. With the arguments presented I find myself siding with the use of RAS technology in line with the benefits presented. However as with all forms of technology in use today, the adaptability of a person in certain situations in my opinion, cannot be replicated with technology. As RAS deals with human life and with challenges still to overcome, I believe a balance should be found to use the technology effectivley without losing the human factor.

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  9. An interesting read
    The use of robotics in a medical environment is an emerging technology that brings both positive and negative implocations which the article has address in a concise manner.
    From my point of view, we shouldn’t reliant upon RAS but it should still be used to improve efficiency and accuracy for surgical applicationso. Once the technology has proven itself under thorough testing it would become more trusted with the wider community it yet & associated stakeholders.

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  10. A good write up on Automisation of Robots in Medical Surgery.

    However, it is too early to conclude on the long-term effect of the involvement of robot in the medical field.

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  11. An interesting read but with improper use of English in certain areas.
    RAS is an improving technology that is underestimated. There are definitely some inconveniences created by using RAS such as the inability of the system to adapt to anomalous conditions in the operating room. Apart from this issue, there is no disadvantage in using robots in surgery.
    There is no certainty of robots causing less injuries to patients than humans. If humans were alone in the operating room, who is to say that those same injuries will not occur. The fear of hacking the robots is void because surgeons can also be coarse into performing faulty surgeries. Robots can also be used in danger zones as stated in the blog and can also be used as the first line to treatment for viruses and radioactive poisoning as they are very contagious but not to robots.
    All together, autonomous robotics have proven to provide ease to humans in their daily life. this is already implemented in different departments such as construction and there is no reason why it should not be implemented in the medical department as well.

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  12. Great article that underlines the points of discussion both for and against RAS. Personally, while I believe that using robots in the healthcare sector may eliminate human factors such as stress, fatigue or distractions, there are always decisions to be made, which may not entirely rational, and require more of a human touch or perspective to it. I especially liked the point on the infancy of this technology and how, as it is likely to become the future, it should receive more government and public support. One of the main talking points for the future is possibly about how the costing would be akin to assigning a monetary value to a life, however, it should not be forgotten that this has already similarly been done with the salaries of doctors and surgeons.

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  13. Great report. I feel engineering ethics today is at a new low. Robotics is a key example of how the engineers have teamed up with the big pharmas and other politically motivated corporate establishments, who seek financial profit rather social and ethical gain. You are an inspiration to investigative journalism. don’t give in. #Fight the power.

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  14. Some great points on both sides. I feel that the use of Robotics has great potential to improve the surgical processes however, there are many problems that have to be addressed in the short term as it was discussed in the article. As it is the case with the new technology, improvements are certain to happen and robotics can not be judged as it has not reached it’s potential yet and it is unfair to say that a robot which will have consistent results is more dangerous than a fatigued surgeon. However, it is clear that there is still a lot more to be done in this field and I would still be sceptical towards using them in high risk procedures with the current rate of accidents. It is true that sacrifices have to be made but those sacrifices should not include human lives.

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  15. Some good points made. Robotics is definitely the way forward. But as with every machine, sometimes its good sometimes its bad.

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  16. This article from a medical professional’s point of view and having assisted in many surgeries poses some valid, yet very practical ideologies, if indeed too practical points.
    A few points from this I felt are..
    – For there to be any use of Robotics it has to go through many tiers of rigorous trials and studies before it is in a state to be tested on humans and 100’s of people may be what you describe as a ‘sacrifice’ but this is a very evocative way of putting this, in the ideal world the technology should not directly lead to a cause of death and I feel that once statistically the number of deaths linked to mechanical failure of robotics is less or equal to the current number of deaths directly caused by physical human error then this is the only time the technology should go mainstream.
    – Yes, people make mistakes when tired, but when working a normal shift with adequate sleep and hydration most people are able to think fast and ethically at the same time during complex surgeries, taking into account the patients’ wishes of their outcome for the surgery i.e risking future bleeding by removing a Meckels’ diverticulum surgically, which can be left alone with future risks in itself as an example of something a very senior surgeon had to make the call on. These are the sorts of decisions a fully autonomous robot I fear will never be able to make, in our lifetime.
    – The world of robotics first came in with the laparoscopic techniques of which has been improved no end like the article said, however this is quite an old, but amazing technique, of which is controlled by a surgeon. Assisting in using these techniques myself, I have found it takes a high level of dexterity and co-ordination of which hopefully could, in the future, be improved by robotics, but reading into this subject many of the operative deaths occurring from robotics have come from software failure and this is my ultimate point….can a robot brain ever match a humans’…this is where I feel robotics fails, when the human brain is removed from the equation.

    In summary I feel this article is very well written from an engineering point of view but needs to involve the patient more and take into account the perceived standard of care they receive. Some interesting, yet controversial points are made and I feel this article is a good starting point for discussing the future of where surgery and that profession can lead. I feel that realistically it will always need a surgeon to think for it, but that is not to say a surgeon cannot be made more efficient, more accurate and less invasive.

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  17. This article raises some interesting issues, and from an engineering standpoint I can see the obvious appeal of perfecting robotic surgery. However, there is one area that a robot is intrinsically unable to compete, the ‘human touch’. As so much of a patients recovery relies on their mental wellbeing, I can’t help but feel that however well the surgery is performed, a robot will never be able to compete with a skilled surgeon, who is also able to be there for the patient and reassure them, in terms of final result and recovery.
    The comment on cost is an interesting dilemma too, while saying that robotics is too expensive is akin to placing value on a life, the medical profession has been doing this since its inception, both public and private, the NHS does work to a budget after all.
    I feel that robotically assisted surgery could definitely be the next big leap in medical technology, but the idea of purely robotic surgery doesn’t appeal and I fear it will never catch on.

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  18. This is a very interesting article. I have definitely gained knowledge from this. I do agree that robotics technology might revolutionise medicine. However I’m quite curious as to how this would affect the employment of medical staff. Would robots replace their human predecessors?

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  19. Great article on Atomisation of Robot in Medical Surgery.
    Surgical Robots have acted as an extension of the surgeons hands where the surgeons controls the Robot .

    That made me wonder why the surgeons didn’t operate directly on the patient like they would normally do.

    What exactly are the benefits of a Robotic Surgery?

    1. Has the ability to make tiny and precise incisions, replacing some traditional operations which require cutting patients open and months of recovery, with far less invasive keyhole surgery.

    2. The surgical robot acts as an extension of the surgeon’s hands and allows the surgeon to carry out complex surgeries through tiny incisions. It miniaturises the movements of the surgeon who control it.

    3. Robotic surgery will help with cancer care especially surgeries involving tumors.

    4. For surgeons, the procedures can be less tiring. They don’t have to bend over an operating table—they can sit in front of a screen with a magnified, full-color 3-D view of the surgical field.

    5. For the patient, there’s usually less blood loss, a shorter hospital stay and less reliance on postoperative pain medication. There’s also the cosmetic benefit of no big scars:

    What are the Risks?

    1. Injury and death rate from robotic surgery
    2. Could be more expensive if used for the wrong type of surgery

    With every technology breakthrough comes Benefits and Risks.

    Like

  20. Great article on Atomisation of Robot in Medical Surgery.
    Surgical Robots have acted as an extension of the surgeons hands where the surgeons controls the Robot .
    That made me wonder why the surgeons didn’t operate directly on the patient like they would normally do.

    What exactly are the benefits of a Robotic Surgery?

    1. Has the ability to make tiny and precise incisions, replacing some traditional operations which require cutting patients open and months of recovery, with far less invasive keyhole surgery.

    2. ‘(The surgical robot) acts as an extension of the surgeon’s hands and allows the surgeon to carry out complex surgeries through tiny incisions. It miniaturises the movements of the surgeon who control it.

    3. Robotic surgery will help with cancer care especially surgeries involving Tumors.

    4. For surgeons, the procedures can be less tiring. They don’t have to bend over an operating table—they can sit in front of a screen with a magnified, full-color 3-D view of the surgical field.

    5. For the patient, there’s usually less blood loss, a shorter hospital stay and less reliance on postoperative pain medication. There’s also the cosmetic benefit of no big scars:

    What are the Risks?

    1. Injury and death rate from robotic surgery
    2. Could be more expensive if used for the wrong type of surgery

    With every technology breakthrough comes Benefits and Risk.

    Like

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