Trusting a Robot…With Your LIFE

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 21^st 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