Surgical AI: Apathy or Improvement?
As technology rapidly advances throughout the early 21st century, an astonishing innovation was made, using aspects that seemed to only have been found in science fiction: robots. This development sparked contrasting responses from the masses, including amazement, shock, and fear. Due to these radically opposing viewpoints, the topic of robotic assistance in surgery has remained a major controversy for decades now, which leads to the question:
How will this affect our futures?
For years now, humans have been fascinated and disquieted by the idea of a superior population with artificial intelligence; however, as time passes, and the development of this mechanical population continues to advance, anxiousness seems to be the most common response. The word “robot” itself was not used until 1921, yet less than eighty years later, a stupefying advancement was made: the da Vinci surgical system. This system involves the surgeon sitting behind a control station and controlling a set of robotic “arms” to perform the surgery; under the direction of the surgeon, these electronic extremities can make incisions smaller than the edge of a coin, cut blood vessels, move organs, and execute other maneuvers to complete minimally invasive procedures. For surgeons, they have provided additional precision, flexibility, and magnified vision through the use of an advanced camera. For patients, there is greater nerve preservation, reduced tissue trauma, less blood loss, and a reduced number of complications. As of today, more than 6 million surgeries have been performed with the assistance of this robotic surgical system, and this number is only expected to grow, specifically by 13.5% annually. Despite the widespread popularity of the technology associated with these numbers, many general surgeons and scientists criticize it, arguing that its benefits are highly saturated and that there has been no objective evidence to support the advertised benefits. Robot-assisted surgery, while proving to be one of the biggest advancements in medical technology to date, has stirred a great amount of controversy over its actual benefits for the patients versus exaggeration of said benefits as a marketing scheme.
The da Vinci surgical system has been used in procedures to treat a wide variety of conditions in specialties including cardiac, colorectal, head and neck, thoracic, urologic, gynecologic, pediatric, and general surgery. As the system continues to popularize, roughly three out of four prostate cancer surgeries are conducted using the da Vinci surgical system, and more women choose robot-assisted, minimally invasive hysterectomy over the use of the conventional laparoscopy. The incisions that are made during these, and other, surgeries are 8 to 12 mm each, one of the greatest advantages of this technology. These minuscule incisions allow surgeons to perform meticulous, delicate surgeries and have the ability to reach places that human hands cannot. Additionally, the cameras that are attached to the robot arms performing the operation enhance the surgeon’s field of vision remarkably. As such, the system has expanded so much that, within the U.S., 86% of urology residency programs and all 42 gynecologic oncology fellowship programs have one.
While this technology is highly advanced and has many benefits, there are still a great number of risks associated with it that cause the system to be rather disputable. One of the main concerns that hospitals and health care offices have is the cost of it. The system itself can cost anywhere from $1.5–2.2 million, with a maintenance cost of $150–180,000 dollars per year, which has consumed the offices that implement it. This dramatic price is countered by making robot-assisted procedures $3,000-$6,000 dollars more expensive for patients. Although benefits of this surgery have been outlined, none of them have been objectively proven; on the contrary, studies have shown that these surgeries often yield the same results, or worse, than general, non-technological surgeries. Many patients who have undergone these procedures reported postoperative complications that were unrelated to their original conditions, serious injury to surrounding tissues (including blindness), severe nerve damage due to unnatural positioning, and unintended retained foreign objects. Not only this, but patients have also reported witnessing issues with the machinery occurring during these procedures such as the robotic arms drifting throughout the surgery, instrument failure, and delays on the console and monitor. Because of the high number of complications that can occur from this surgery, a common risk of it is unfortunately also death. As of August 2012, approximately 71 deaths have been logged in the FDA’s online report database, which is a shockingly high number when considering the widespread reputation of the da Vinci system.
The da Vinci system is a constantly advancing technology that continues to adapt more individual features to reduce the risks associated with it, however, it seems to also be a dangerous technology. Concerns about its cost and outcomes are ever-growing, yet it continues to be a popular option for health care offices. Patients who are considering having a robot-assisted procedure conducted should research its risks and benefits, and discuss their findings with their care provider, before undergoing one. This may be a technology that has sparked a lot of debate, but it remains one that will be ever-increasingly important and influential in the future.
References:
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