Robotic Surgery, Research Paper Example

Technology, Society, and Culture

Introduction

Considered by medical professionals and surgeons alike as one of the most important technological advances in the field of medicine, robotic surgery has revolutionized how surgeons perform various operations on the human body. One of the major advantages to this new form of surgery is that it is less invasive, meaning that it eliminates the use of scalpels to enter the body and to repair and/or remove diseased or damaged tissue and organs. This less invasive technique also lowers the chances of infection and of course results in a very small scar as contrasted with traditional surgical techniques.

Description of the Technology

In technical terms, robotic surgery is often referred to as computer-assisted surgery or CAS, image-guided surgery, surgical navigation, and 3-D computer surgery, all of which involve computer-based procedures and techniques that utilize technologies like 3-D imaging in order to plan and execute specific surgical procedures, such as robotic assisted pelvic surgery, CT guided stereotactic brain surgery, robotic-aided prostatectomy or the removal of the prostate gland, and robotic-aided cardiac surgery or surgery performed on the human heart. All of these types of robotic-assisted surgeries are growing in popularity, due in part to being less invasive and time consuming (Robotic Surgery, 2012). In addition, CAS or computer-aided surgery “allows for better visualization and targeting of sites as well as improved diagnostic capabilities” as compared to older techniques via the use of X-rays, CAT scans, and even the more advanced PET scanning (Robotic Surgery, 2012).

Although the term “robot” may be somewhat misleading, due to the common perception of a robot as found in many science fiction films and literature dating back to the 1920’s, a true surgical robot can be defined as “a computerized system with a motorized construction,” such as some type of a mechanized arm, that is able to interact with its environment” (Robotic Surgery, 2012), in this instance, the exterior and interior of the human body.

This type of highly specialized system also involves sensors that “provide feedback data on the robot’s current situation” i.e., where and what types of activities it is performing in real time, and “a system to process this information so that the next action” or surgical move or procedure can be determined. In this way, the surgeon who acts as a sort of guide or director for the robot, can instruct the robot to “repeat identical motions,” such as cutting or removing a piece of tissue (Robotic Surgery, 2012).

Since the surgeon does perform a very important role in utilizing a robot during an operation, the amount of interaction between the surgeon and the robot have been divided into three specific procedures. First, supervisory controlled surgery is done exclusively by the robot, based on a computer program installed before the procedure; second, telesurgical, also referred to as remote surgery, “involves the actions of the surgeon via the manipulation of the robotic arm from a distance” or from a remote location. The best-known robotic device related to this type of surgery is the da Vinci Surgical System, named appropriately after Leonardo da Vinci; and third, shared control system which involves more than one surgeon and utilizes a robot that allows the surgeon to make intricate cuts and removals via a stead-hand system (Gharagozloo, 2008, p. 56).

Of course, utilizing a robot to perform intricate surgical procedures can be risky, especially if the surgeon is not fully trained on how to use the robot properly. As noted by the Brown University School of Medicine, using a robot to perform an operation on a human being holds the potential to be fatal if the robot itself malfunctions during the course of the procedure (Robotic Surgery, 2012).

With this in mind, there is an on-going debate between surgeons who use robots and those who prefer traditional surgical techniques and procedures. Part of this debate centers on the risks associated with medical errors on the part of the robot, even when a shared control system is being utilized by several surgeons for an operation. In response, robotic manufacturers have devised a number of built-in safety devices, but these tend to increase the cost of the robotic system, thus placing them out of the reach of surgeons and hospitals.

But like everything connected with technology, future advances in robotic construction, design, and utilization will bring about an era of unprecedented discovery when the use of robots in surgical procedures will be commonplace. In fact, robots have almost taken the place of surgeons in a number of surgical procedures, an area that will be explored in the next section.

Applications of the Technology

For this section, we will examine three specific surgical technologies and applications that utilize robots to a great extent during an operation on a human being. First, according to K. Ahmed, over the last ten years, the application of specialized robotic surgical systems has grown considerably, especially in the area of pelvic surgery that includes urology, colorectal, and gynecology. Thus, as a new methodology in surgical medicine, robotic surgery has “opened new horizons for performing pelvic surgery with precision and accuracy,” and despite the fact that the application of robotic surgery is currently expanding in all surgical fields, “further comparative studies are needed to provide robust guidance” concerning the most appropriate applications of this new and often startling technology in the world of surgery (Ahmed, Khan, Vats, Nagpal, Priest, Patel, Vecht, & Ashrafian, 2009, p. 439).

The most common type of robot-assisted pelvic surgery is known as laparoscopy surgery that involves the use of a laparoscope, an illuminated tube with an optical system that is inserted through the abdominal wall for examining the peritoneal cavity. Although mostly utilized to examine and operate upon organs in the abdominal cavity, this type of surgical application is also used to examine up-close and with minimal invasiveness the liver, the gall bladder, the prostate gland, and other peripheral organs and tissues. It is also utilized to examine organs for signs of cancer and to surgically remove the prostate gland in men and to examine fallopian tubes in women. One of the great advantages to using this type of surgical system is the amount of time saved by the surgeon as compared to traditional surgical procedures (Ahmed, Khan, Vats, Nagpal, Priest, Patel, Vecht, & Ashrafian, 2009, p. 435).

The second type of robot-assisted surgery is known as robotic prostatectomy which is used to examine and often remove the prostate gland in men. As D.I. Lee relates, one of the most important advantages of this type of robotic surgery is that it minimizes patient morbidity while “improving both functional and oncological outcomes,” and despite the fact that robotic prostatectomy is relatively new in the world of non-invasive surgical technology, it is nonetheless being more widely accepted by surgeons. Perhaps this acceptance has something to do with Lee’s estimate that “more than 30,000 patients have undergone this procedure worldwide” with a success rate of about 90% as compared to traditional surgical techniques (2009, p. 180).

Robotic prostatectomy is also the most common type of surgery that utilizes telesurgery via the “integration of multimedia, telecommunications and robotic technologies at a distance.” Within this new form of surgery, surgeons are able to exchange “real-time data of medical information between physicians in different locations” and through the use of telementoring, surgeons are assisted by more experienced surgeons in remote locations. A good example is that an experienced surgeon in a remote location “can teleoperate the robotic arm and guide the primary surgeon through a procedure” (Robotic Surgery, 2012).

The third type of robot-assisted surgery is robotic cardiac surgery that involves operating on the human heart. According to P.I. McConnell, E.W. Schneeberger, and R.E. Michler, much like the technological advances related to robot-assisted pelvic surgery and robotic prostatectomy, robot-assisted cardiac surgery has created new ways to operate on the human heart without having to resort to traditional surgical techniques that for the most part are very invasive, meaning that the entire chest cavity has to be opened which results in large sutures and scarring that last for an entire lifetime. For example, a traditional coronary bypass operation involves opening the chest cavity which leads to a prolonged period of recovery for the patient (2003, p. 22).

In contrast, by utilizing robot-assisted technologies, the chest cavity does not have to be opened and as a result, the patient goes home after a short recovery period with only several small incision entries in the chest and sternum (McConnell, Schneeberger, & Michler, 2003, p. 23). Of course, by utilizing robot-assisted technologies, such as the da Vinci Surgical System, trauma to the heart and chest are minimized, along with the chances of complications. McConnell, Schneeberger, and Michler also point out that robot-assisted cardiac surgery generally falls within four distinct categories or levels, ranging in complexity and robotic utilization, all of which involve assistance through a video system and what are known as port incisions that are performed by the robot (2003, p. 25).

Historical Timeframe

In “Robotic Surgery: A Current Perspective,” A.R. Lanfranco, A.E. Castellanos, J.P. Desai, and W.C. Meyers provides an in-depth look at the history of robotic surgery and how it has gained momentum as a dependable surgical procedure over the last decade. The first time that surgeons began to consider the possibility of minimally invasive surgical techniques dates back to 1987 when the first laparoscopic cholecystectomy was performed which included the use of a laparoscope to remove a patient’s gallbladder. Since 1987, the number of medical procedures performed via a laparoscope and related instruments “has grown at a pace consistent with improvements in technology and the technical skill of surgeons” (2004, p. 16).

One important reason why robotic surgery has increased since the late 1980’s is because of its minimally invasive nature. Incisions, generally made with a scalpel or some other type of cutting instrument, tend to be much smaller and less noticeable; also, the chances of infection are lowered, “hospital stays are shorter, if necessary at all, and convalescence is significantly reduced” (Lanfranco, Castellanos, Desai, & Meyers, 2004, p. 17).

In regards to the use of robots themselves in surgical procedures, the first robotic device was the Puma 560, “a robot used in 1985 to perform neurosurgical biopsies with greater precision.” Then, in 1988, the advanced Puma 560.12 was utilized to perform a transurethral resection of a patient’s prostate gland when then led to the development of PROBOT, “a robot designed specifically for transurethral resection of the prostate.” At about the same time, another robotic system called ROBODOC was designed as a way to “machine or shape the femur with greater precision in hip replacement surgeries” (Lanfranco, Castellanos, Desai, & Meyers, 2004, p. 18).

By the early 1990’s, the science of robotic surgery was well on its way to becoming commonplace in hospitals but only for specific types of surgical procedures, such as hip replacement surgery, the removal of the prostate gland, and operations involving organs within the abdomen cavity. This was also when telesurgery or telepresence surgery became an area of intense interest by surgeons, physicians, and robotic manufacturers. As Lanfranco, Castellanos, Desai, and Meyers point out, the concept of telesurgery “became one of the main driving forces behind the development of surgical robots” which inspired researchers at NASA and the Stanford Research Institute to design a virtual reality system purely intended for surgery on the hand, sometimes referred to as a telemanipulator (2004, p. 19).

In the years that followed, great advances were made in the design and functionality of robot-assisted systems and with the advent of the 21st century, new robotic surgical systems are being utilized in hospitals globally. For instance, in Germany, researchers have developed the Artemis .13 that is made up of “two robotic arms controlled by a surgeon at a control console.” In Italy, a robotic surgical system has been developed specifically for operating on the colon and related organs. Technically, this system “provides the same functions as conventional colonoscopy systems” but utilizes “an inchworm-like locomotion using vacuum suction” (Lanfranco, Castellanos, Desai, & Meyers, 2004, p. 20), thus practically eliminating traditional invasive surgical techniques.

Social and Cultural Aspects of Robotic Surgery

As one might suspect, these and other great advances in the science of robot-assisted surgery has influenced society and culture to a great extent, particularly related to the patients who undergo robot-assisted surgeries and the growing realization of society that these technologically-advanced systems are the wave of the future.

According to C. BenMessaoud, H. Kharrazi, and K.F. MacDorman, perhaps the main impact on society is related to convincing surgeons, hospital administrators, and patients that the use of surgical robots is only going to increase rather than decrease, due to sweeping advances in technology and the growing evidence that in many instances, robot-assisted surgery is superior to traditional surgical techniques and procedures. Therefore, as a result of the continued application of robots, “healthcare institutions and medical technology companies” will greatly benefit, both socially and financially over the course of time, and will help medical schools and their students to “understand the facilitators and barriers to the acceptance and use of robots in surgical procedures” (2011). This acceptance of robots within the social realm of medicine will also help to persuade medical school administrators to include in-depth courses on robot-assisted surgical techniques and procedures which in the long run may influence future medical school graduates to employ robot-assisted systems in their practices.

As for patients, once the benefits of robot-assisted surgical techniques and procedures have been clearly demonstrated to them, either through classroom instruction prior to surgery or via the surgeon demonstrating how a typical robot-assisted surgical procedure is done, acceptance will come with understanding, especially when patients are informed on the non-invasive nature of robot-assisted surgery and how their stay in the hospital for recovery will be cut in half, thus allowing them to return home much earlier and to resume their daily routines and employment.

Of course, as compared to traditional surgical methods, the costs associated with utilizing robot-assisted surgery in a hospital setting are much greater, due to the specialized abilities of surgeons who perform robot-assisted surgeries and the cost of the machines themselves. As BenMessaoud, Kharrazi, and MacDorman remind us, only 14% of hospitals in the state of Indiana currently utilize robot-assisted surgical procedures, and not surprisingly, the percentage is even lower in hospitals located outside of major metropolitan centers. However, as robot-assisted surgical techniques and procedures become more prevalent, potential patients will begin to request that their doctors and physicians utilize robot-assisted systems which eventually will help to significantly lower costs (BenMessaoud, Kharrazi, & MacDorman, 2011).

Conclusion

Like all new forms of technology, as the application of robots in surgery increases in hospitals, improvements will be demanded from surgeons and patients alike. According to Dr. Pedro J. del Nido, Chief of Cardiac Surgery and Senior Associate in Cardiovascular Surgery at Children’s Hospital in the city of Boston, the most important area for improvement, besides scaling down the size of most robots used in surgery (some take up an entire room), is the issue of the absence of tactile sense, “the lack of ability to sense (or feel) what one is doing to tissues” inside the human body (Robotic Surgery, 2012). But Dr. del Nido also points out that advances in technology are slowly making it possible for surgeons to actually feel and sense a surgical procedure via the use of a robot.

But perhaps the most stunning change that may come about in society is related to the fact that most of today’s surgeons that utilize robot-assisted technologies are far younger than their counterparts. As Dr. del Nido relates, “Usually, it is younger surgeons who have been trained to do robotic-assisted procedures. It’s rare to see older surgeons using these advanced surgical systems” (Robotic Surgery, 2012). Thus, the day may arrive when traditional surgical methodologies become redundant, only to be replaced by robot-assisted surgical techniques and procedures that in the present are closer to science fiction than to reality.

References

Ahmed, K., Khan, M.S., Vats, A., Nagpal, K., Priest, O., Patel, V., Vecht, J.A., & Ashrafian, H. (2009). Current status of robotic assisted pelvic surgery and future developments. International Journal of Surgery, (7)5: 431-440.

BenMessaoud, C., Kharrazi, H., & MacDorman, K.F. (2011). Facilitators and barriers to adopting robotic-assisted surgery: Contextualizing the unified theory of acceptance and use of technology. PLos One, (6)1. Retrieved from http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone. 0016395.

Gharagozloo, F.N.F. (2008). Robotic surgery. New York: McGraw Hill Professional.

Lanfranco, A.R., Castellanos, A.E., Desai, J.P., & Meyers, W.C. (2004). Robotic surgery: A current perspective. Annals of Surgery, (239) 1, 14-21.

Lee, D.I. (2009). Robotic prostatectomy: What we have learned and where we are going. Yonsei Medical Journal, (50)2: 177-181.

McConnell, P.I., Schneeberger, E.W., & Michler, R.E. (2003). History and development of robotic cardiac surgery. Problems in General Surgery, (20)2: 20-30.

Robotic Surgery. (2012). Retrieved from http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04.