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Bringing Surgical Robots Into the Mainsteam

The New York Times is running a story about how using robots to perform surgical operations has been transformed from a controversial dream to reality. Dr. Frederic Moll abandoned his residency for Silicon Valley and helped to revolutionize the industry. The lengthy article also discusses some of his innovations. We've discussed various robot-assisted medical procedures in the past. From the Times: "'I was struck by the size of the incision and injury created just to get inside the body,' Dr. Moll says. 'It felt antiquated.' He took the idea to his employer, Guidant, a medical device company. Guidant decided that robotic surgery was too futuristic and too risky, so Dr. Moll rounded up backers, resigned, and in 1995, founded Intuitive Surgical. The company prospered by proving that robots could deftly handle rigid surgical tools like scalpels and sewing needles through small incisions in a patient's skin."

24 of 73 comments (clear)

  1. I bet... by neokushan · · Score: 2, Funny

    They have detailed files on human anatomy.

    --
    +1 IDisagreeSoHeMustBeATrollOrAnAstroturferOrAShill
    1. Re:I bet... by Anonymous Coward · · Score: 5, Informative

      These machines don't have any knowledge of anatomy.

      They are more like "remote control" surgeons than robot surgeons.

      It's basically laparoscopic surgery taken to a new level of miniaturization.

      analogous to fly-by-wire in planes versus old hydraulic connections.

    2. Re:I bet... by vertinox · · Score: 2, Informative
      *sighs* I think I was the only other person that got his joke.

      John Connor: You know what you're doing?
      The Terminator: I have detailed files on human anatomy.
      Sarah Connor: Makes you a more efficient killer, right?
      The Terminator: Correct.
      --
      "I am the king of the Romans, and am superior to rules of grammar!"
      -Sigismund, Holy Roman Emperor (1368-1437)
    3. Re:I bet... by Hootenanny · · Score: 2, Informative

      This is correct. I've been in the OR for open, laparoscopic, and robotic surgeries. The advantages to the robot, versus standard laparoscopy include: 1) The robotic instruments have numerous articulated joints (i.e. wrists) whereas laparoscopic instruments are straight and more unwieldy in some circumstances. 2) The robotic camera is high-definition and stereoscopic, so the surgeon can see everything in three dimensions, adding additional safety beyond laparoscopy.

      The robots are not a panacea - don't bother asking your surgeon to perform a transplant robotically - but under certain circumstances, they make operations easier and safer. An excellent example is when the prostate is removed for cancer. The robot makes it much easier to operate in the pelvis, which is normally an awkward region of the body to access.

    4. Re:I bet... by hotfireball · · Score: 3, Funny

      These machines don't have any knowledge of anatomy. They are more like "remote control" surgeons than robot surgeons.

      You are about to cut a surface with the sharp tool. Cancel or allow?..

      Allow

      Are you sure? Y/N

      Y

      *shows mouse cursor as a clock*, *HDD works heavily*

      *guh!* Error -0xFF46A1: Unable to connect to socket 0x0650 at address 0xFFFF44DD. [ OK ] [ Retry ] [ Ignore ]

      OK

      *silence*

      *still silence*

      ...

      You are about to cut a surface with the sharp tool. Cancel or allow?..

      Allow

      Are you sure? Y/N

      Y

      *shows mouse cursor as a clock*, *HDD works heavily*

      *guh!* Error -0xD4EE9: Windows Networking not found. [ Configure ] [ Cancel ]

      Configure...

      TCP/IP adaptor was not found. Please insert installation DVD to find one.

      Driver found, install? (Cancel or Allow?)

      Allow

      Really?

      Y

      Really?

      R

      Really?

      *click* OK

      *Guh!* Error: The driver from this manufacturer can not be installed on this operating system edition. [ OK ]

      *reboot*

      Welcome to Windows Vista!

      ...

      ...

      ...

      ...

      You are about to cut a surface with the sharp tool. Cancel or allow?..

      Allow

      Are you sure? Y/N

      Y

      *shows mouse cursor as a clock*, *HDD works heavily*

      ...

      ...

      ...

      *patient throws the chair and walks away*

  2. The laws and open sore software by Harmonious+Botch · · Score: 4, Insightful

    I can forsee two possible futures:

    Laws that say that only an MD is allowed to use a surgical robot, and that a manufacturer can sell them only to MDs, and that you can only sell/distribute software for them if you are an MD. This may seem paranoid perhaps, but consider the lawws restricting x-rays: You can buy an x-ray machine for checking welding seams or for x-raying dogs + cats, but you can't use it on humans.

    Or there could be a much looser future, in which anyone can buy one, and anyone can program one. If I were having surgery done by a robot, I'd want one that was running open source software.

    1. Re:The laws and open sore software by nametaken · · Score: 2, Insightful


      I think I'd want every last movement checked, approved, monitored, and then rechecked by an MD.

    2. Re:The laws and open sore software by Idiot+with+a+gun · · Score: 2, Insightful

      Of course. But at the reliability rate of current proprietary software, I wouldn't want some company saying "It works, we tested it, trust us!"

    3. Re:The laws and open sore software by Have+Blue · · Score: 3, Insightful

      Surgery is just about the last place anyone who isn't a trained expert should be involved.

    4. Re:The laws and open sore software by Anonymous Coward · · Score: 2, Funny

      If I were having surgery done by a robot, I'd want one that was running open source software. You'd go into surgery a guy and then you'd wake up as a girl. This is not a bug but a feature, because after much debate the developers collectively agreed girls are neat.

      Aw heck who am I kidding, we'd all love that.
    5. Re:The laws and open sore software by kmahan · · Score: 3, Informative

      Times are changing.

      An example is the defibrillator. It used to be that only medical professionals were able to purchase/use them. Now there are several such as the Phillips HeartStart that are sold on Amazon. The units are designed so that the average idiot can use them. Slap the pads on the victim's chest, hit the big button, and the unit figures out if the victim needs a shock, and if so gives it. Otherwise it doesn't.

      --
      Invalid Checksum. Retrying.
    6. Re:The laws and open sore software by Harmonious+Botch · · Score: 3, Insightful

      Surgery is just about the last place anyone who isn't a trained expert should be involved. It is exactly that athoritarian mindset that concerns me. It should be the patient's decision. It's my body; it should be my choice. ( hmmmm, what does this do to the abortion issue? )
    7. Re:The laws and open sore software by Anonymous Coward · · Score: 2, Funny

      I'd especially like it when the OSS gives a seg fault, and the joints jerk into their neutral positions, inadvertantly slicing your abdominal aorta and IVC, causing you to die rapidly of severe internal hemmorage.

    8. Re:The laws and open sore software by piojo · · Score: 2, Funny

      If I were having surgery done by a robot, I'd want one that was running open source software. You'd go into surgery a guy and then you'd wake up as a girl. This is not a bug but a feature, because after much debate the developers collectively agreed girls are neat. I can't help but think this is an oblique reference to Pidgin.
      --
      A cat can't teach a dog to bark.
    9. Re:The laws and open sore software by NMerriam · · Score: 4, Interesting

      The FDA approves all medical devices like automated external defibrillators and surgical robots. It's a long, expensive process that is considerably less fungible than, say, pharmaceutical trials.

      I've worked with a lot of the surgical robots and voice control systems available in the past decade, and they're much more reliable and consistent in manual performance than whatever random surgeon happens to be on call that day. Sure, a doc always has to be driving the thing -- they're nowhere near autonomous (that's still decades away for even simple things), but the point of the robotics is not to remove the expert decision-making of the doctor, it's to eliminate the mechanical aspects of surgery where most things go unpredictably wrong. Just brushing your glove up lightly against the wrong piece of anatomy can cause major internal bleeding, not to mention how difficult it is to precisely control your hands for every split second of a 14-hour long procedure where doctors might have to trade off several times with all sorts of tools still inside the patient.

      The robotics also make an unbeatable teaching tool. The surgeons in 50 years are going to be vastly superior to even the docs we have today, because they'll not only be able to watch from the chief's POV from day one of their residency, they'll be used to rehearsing every procedure in the simulator beforehand and handing off the controls to different specialists elsewhere for a few minutes whenever they need.

      --
      Recursive: Adj. See Recursive.
  3. Re:Autodocs by maxume · · Score: 2, Interesting

    There are experiments or ongoing efforts(don't remember which) towards robots that can operate on a beating heart, something a human surgeon simply can't do. So some of the technology is actually additive, rather than simply useful as an emergency backup.

    --
    Nerd rage is the funniest rage.
  4. Re:Autodocs by Original+Replica · · Score: 2, Insightful

    I wonder how far away fully automated surgical systems, the "autodocs" of Larry Niven stories like Crashlander , are.

    I would think that the combination of MRI tech and facial recognition type software could enable robots to see and "understand" the precise physiology of a patient. I don't know how well the triage process or dealing with non-standard problems would work without significant human help. More routine procedures might not be too far away, Lasik surgery is already half way there. I would think an autodoc that could procedures that are not life or death like plastic surgery or setting a broken bone would be possible in the next ten years if there was a well funded organization with that as the goal. But I would be surprised to see a robot that could diagnose and treat serious trauma in less than 50 years.

    --
    We are all just people.
  5. These are not robots. by mbone · · Score: 3, Informative

    These are not robots. These are medical telepresence devices. They have no artificial intelligence or autonomy at all; they are intended to provide the surgeon with tiny hands and eyes in places they could not otherwise reach.

    They are cool machines, but they are not robots.

  6. Re:Soon being a surgeon will be worth nothing. by maxume · · Score: 2, Insightful

    Early machines will *only* replace technicians. It will be a long-ass time before a machine is actually coming up with new surgical procedures and ideas.

    --
    Nerd rage is the funniest rage.
  7. Re:Soon being a surgeon will be worth nothing. by TXISDude · · Score: 3, Insightful

    Your argument sounds like one that pilots would have tried when autopilots were first installed in cockpits. Just as autopilots changed aviation, just as imaging have changed aviation (radars, ILS) and medicine (x-rays, cat, pet and MRI scans) - high tech robotics can make new things possible in surgury. Less invasive, more precision, better outcomes - but these will all require more skill, not less from the surgeons. Do not confusing cutting of flesh skills (butchery) with modern medicine - Dr. McCoy's word come to mind - I'm a doctor Jim, not a butcher.

    --
    Hope is the worst of evils, for it prolongs the torment of man. -- Friedrich Nietzsche
  8. Re:Soon being a surgeon will be worth nothing. by Vellmont · · Score: 2, Insightful


    if robotics allow every first year med student to perform as flawlessly as the highest skilled brain surgeon by compensating for their every mistake, then it's time to move to some third world country.

    I kind of doubt it. This device is likely going to be mainly used to do things a surgeon is bad at, and is never going to be good at (nerve fibers in a prostate surgery), or tedious, time consuming things better left to a robot. It seems unlikely it'll put you out of a job.

    What I _do_ hope though is that this device can lower costs by reducing complications, or having fewer assistants during a surgery, or perform more surgeries/day, etc.

    --
    AccountKiller
  9. Oh no by td04impostor · · Score: 2, Funny

    Robot surgeons? This is a really bad idea...

  10. A day at the hospital by Rui+del-Negro · · Score: 4, Funny

    Welcome to MS Surgery 2008 (c) Microsoft 1983-1992

    > run appendix

    appendix is undefined.

    > run "appendix"

    appendix not found.

    > run "Appendix"

    - Appendix script started...
    - Setup complete.
    - Loading scalpel vector data.
    - Reticulating splines.
    - Blade initialized.
    - Cutting...

    [Message from AutoUpdater: an update for LifeSupport.sys is available and will now be installed.]

    LifeSupport.sys has performed an illegal operation and was terminated.
    Restart? Y/[N]

    > y

    Restart? Y/[N]

    > Y

    LifeSupport.sys failed to start due to error:
    0000 - General error

    Patient has terminated unexpectedly.

  11. Re:Soon being a surgeon will be worth nothing. by camperdave · · Score: 3, Insightful

    So you would rather open a hole in someone's abdomen large enough to get your hands in, just to remove the grape sized growth on their liver, rather than opening a pea sized hole and using a machine? Barbaric. I think you need to rethink things. Sure, surgery requires skill and dedication. It will for quite some time to come. But in the end, it is a common technician type of job: Cut, remove, splice, stitch.

    --
    When our name is on the back of your car, we're behind you all the way!