Steve Rajeckas – Page 2 – Future Guidebook

Surgeons are an incredibly important piece of the healthcare puzzle. They perform dangerous, necessary procedures that other doctors simply aren’t qualified for. So, will surgeons be replaced by robots? No, surgeons will not be replaced by robots anytime soon. While robotic tools to aid surgeons are becoming more prevalent, robots that completely fill the role that human surgeons perform are extremely far off. Although far from replacing humans, the current advances in surgical robotics are nevertheless fascinating, and offer valuable insight into what the future of surgery holds. The rest of this article will discuss these advances, how they are affecting the field of surgery, and what barriers lie in the way of completely autonomous surgical robots. How robots are currently affecting surgeons Gone are the days where a patient’s well-being in the middle of a surgery relies entirely on a human surgeon and their competency with their tools. Robots have entered the operating room, and they aren’t going anywhere. da Vinci Surgical Systems The da Vinci surgical system is one of the pioneering examples of surgical robotic technology. The da Vinci is an all-in-one surgical hub that sports multiple arms, high-definition 3D vision, a magnified view, and computer assistance. The surgeon operates the da Vinci from a control console in the operating room. The device essentially becomes a more precise extension of the surgeon’s individual skill. Smart Tissue Autonomous Robot The Smart Tissue Autonomous Robot (STAR) is another surgeon-assisting robot. Its specialty is sewing stitches. Sewing stitches is a precise and repetitive task, so it’s not too surprising that a machine like STAR can sew more evenly and consistently than surgeons who have been practicing their craft for decades. Like da Vinci, STAR takes a backseat to the surgeon’s individual skill. It’s a tool that complements the surgeon’s skillset. It isn’t trying to replace surgeons ‒ only assist them with a small part of their job. That being said, STAR brings surgery a lot closer to autonomy than da Vinci. In 2016, STAR was used to successfully suture a pig intestine with little input from human surgeons. It used a state-of-the-art computer vision system, a force sensor, and a predetermined algorithm to which sutures to use and how to best apply them. To gauge STAR’s performance compared to more traditional suturing methods, the researchers also performed the suturing procedure using three other methods: hand-sewing, laparoscopy, and the da Vinci surgical system. The semi-autonomous STAR beat out all these methods in one key area: spacing between sutures. The algorithm driving STAR was able to space the sutures in such an optimal fashion that the intestine STAR worked on was able to withstand almost twice the amount of pressure as the intestines sutured via the other methods. Sedasys Anesthesia device One example of the medical community’s hesitance to embrace autonomous robots is Johnson & Johnson’s now defunct Sedasys Anesthesia device. Sedasys, which automates placing patients under mild to moderate sedation, was being denied denied approval by the FDA in 2008. After five years of back and forth, the FDA finally approved the device for use in medical settings in 2013. The device saw an extremely limited rollout, with just four U.S. hospitals signing up to try it out. Part of the reason for this small group of initial users was that Johnson & Johnson was deliberately conservative in their approach to selling the machine. And it makes sense ‒ the Sedasys was not just another run-of-the-mill medical tool. It was the first tool that could actually do the job of a medical specialist. Given enough time, the device could have possibly been upgraded beyond its narrow use case (colonoscopies, endoscopies and other simple screenings). Sedasys, although it worked as intended, faced a lot of resistance. The American Society of Anesthesiologists came out against the device, claiming that automating the process of sedation could endanger patients. Individual anesthesiologists also spoke out against the device; partially out of concern for their patients’ safety, and partially out of concern for their own continued employment. In 2016, Johnson & Johnson discontinued the Sedasys automated sedation system. Sales were lower than expected, and company representatives claimed the decision to stop selling the machine was solely based on the lower-than-projected sales results. I’m telling you about the failure of Sedasys to show you how strong the pushback against autonomous robots in a medical setting can be. Although the Sedasys device was safe and effective, the negative reaction from the medical community it was attempting to replace was strong. The resulting lack of sales from that reaction was enough to force the manufacturer to discontinue production. There’s no way to know for sure whether the commercial failure of Sedasys is indicative of how future autonomous medical devices will be received or if Sedasys was just ahead of its time. Nevertheless, it definitely sets a precedent for how the medical community will react when they feel their livelihoods are being threatened by autonomous devices. Why surgeons are relatively safe from automation Despite significant advances in robotic surgery, surgeons won’t be automated out of their jobs anytime soon. Even if the capability to completely replace robots with surgeons exists, a number of different groups would have to approve of the replacement before it went into effect. First of all, governments would have to approve the autonomous surgery robot for use on live humans. The process to get minor therapies approved for use by doctors and hospitals is incredibly stringent. The robot would have to be significantly more competent than the best surgeons in the world to even stand a chance of getting approval. Next, hospitals and medical centers would have to agree to use the robots. The surgeons at these hospitals would have enormous influence over which surgical implements are used during operations. If these surgeons felt their livelihoods might be threatened by the use of these machines, there’s a good chance they would adamantly oppose their use ‒ even if the machines were better than the surgeons. Finally, the patients would have to feel comfortable putting their lives in the hands of a robot. While it’s true that humans are getting progressively more comfortable with robots, a sizable portion of the population will likely never be okay with an autonomous robot cutting them open and performing life-threatening surgery. Even if surgery robots are proven to be ten times safer and more effective than traditional human surgeons, people will still be wary. So even if a fully autonomous robot capable of performing surgery on its own were to be developed, there are a bunch of societal roadblocks standing between it and the kind of mass adoption that would be required to put surgeons out of work. What the future holds for robots in surgery If STAR is any indication of things to come, surgical robots will only be getting more effective as the years go on. And as the quality of autonomous medical devices continues to improve, regulators and hospital administrators will have an increasingly hard time keeping these devices out of the operating room. It may even get to the point that robots are so much safer and more effective than surgeons that it will be seen as reckless not to use them in a surgical setting. If technology is ever going to reach that point though, it is far into the future. Human surgeons are not going anywhere anytime soon.