Steven Spielberg
The patient is brought to the preoperative holding area on a “smart stretcher,” which records the vital signs, and then anesthetizes the patient. A total body scan is performed, providing a complete “information-equivalent” image of the patient. The patient is then completely prepared for sterility and brought into a sterile operating room. The stretcher docks with the robotic console in the room, and all the information about the patient is shared with the robot’s surgical console outside the room. In the operating room, instead of a scrub nurse, there is an automatic tool changer and instead of a circulating nurse, there is an automatic parts dispenser.
The surgeon is able to control numerous hands; the instruments are changed automatically and the supplies (sutures, gauze etc.) are automatically dispensed. Every time a new instrument is changed or a supply is used, three actions occur:
• the patient is billed,
• a new instrument or supply is restocked for the operating room,
• and a request to reorder is sent to the supply office for a new instrument or supply from a vendor.
All three actions occur within 50 milliseconds. By eliminating, the scrub nurse and circulating nurse from each of the rooms (as well as the “relief” nurse –Remember robots do not take coffee breaks), it is possible to safely run two operating rooms with a single supervising nurse or technician, reducing the number of people from six to one (an 85% reduction in personnel costs).
The totally integrated operating room based on robotic and information systems enables the surgeon to monitor every motion of the robot, providing a continuous record for quality assurance, error detection and reduction, and improved patient safety.
This may seem “Science fiction” now, but this is truly going to be the “Science” of surgery in the years to come.
Imagine a situation where the surgeon will be sitting at the surgical console with the preoperative scan, rehearsing the patient’s operation on the patients specific image
(just like mission rehearsal in the military, to perfect the procedure by rehearsing many times before actual performance).
After the patient completes the immediate preoperative scan, and while the patient is being prepared and taken into the operating room, the surgeon can “warm up” on practice simulations.
Surgery is still in the industrial age--typewriter instead of word processor !!! To go beyond human limitations, we have to engender a mindset to take a new perspective and appreciation of robotics as a systems approach to surgery.
The far-future step will be to perform the procedure on the patient’s image, then “edit” the procedure until it is exactly as the surgeon would like it to be (editing out any mistakes), and finally executing the “operate” command to have the robotic system conduct a perfect procedure.
With the current advances and the untiring efforts of researchers, such “Programmed Surgeries” would become a mainstream practice.
FUTURE
Robotic surgery is still in its infancy. The current status is just the beginning of the full potential of robotic surgery.
Researchers, Biomedical Engineers and Surgeons, across the globe, are making efforts to achieve force-feedback and a simple sense of touch in robotic systems.
Force-feedback is the pressure that is felt in the fingers, hands and arms when manipulating an instrument. Where as the sense of touch refers to the delicate sensations on the pads of the fingertips and palms of the hands, which convey the subtle forces able to distinguish texture (rough versus smooth from vibratory forces), traction (sticky versus slippery from tangential sheer forces), and so forth.
By providing the use of a variety of technologies to enhance the capabilities of human surgeons, robotics will become an increasingly vital component in the medical world. Doctors of the next century must learn to use this information to complement their capabilities in order to provide better patient care.
If this is achieved, one can believe, that Robotic Surgery will fulfill the promise that was begun by laparoscopic surgery.
MORAL AND ETHICAL ISSUES
A final issue of the profound change robotics can make is raised when considering the humane implications of using robotic systems.
Q. Will this change the doctor-patient relationship?
Although there will be no immediate change, since current systems are used only by the surgeon in the same hospital and operating room, the question of an “itinerant” or “fly by night” surgeon may be a consequence of tele-surgery.
Q. If a complication occurs, will it be the fault of the robotic system or the surgeon?
Although complications are possible, they are highly unlikely. Robotic systems are constructed to be fault tolerant (constrained by hardware and software fail mechanisms) and highly redundant.
In addition, they have “graceful degradation”: should one component begin to fail, the system slowly either compensates or degrades to a lower level of performance rather than suddenly quitting or causing an erratic motion.
Q. What happens when there is a conflict between what the surgeon wants to do and the safety constraints built into the robot?
The truth be said, technology can only compliment the surgeon, it can never replace the surgeon. The robot will obey the commands of the surgeon within the programmed limitations of the system.
It is clear that, the future of robotics is absolutely central to the future of surgery. It has been one short decade since the first report of tele-operated surgery and 5 years since the first tele-operated robotic surgery on a patient. Image guided surgery has a slightly longer history, and also has become an accepted surgical practice.
There are numerous improvements underway, as well as enhancements that can move the science well beyond the current level.
