It is claimed that within 30 years most jobs will be taken over by robots. In fact in the field of surgery there are already plenty of working robots. Don’t worry, though: they are not autonomous beasts, capable of turning bad. They are entirely dependent on human input. We are probably generations away from a truly independent robot.
The initial driver of robotic surgical research was the military and space industry. The aim was to develop technology to help injured soldiers on the battlefield or astronauts who needed surgery in space. That hasn’t happened yet, but there are now 60 robotic systems in Britain. About one in four hospitals that perform major surgery has one. They are mostly used by urological surgeons performing prostate cancer surgery; there is far less uptake in other surgical specialities.
For example, in my own speciality of colorectal surgery, there are only about 10 national robotic programmes. I have a niche within colorectal surgery dealing with the pelvic floor and probably have performed the most robotic pelvic floor operations in the country. In a sudden impulse of vanity, I attempted to show this fact off to my mother, who asked, with complete sincerity, if I was ‘not good enough to operate without one’.
In the last 10 years, there really has only been one type of surgical robot available, going by the fantastic name of da Vinci. It consists of a surgeon console and a slave unit with all robotic surgery performed using keyhole techniques (that is, involving a few small incisions in the abdominal wall through which a miniature video camera and surgical instruments are inserted).
I start all operations just like a normal keyhole procedure and then, when everything is ready, the robot slave unit is placed next to the patient. This slave unit has robotic arms. These arms are attached to keyhole instruments that in turn enter the patient’s body through small incisions at different sites. I will then leave the patient and go and sit in the surgeon console, which is usually at the side of the operating theatre (but can be miles away). I use hand and foot controls in the surgeon console to control the slave unit arms and instruments to operate.
The beauty of the robot is that it allows 3D vision, as opposed to most normal keyhole surgery utilising 2D, and this improved depth perception benefits the surgery when space is limited. If I’ve drunk too much coffee the robotic system cuts out my tremor. Additional precision comes from the scaling down of my hand movements: that is, if I move my hands 6cm in the surgeon console, the robotic instruments only move 1cm. Normal keyhole instrument tips have a limited range of movement, but robotic instruments have similar dexterity to the human wrist, making tasks such as throwing a knot easy.
There are limitations to using the robot for surgery. In abdominal surgery, normal keyhole surgeons can move from one part of the abdomen to another with ease, whereas robotic platforms are cumbersome and clumsy in this regard. Research has only shown one type of surgery (prostate cancer surgery) to be better robotically. Other procedures seem to have no better outcome, but this research is still in its infancy. The biggest downside of robotic surgery is the cost: the new da Vinci costs £1.5 million. Each surgery takes longer and costs more, all at a time when the NHS is in financial trouble.
However, it is early days for robot technology. I find it incredible that computers and TVs are getting bigger, better, brighter and yet are costing less each year. The same is true for robotic surgical systems. The tricks of the trade I had to come up with using earlier generation da Vincis are not needed with the new da Vinci model. Furthermore, new robot systems are out already. Google will have its one ready in one to two years. The prices for these systems are following the same path as other technology. Half the price, for something twice as good. I can’t wait.
My final contribution is to add that just because your surgery is performed robotically doesn’t mean it is better. A robotic system can make a good surgeon’s surgery more precise. But it will not make a poor surgeon great.
Dr Shahab Siddiqi is a consultant colorectal surgeon with Medstars.co.uk.