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Bringing Surgical Robots Into the Mainsteam

Posted by Soulskill on Sun May 04, 2008 12:17 PM
from the i'm-a-doctor-not-a-machine-oh-wait dept.
Robotics Medicine Technology
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."
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  • I bet... (Score:3, Funny)

    by neokushan (932374) on Sunday May 04 2008, @12:19PM (#23292808)
    They have detailed files on human anatomy.
    • I'm sure they can never have enough, though. If this were my company, I would make absolutely certain to have all the information on anatomy that I could get, whether in photos or movies. Also, I'd make sure that I reviewed all of the information I can, taking a real hands-on approach. When it comes to things like this, I find that I can never get enough.

      • Re:I bet... (Score:5, Informative)

        by Anonymous Coward on Sunday May 04 2008, @12:45PM (#23293004)
        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.
        • Yeah when one reads of Robotic surgery the picture of an actual robot operating on a person comes to mind.

          If that were the case, I would worry that our future robotic adversaries does, in fact, have detailed knowledge of how we work.

          But for now the borg will have to wait - we are still in control. ...in Soviet Russia, we asimilate BORG!

        • Re: (Score:3, Informative)

          by vertinox (846076)
          *sighs* [imdb.com] 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'm glad SOMEONE did, otherwise I'd be worried about Skynet taking out the human race using little more than the processing power of a speak-and-spell.

        • Re: (Score:3, Informative)

          by Hootenanny (966459)
          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

        • 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

    • They have detailed files on human anatomy.

      Its CPU is a neural net processor, a learning computer. The more contact it has with humans, the more it learns.
    • Of course it makes them better at killing...

      I mean um.... Healing
  • I wonder how far away fully automated surgical systems, the "autodocs" of Larry Niven stories like Crashlander [amazon.com] , are. While there are no doubt many dangers involved, an automated system would be better for nothing when it comes to things like removing appendixes when the local human doctor is dead or incapacitated.

    • Re: (Score:2, Interesting)

      by maxume (22995)
      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.
    • 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 thin
        • one of the stories has the main character regrown from the neck down... how long until _that_ tech is available... it would be pretty sweet, decapitate, regrow body, rinse, repeat
  • Bringing Surgical Robots Into the Mainsteam?

    Sure sounds like a promising Anime scenario: robots, surgery, steam.

    Just throw a few pretty high school girls in sailor suits and you have a winner.

  • The laws and open sore software (Score:5, Insightful)

    by Harmonious Botch (921977) * on Sunday May 04 2008, @12:34PM (#23292910) Homepage Journal
    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.

    • Re: (Score:3, Insightful)

      by nametaken (610866)

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

    • Re:The laws and open sore software (Score:4, Insightful)

      by Have Blue (616) on Sunday May 04 2008, @12:56PM (#23293094) Homepage
      Surgery is just about the last place anyone who isn't a trained expert should be involved.

      • 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? )
        • It is exactly that sort of arrogant mindset that can get you into trouble.

          Here's a tip: If your estranged wife dies unexpectedly and your lawyer advises you not to testify, don't testify.
      • Agree, I'm sure the patient was rather elsewhere.

    • Re: (Score:2, Funny)

      by Anonymous Coward

      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.

      • Re: (Score:3, Funny)

        by piojo (995934)

        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.

    • Re:The laws and open sore software (Score:4, Informative)

      by kmahan (80459) on Sunday May 04 2008, @01:02PM (#23293148)
      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.
    • Well, I'm not sure those laws are really necessary since anyone who uses one to perform surgeries and isn't certified to actually perform surgeries is practicing medicine without a license, and that's a big no-no (jail and fines and what not).

    • Re: (Score:2, Funny)

      by Anonymous Coward
      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.
    • 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.
    • I'd want the one that does the best job. fuck open source if it's inferior.
  • I've actually gotten a chance to play with a surgical robot once, they are amazing. The particular one I worked with had 2 cameras, and coordinating monitors/eyepieces to view through, so you have the proper depth perception to work with. Truly amazing.

  • These are not robots. (Score:4, Informative)

    by mbone (558574) on Sunday May 04 2008, @01:10PM (#23293228)
    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.

    • 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.

      That sounds good for all of the doctors in India and China and othe relatively poor countries. I'd expect their fees are much lower. When I need surgery, all I have to do is rent the machine, and hire one of them, and make sure that I have a very reliable connection so I can be assured that nothing goes wrong during the operatio..^%^*&(# NO CARRIER...

      • The 200-300 msec round trip latency between the US and India or China is thought to be fatal to such long distance surgery (no pun intended). However, the US DOD is, I think, interested in short distance telesurgery, say Kuwait to Iraq, which should be technically possible.
  • Robot surgeons? This is a really bad idea [pbfcomics.com]...

  • A day at the hospital (Score:5, Funny)

    by Rui del-Negro (531098) on Sunday May 04 2008, @01:44PM (#23293504) Homepage
    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.
  • I took part in a demo of a surgery robot (actually a remote control, not a robot). It was really intuitive! In seconds, I learned how to manipulate all the controls, everything felt very comfortable, I was able to move small rings, and place them over spikes, move and rotate in different directions and angles. It was sweet!

    As for anatomy, anatomy is different from person to person! some people have their heart on the wrong side! some peoples liver is much larger than others (hopefully mine is I drink l

    • I for one do not welcome our new surgery-performing overlords. I study to be a surgeon because it's a job that needs exceptional skill and dedication. I love the stress, the blood, the gore and the responsibility. If all this turns out to be equal to being a common technician and not about being as skilled and concentrated as humanly possible, 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. Selfish? Absolutely. I still do hope, that robotic surgery will not be applicable to every single procedure.

      I feed on difficulties, challenges and competition and my ego is, by this, most certainly bruised.

      Your post rather frightens me... when I considered becoming a surgeon, I liked the idea of helping people, but it was the blood and gore that turned me off. Why is this a draw for you?

    • Re: (Score:2, Insightful)

      by maxume (22995)
      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.

    • Re: (Score:3, Insightful)

      by TXISDude (1171607) *
      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

    • Re: (Score:3, Insightful)

      by Vellmont (569020)

      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 thi

        • Your first paragraph is all wrong. This is nothing more than a fancy scalpel. Albeit one with tremor-dampening, and fancy haptics/cameras but still a tool nonetheless.
          I'm sure you're right. My point is really that all these tools are going to be "surgeon assistants" rather than "surgeon replacements". I have a hard time believing any patient is going to want to trust their internist to do complicated surgery by a robot. Thus those kind of tools will not be developed (and it's likely not even possible).

          An
    • Wow, you're quite an asshole. You hope that all of humanity remains in the dark so that you can have a job and feel important? You obviously don't really give a shit about helping people so why should we give a shit about your complaints? What would you do if you had both an HIV vaccine and an HIV treatment drug? Let me guess, you'd shelve the vaccine so you can get repeat business, make more money and feel in control.

      You're a douchebag and I hope you slam your hands in a car door so you can never work agai
        • I appreciate your honesty, and understand where you are coming from. It's good to have a drive for personal excellence. However, I hope you outgrow your attitude somewhat, because acting like an elitist asshole is ultimately counter-productive. It alienates people, and will give you a blind spot caused by caring more about yourself and unable to accept legitimate criticism.

          When I read your comments I'm reminded a lot of Dr. Moon [nih.gov].

        • Who do you want to perform your GABG, a mediocre altruist or an egocentric professional who is confident because he/she really is that good?

          I'd prefer the guy who is good enough that he's not trying to prove something. You sound like a cowboy, and cowboys CAN perform miracles... but usually they end up falling down due to hubris and lack of planning. I want a professional who can make sure the whole process is done properly, not just some guy who may or may not do an excellent job depending on how many drinks he had the night before or how much his girlfriend is putting out or whatever decides whether he's feeling on form.


        • Who do you want to perform your GABG, a mediocre altruist or an egocentric professional who is confident because he/she really is that good?
          Ever consider that the "egocentric professional" might just be closer to Frank Burns than Charles Emerson Winchester III? When you think you're the best, it might just wind up hiding a lot of mediocrity.

          As a software developer, I've seen little correlation between ego, and skill. Some of the worst code I've seen came from a guy with (reportedly, I never met him) a hug
    • 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.

      • 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.

        The decision to perform an operation laparoscopically versus open is not as straightforward as you suggest. The overriding goal is patient safety, but smaller incisions do not necessarily imply safer operations. Laparoscopic surgeries almost always take longer than their open counterparts, which means the patient might remain under the effects of anesthesia and numerous other drugs for 6 hours rather than 2 - this is not benign. Also, visibility tends to be greater during open operations, so vital struc

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