I have been to my fair share of hospital emergency rooms,
including one interesting trip to an ER in Seoul, South Korea (which is a story
for another day). Luckily enough, these visits were usually minor and involved
some level of stupidity on my end. For
those of us who have been less fortunate, hospital visits have involved some
sort of surgical procedure. From a routine outpatient podiatry procedure that
lasts less than a half hour to a complex cardiothoracic surgery that takes
multiple days and requires an inpatient stay of months, surgery can be scary,
painful, and costly. The fact is that the patient must trust the doctor with his limb, his heart, or even his life. While
surgeons are able to safely perform operations today that healthcare
professionals could have only dreamed of twenty years ago, complications, pain,
and suffering will continue to pervade the process of undergoing surgery no
matter how advanced the field becomes. This is clearly evident, as all of us
have at least known someone close to them who has had to have an
operation. Surgery can save lives and,
in other cases, can just as easily take them. The surgeon’s duty is to give
their patients the best care, whether that means performing an operation or to
advising against it and recommending alternative solutions. The patient’s duty
is to decide if the doctor’s advice is sound and, if so, to trust it. Now, just imagine how hard it
is to trust someone with your life.
Now, do it again – but this time, imagine trusting
a robot with this responsibility…..
In 2000, Intuitive Surgical, Inc. introduced the FDA
approved da Vinci robotic surgical system. The system is composed of a
surgeon’s console, fitted with a high-resolution viewing screen and an
Endowrist system that reacts to the surgeon’s movements, and a patient
side-cart, equipped with four robotic arms capable of emulating the surgeon’s
movements almost exactly. Since 2000, over 1,400 da Vinci systems have been
purchased and successfully employed in hospitals from the United States to Austria.
At a price of around $2 Million, the da Vinci system represents an innovative,
but expensive approach to surgical procedures. While the price may seem steep,
sales have risen dramatically over the past few years and are expected to
increase by 400% next year. So why are more and more hospitals around the world
willing to pay so much for this system? For starters, the system allows
surgeons to perform minimally invasive procedures with more accuracy and
greater effectiveness. Rather than having to saw through someone’s mandible in
order to reach a cancerous mass in the back of someone’s throat, this system is
able to make a tiny incision in neck or even proceed directly down the throat
in order to reach the same malignancy. This not only reduces the trauma levels
inflicted to the patient, but also preserves tissue and dramatically reduces
recovery time. This saves the patient and the hospital lofty costs associated
with extended inpatient stays, increases patient satisfaction, and increases a
hospitals’ brand in terms of innovativeness. No wonder hospitals are jumping at
the chance to be the next institution to employ the da Vinci system in their
surgical centers, right? From the sounds of it, I would trust this thing more
than I would trust the Cleveland Browns to disappoint their fans (which is
pretty much guaranteed).
Now, here’s the other side of the story. The surgical robot
is not autonomous – it requires a surgeon who is not only comfortable
performing the operation remotely, through a screen, but who is also capable of
deftly maneuvering the Endowrist system well enough to make it react as if its
his own hands. In theory, this is how it’s supposed to work. This requires
hours and hours of training and even then, success is not guaranteed. In being
detached from the patients’ tissue, the surgeon will obviously have less
sensitivity. In some cases, this has resulted in mistakes that result in even
bigger problems than the initial surgery was meant to correct. In addition,
more and more cases are being reported as problematic as research begins to
surface regarding the da Vinci’s outcomes. So far, only 245 problematic
operations have been reported, according to the FDA. But, these problematic
cases are self-reported and as a result are vastly underreported. While the da
Vinci system is understandably an innovative approach to surgery in the 21st
century, it is far from a perfect machine. As I said before, every surgery
involves some sort of risk. The question is whether or not this robot is able
to minimize these risks effectively.
Brendan Cmolik