Fiction: A Surgery Incision by da Vinci Max
Novel technological approaches are being implemented in operating rooms (OR). For example, surgeons are provided with high definition 3D views and tiny bending vastly-flexible instruments, which synergistically perform complex operations with a few tiny incision. One such advancement for robotic laparoscopy is the human-controlled da Vinci System, which provides a 3D visualization of the operating room and performs accurate motor actions (Blavier et al, 2007). Although, with the introduction of robotic laparoscopy the percentage of complication cases decreased, there is still room for improvement. Hence to help decrease the number of laparoscopy surgeries with human error, an autonomic robot surgeon is proposed — the da Vinci Max, which executes incisions in a solo uncontrolled fashion.
Laparoscopy is a surgical procedure, which allows doctors to better-explore abdominal or female pelvic organs through a tube introduced into the stomach via a thin incisions. This technique is critical for evaluations of tumors, cysts, fibroids, adhesions, infections, and for tissue-sample-taking in biopsy analysis. Seldom the exceeding number of surgeries, the da Vinci Max performs quick and precise operations with a 3D view adaptation (Blavier et al, 2007). The large and obtrusive machine is centered in the OR, shrouded in protective drapery to keep the operating environment sterile; spiderlike with arms extending horizontally from the formless body; with plastic sleeves and legs that promote vastly flexible bending; and an extension-desk protuberant from the machines stomach, where the patient will be located during the operation procedure. With the da Vinci Max incorporating three-to-eight arms (depending on the model) that simultaneously hold the scissors, scalpels, retractors, decapitators, forceps, sponges, etc prostate cancer surgery is performed quickly with minimal incisions, less blood loss, and magnified visual perspective. Best of all, the robotic camera offers an unsurpassed view into the claustrophobic target-fields, magnifying them 10-fold to allow da Vinci Max to perceive the tumor dimensions, to evaluate the affected organs, and to decide on the required corresponding incision.
Da Vinci Max is a sophisticated robot, which by analogy to the human brain has a perception — action functions intertwined. Prior to performing the incision, da Vinci Max transforms the sensory patters, including patient-related information, from its environment into patterns of required corresponding motor movements. Da Vinci Max does not have a physically defined brain, yet it contains the systems within its body that are required for the top-down processing. The neuronal processes in the parietal lobe allow da Vinci Max to recognize himself in the physical space of the OR. Once the patient is placed on da Vinci Max’s extension-desk, via the inferior temporal lobe he perceives surgery-relevant visual information by identifying the patient’s body, the extrinsic representational properties displayed on the Multi-Parameter Monitor, and the tools required for the incision. His temporal lobe simultaneously processes input of both the bottom-up (feature driven) and the top-down (memory driven) neuronal networks. To decide the specific direction and orientation when carrying the scalpel and touching the skin of the patient, da Vinci Max translates information from M-type retinal ganglion cells to magnocellular Lateral Geniculate Nucleaus (LGN), and then to the Primary Visual Cortex (V1). Then he gently places a scalpel right above the targeted-area of the patient’s body. Meanwhile, he translates the body shape related input from P-type retinal ganglion cells to parvocellular LGN layers to V1 (Goldstone, 2011). Gradually, da Vinci Max integrates information from the ventral stream (“what” pathway) which helps in deciding that the incision is going to be performed at this particular time; and the dorsal stream (“where”pathway) via visual processing, estimating the precise area on the patient’s body to make the incision. Nevertheless, as Anderson once concluded “it is not only neurons (or sub-neuronal structures) that matter; nor is it only the interaction of organism and environment. Rather, the structure and function, action and interaction, matter from top to bottom, affecting the nature and contact of mental entities and events” (Anderson, 2007). Hence it is not only the neuronal proceedings, but the form-functions of physical features present in the environment and the perceptual mechanisms, which together allow the cognitive accomplishment of the incision done autonomically by a robot surgeon to be performed. The da Vinci Max making the incision, and the surrounding multimodal environment of the O.R. are structurally coupled, since da Vinci Max is embodied into the environment and changes bi-laterally influence one another.
Without the information processing, stability in reproducibility, and persistence in performing an incision, it would be virtually impossible to reason about certain temporal dynamics of the perception — action functions held in a coordinated manner. Da Vinci Max allows exploring the complexities that the 3D visualization and the vastly-bending instruments introduced into the operating field; moreover, further evaluations, reasoning, and predictions could promote speedy upgrades for the current robotic surgeons, and introduce a model with advanced perception — dynamic action constituents. “This core interactive process — project then materialize — underlies much of our epistemic and pragmatic engagement of the world. By materializing our initial projections, by creating traces of them through action, most of us find we have created something that can serve as a stepping-stone for our next thoughts. This is why the interactive strategy of project then materialize is so powerful” (Kirsh, 2009).
In terms of minimal blood loss and smaller incisions that result in faster recovery time, the da Vinci Max greatly out performs manual surgery. Statistically, laparoscopy performed by a robot allows patients’ to be discharged from the hospital within 24 hours, with only 5–10% cases of complications, in juxtaposition with nearly 30% of open-surgery cases. (Drehle, 2013). To conclude, da Vinci Max robotic system obviously has advantages: binocular vision in all tasks, depth of field is compensated by the camera or movements of the hands, movement of freedom of the instruments carried in multiple arms simultaneously, and the fine, gentle, gradual motor gestures. Such cognitive artifact as da Vinci Max has its effects by recognizing cognitive capacities into functional constellations that provide the new capacities (Hutchins, 2006). When da Vinci Max is invited to perform laparoscopies, perceptual information is compartmentalized and epistemic actions are incorporated.
References:
Anderson, M. (2007). How to study the mind: An introduction to embodied cognition. In F. Santoianni and C. Sabatano, (Eds.), Brain Development in Learning Environments: Embodied and Perceptual Advancements, Cambridge Scholars Press, pp. 65–82.
Blavier,A., Gaudissart, A., Cadie` re, G., Nyssen, A. (2007). Perceptual and instrumental impacts of robotic laparoscopy on surgical performance. New Technology. 21, 1875–1882. https://orbi.ulg.ac.be/bitstream/2268/11511/1/surg.endoscopy-07-21.pdf
Goldstone, R. (2011). Higher Perceptual Functions. Indiana University: Cognitive Psychology. http://cognitrn.psych.indiana.edu/busey/q551/PDFs/week7.pdf
Hutchins, E. (2006). The distributed cognition perspective on human interaction. In The Roots of Human Sociality, 375–398.
Kirsh, D. (2009). Interaction, external representations and sense making. In N. A. Taatgen and H. van Rijn (Eds.), Proceedings of the 31st Annual Conference of the Cognitive Science Society. Austin, TX: Cognitive Science Society.
Von Drehle, D. (2013). Meet Dr. Robot, TIME. Rise of the Robots. 80–85.
