Robotics in healthcare is not a new topic. In many hospitals today, robots can already be found monitoring patients’ vitals and alerting medical staff. They deliver supplies and medicine on the hospital floor and work to improve strength and mobility in rehab patients. Perhaps the greatest impact of medical robots, however, has been in the operating room.[1]
Positive collaborations between surgeons and robots pose immense opportunities for patients and surgeons alike. The potential to improve surgical outcomes, enhance surgeon capabilities and ultimately have a positive impact on patients is greatest when the surgeon voice is at the center of future technological developments in robotic surgery.
Robotics in healthcare is not a new topic. In many hospitals today, robots can already be found monitoring patients’ vitals and alerting medical staff. They deliver supplies and medicine on the hospital floor and work to improve strength and mobility in rehab patients. Perhaps the greatest impact of medical robots, however, has been in the operating room.[1]
Since the first documentation of robots used in surgery in 1985, the field has been developing at a rapid pace.[2] Robots in the operating room today are primarily used for the positioning and manipulation of surgical instruments, although robotic capabilities are now starting to appear in other devices, such as intraoperative imaging. What defines success for a robot in a human-centered field? And as surgical robotic technology advances, how will physicians and robots collaborate? We’ll take a deeper look at how surgeons and robots interact in the O.R.
How Robots Assist Surgeons
Human-Robot Interaction (HRI) is a field of study that strives to assess and optimize robots for use by humans. Success necessitates that the two cooperate, divide tasks, and ultimately rely on the other to skillfully perform their job. In robot assisted surgery, humans and robots are required to not only communicate, but also share goals.
One of the common goals of surgery, especially in minimally invasive procedures, is to work accurately while causing the least amount of trauma possible to enable a quicker recovery. In minimally invasive surgery, robotic technologies assist human surgeons by helping them to achieve high levels of accuracy. Greater precision has the potential to decrease patient radiation exposure as increased accuracy calls for fewer verification scans.[3] Precise pedicle screw placement in robotic spine surgery, for example, can even reduce early postoperative complications and revision surgeries.[4]
Studies have shown that surgeons consistently find many robotic technologies to be of immense use in the operating room.[4,5]Robotic surgical assistants can be seen as an extension of the surgeon themselves, giving surgeons a “hand” during the procedure that never tires and doesn’t deviate from its position. Immersive feedback through voice control, visual displays, and head-mounted displays allows once static surgical tools to react and respond to surgeons’ instructions and movements in real-time.[5]
“The surgeon must see the evolution of robotics in surgery as a journey filled with meaningful explorations toward greater knowledge for the sake of our patients.”
Envisioning the Future of Robotic Surgery: The Surgeon’s Perspective
Most medical robotic technologies aim to support clinicians in executing surgical procedures more accurately and with less irregularity and so far, they have been broadly successful.[5] Surgeons have identified, however, that while these technologies are having an impact on surgical outcomes, there are still hindrances to broad adoption in the areas of user experience and education.[5]
Since costs associated with medical robots in hospitals are often substantially higher than traditional surgical tools,[6] surgeon buy-in has to be high. Yet, there are still hesitations that robotic artificial intelligence will restrict surgeons’ actions.[7] The learning curve is steep; even experienced surgeons often need upwards of 30 operations to master a new technology.[5] Many also still harbor concerns about the effects of autonomous functions on safety and team dynamics.[5] Widespread use of robots in the O.R. largely depends on overcoming these hindrances.
Advancing Robotic Surgical Technology
Human-robot interaction in the surgical field should be primarily concerned with the clinician’s user experience: ergonomics, comfort, usability, user feedback and interfaces, and communication. Users that are well-trained and comfortable with a given surgical robotic technology are in a prime position to capitalize on the benefits. As the movement towards robotic assisted surgery becomes evident, young surgeons in particular need to be supported in developing increasingly different skills than their predecessors, from remote surgery to interpreting intraoperative haptic feedback via augmented reality.
In order for robotic surgery to reach its full potential, surgeons need to be at the heart of the development of robotic medical equipment. The success of robots in the O.R. requires a multidisciplinary approach to design. Close collaboration between medical device engineers and medical professionals is key to the creation of technology that not only has the potential to improve surgical outcomes, but also achieve optimal results in the hands of enthusiastic users.
It is crucial that companies develop products that surgeons can rely on. Trust in both the robotics and the businesses behind them will allow surgeons to embrace new developments bring improvements to patient treatments. Surgeons should, in turn, take available opportunities to partner with medical device companies, test products and evangelize the use of game-changing robotics in the O.R.
The Future of Robots in the Surgical Field
The era of robots in surgery is here. Both patient and physician demand for such devices and operations continue to grow, as evidenced by an industry expected to reach $6.4B by the end of 2020.[8]
New and exciting developments in the field of robotic surgery are also underway. Expanding on minimally invasive surgery, the future use of nanorobotics is becoming increasingly likely. Just 100 nm in size, antibody-coated drug carriers are already being tested in the treatment of acute respiratory distress syndrome.[5] Autonomous as well as magnetically-controlled ingestible soft robots could open doors in intracorporeal surgery and imaging.[6] Though the everyday use of these ground-breaking technologies in the O.R. may still be years away, the revolutionary potential is clear.[6]
While the exact role of the surgeon may change with these new technologies, the necessity of skilled and experienced surgeons in the O.R. is never in question. As the field continues to evolve, it is crucial that surgeons view advancements as enhancing their own capabilities and expertise. Across surgical domains, robotics are transforming traditional operating rooms. Positive collaborations between doctors and robots are already making a positive impact on the lives of patients.
[1] Beasley RA. Medical Robots: Current Systems and Research Directions. Journal of Robotics. 2012;2012:1-14. doi:10.1155/2012/401613
[2] Lane, Tim. “A Short History of Robotic Surgery.” The Annals of The Royal College of Surgeons of England 100, no. 6_sup (May 2, 2018): 5–7. https://doi.org/10.1308/rcsann.supp1.5
[3] Galetta MS, Leider JD, Divi SN, Goyal DKC, Schroeder GD. Robotics in spinal surgery. Annals of Translational Medicine. 2019 Sep;7(Suppl 5):S165. DOI: 10.21037/atm.2019.07.93.
[4] Sayari, Arash J., Coralie Pardo, Bryce A. Basques, and Matthew W. Colman. “Review of Robotic-Assisted Surgery: What the Future Looks like through a Spine Oncology Lens.” Annals of Translational Medicine 7, no. 10 (2019): 224–24. https://doi.org/10.21037/atm.2019.04.69
[5] Aaltonen IE, Wahlström M. Envisioning robotic surgery: Surgeons needs and views on interacting with future technologies and interfaces. The International Journal of Medical Robotics and Computer Assisted Surgery. 2018;14(6). doi:10.1002/rcs.1941
[6] Perez, Rafael E., and Steven D. Schwaitzberg. “Robotic Surgery: Finding Value in 2019 and Beyond.” Annals of Laparoscopic and Endoscopic Surgery 4 (2019): 51–51. https://doi.org/10.21037/ales.2019.05.02
[7] Lazar, John F. “Envisioning the Future of Robotic Surgery: The Surgeon’s Perspective.” The Annals of Thoracic Surgery 105, no. 2 (2018): 343–44. https://doi.org/10.1016/j.athoracsur.2017.10.017
[8] Childers, Christopher P., and Melinda Maggard-Gibbons. “Estimation of the Acquisition and Operating Costs for Robotic Surgery.” Jama 320, no. 8 (2018): 835. https://doi.org/10.1001/jama.2018.9219