It wasn’t that long ago that the idea of having robots as doctors was something reserved for Hollywood sci-fi movies. It turns out Star Wars, Alien and countless other films weren’t that far off. Today, we stand at the threshold of a major wave of technology in robotics and miniaturization that could only be dreamed of before.
What does it mean? If you ever need surgery to remove a tumor, malignant or benign, you might be a candidate for robotic surgery. That’s a good thing, because robots have helped surgeons finally level the playing field, greatly reducing the strain to themselves and patients on intricate surgeries and speeding up patient recovery time.
We’re not quite to the point of robotics becoming a common feature in all hospitals, though. Yes, the United States is the world’s leading innovator and practitioner of robotics in the operating room, but we’re also the most expensive healthcare provider per GDP in the world, hands down. The reason why the U.S. is the runaway leader in the exciting new robotics technology is precisely because of cost. Few other nations can afford it.
Robots are very expensive. Only one company, Intuitive Surgical of Sunnyvale, CA, provides the da Vinci Surgical System used by cutting edge surgical centers. With no competition in the marketplace, Intuitive charges nearly $2 million for a shiny new model, complete with an accompanying maintenance agreement and training. That’s a lot of money to cough up for a relatively new technology with roughly the same outcome as patients opting for traditional minimally invasive endoscopic surgery.
Cost is primarily why other hospitals with limited budgets have been slow to adopt the technology. Not only do you need money for robots, but you also need skilled surgeons with thousands of hours of training on qualified candidates. “Without the funding for robots, other countries have not developed surgeons at the same pace as the United States, so in that sense, the U.S. is far and away the leader in this technology,” said Dr. Jacque- Piere Fontaine, a robotic surgery specialist at Moffitt Cancer Center in Tampa, FL.
At Moffitt Cancer Center, one of the largest free standing cancer centers in the United States, robotic surgery is performed daily for patients with prostate, bladder, gynecologic, endocrine, thoracic, and gastrointestinal cancers. According to Dr. Eric Toloza, the results speak for themselves. “Our results with the robot are better than the national average, both open and minimally invasive,” he said.
The funding and research that led to the development of the da Vinci Surgical System was actually conducted in the late 1980s by SRI International, with funding from the Defense Advanced Research Projects Agency (DARPA). You may have heard of DARPA. Their core mission is to maintain the technological superiority of the U.S. military by inventing technologies and gadgets well ahead of their time. In 1969, for example, they put the Internet into play. The da Vinci prototype was developed because the military wanted a way for surgeons to operate remotely on front-line soldiers. There was also a desire to be able to operate on an astronaut in space while the doctor performed the virtual procedure from Earth.
Now, the technology is moving quickly toward more practical and widespread use. Once the problem of lag time is eliminated between the doctor’s movements and corresponding robot movements (especially over long distances), then people in rural communities will have access to the most advanced procedures without having to travel to big cities.
What are the advantages of robots? Right now, other than the accessibility to treatment over long distances, not a lot. However, that should change in the near future as more surgeons become adept at the new technology, and the pool of doctors with low complication rates increases. We’re in a big learning curve for doctors. As they accumulate more hours on the robots, their skill levels will continue to increase. Think of how heart transplant training skyrocketed into today’s commonplace environment after Dr. Christiaan Barnard broke the ice with his successful procedure in 1967. Robotics could well follow the same arc into everyday use.
Doctors with robots view the procedure in threedimensional high def., a large leap forward from the conventional 2D TV monitor for thoracoscopic procedures. Watching a procedure on a TV monitor is counterintuitive, which makes a big difference when it comes to depth of vision. Also, the tools are “wristed” with the robots, which allows for greater dexterity. The “old” way utilizes instruments that are straight sticks, similar to little chopsticks, that act like a fulcrum on a see-saw. The computer in the da Vinci Surgical System actually translates the doctor’s hand movements, which makes it easier to learn and teach. The good news is that tactile feedback in the surgeons’ hands is right around the corner.
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There are ergonomic benefits for the surgeon as well, since he can perform procedures while sitting instead of standing. The new technology also gets rid of the surgeon’s “tremor”. Patients who have opted for this type of procedure have experienced quicker recovery time, smaller incisions, and a reduction in the amount of post-operation meds they took. While less than 5% of procedures are conducted with robots in the U.S., that number is expected to climb, as manufacturers from Japan and Canada introduce competitor robots into the marketplace. Someone has to lead the way in this technology, and even though the U.S. wastes a considerable amount of money on healthcare, we remain innovators in this type of technology, and how it is used.