Viability of Robotic Surgeries - Essay Example

? Viability of Robotic Surgeries Submitted Submitted by: Executive Summary Undoubtedly, the current human race has witnessed an astonishing incremental curve in the advancement of technology that no other era has ever experienced. The impact of such revolutionizing changes has been marked in every walk of life; communication has been improved with the advent of a diverse range of technological means, the field of graphics has been transformed from black to white to realistic 3D imaging. Even the health industry has transformed itself and treating diseases that were considered fatal in the past. Robotic surgeries have also made their space on the surgery schedule boards in hospitals around the world. A procedure that could once only be imagined for a sci-fi adventure has now become a reality. This extensive inclusion of technology that would have raised eyebrows in the past is being accepted and adopted by doctors around the world as a competitive advantage in hospitals. It was only a matter of time that the increasing trend of medical advancement and equipment technology would lead us to the point where we risk our lives in the hands of a robot. The robot, being controlled by a surgeon, performs the procedure on the patient. The surgeon might be located a few blocks away or across a couple of oceans. The revolutionary step in the field of health sciences has attracted many; however, it is still not free from risks and reservations. Just like any other invention in its initiation phase, robotic surgeries need to take few more steps to ensure minimal risks and dangers for the patients. 1. Introduction The robotic technology, that started with making small machines perform interesting stunts or house chores, have been given a more creditable status in the medical field since they are being used to save human lives. The initiation of the idea of letting robotic arms and other components come in contact with the patient, rather than the surgeon, initiated in 1980s. The innovative concept attracted the technologists in the industry and thus gave way to surgeons being miles away from the physical location of the operation and relying on technology to maintain connection from the surgeon to the robot that operates on the patient. The state of the art surgical procedure is being commonly known as, ‘Da Vinci Surgery’; this name has been given by the manufacturers of this innovative robot technology, Intuitive Surgical Inc. The company, Intuitive Surgical Inc (2013) explained that the name is kept after the inventive artist for his passion for human anatomy and automation in the 1450s. Leonardo Da Vinci is known to design the first robot of its kind in 1495 which was discovered hundreds of years later in 1950s. Leddy, Lendvay and Satava (2010) gave valuable information about the initiation of the idea of such a risky mode of treatment where the surgeon cannot control the consequences of any atypical scenario; robotic surgeries were initially aimed to perform remote surgeries in the battlefield to ensure immediate treatment to soldiers. The robotic equipment was mounted on the top of the vehicles and surgeons were expected to perform the surgery with the aid of the robotic arm while sitting in their own comfortable space. These authors defined it as the surgical procedure that separates the surgeon from the patient by adding a robotic device in the middle of them. With the passage of time, the concept made its way in the civilian territory and started being used for commercial treatment. The passive role of medical equipment and technological devices has been transformed into a major one in an operating room. A diverse range of procedures are now being performed with robots being the direct contact with the patients, namely gynecological and urological procedures and many mores. 2. Research Quality and Patient Safety Division: Commonwealth of Massachusetts Board of Registration in Medicine. (2013) stated that robotic surgeries have started becoming common since the mid-2000s which makes this technology rather immature in the field of health sciences. Ever since its emergence, few advantages have been proven such as reduction in the post operation hospital stay and faster recovery for some successful cases. University of South Carolina (2013) pointed out some of the benefits of robotic surgeries and stated that procedures take place with small incisions and make the patient recover far earlier than conventional surgeries with even lesser pain after the procedure. One of the patients quoted in this research wanted to go to work after two weeks of a major hysterectomy procedure operated by a Da Vinci surgical robot. Whereas, a conventional open surgery involves a significant cut in the abdomen and generally requires 6 to 8 weeks as recovering time. Leddy, Lendvay and Satava (2010) stated an advantage of robotic surgery by striking a comparison between conventional laparoscopic surgeries and robotic surgeries; robotics surgeries are powered to have 3D visualization as well as minimal presence of any tremor by the surgeon’s hand. The arms and wristed robotic components allow the surgeon seven degrees of freedom to achieve greater precision whereas instruments and equipment used in traditional laparoscopic procedures only provide five degrees of freedom. Alongside these benefits of robotic surgeries, there exist multiple drawbacks that make the procedures free from risks and complications. Significant degrees of issues are being reported where successful results are not being attained even in the presence of such an advanced technology. One of the major obstacles in common usage of the technology is the initial investment that is required to transform the typical operating theater into a space that is equipped with robotic technology. Berger et al. (2013) provided some figures that make Da Vinci surgeries an expensive alternate for hospitals; roughly 1.4-2.2 million dollars are required to purchase a single robot for these innovative surgeries. The instruments installed in the machine are advised to be discarded after 10 uses therefore the annual maintenance cost also amounts to a large amount of $100,000-$150,000. Figure 1: An image from a robotic surgery being controlled by a surgeon present at a remote location while medical attendants observe the process. (Naish, 2013, October 21) It would not be wrong to state that almost every patient tends to differ from another on the basis of their conditions and required course of action; typical procedures do not suffice for every patient therefore appropriate measures should always be in place to cater atypical instances in an operating room. Therefore, the occurrence of atypical scenarios cannot be controlled by the medical assistants as effectively as would be possible by a certified surgeon. Quality and Patient Safety Division: Commonwealth of Massachusetts Board of Registration in Medicine. (2013) provided some relevant examples of how surgical cases have not been successful due to the reliance on robotic devices for a direct contact with the patient. One of the case study presented by the author included a patient who was undergoing a surgery for laparoscopic hysterectomy and bilateral salpingo-oophorectomy (removal of tubes and ovaries). As per a typical robot assisted surgery, two surgeons were performing the procedure with the aid of robotic arms and other devices from a remote location. At the completion of the surgery, few complications were witnessed in the recovery of the patient, such as injury in the pelvic sidewall, some part of the sigmoid colon mesentery to be damaged etc. The post-op inquiry of the mishaps made the surgeons reach to a conclusion that robotic assisted surgeries should preferably not be used for complex surgeries since damage and injuries are more likely to take place and extend the recovery time. Figure 2: Setting up Da Vinci surgical robots before the initiation of the surgery. (Naish, 2013, October 21) Another case study discussed by the author raised the possibility of leaving unwanted objects or tissues in the patient’s body. Robots have been programmed by humans and they are bound to act according to a certain workflow. Quality and Patient Safety Division: Commonwealth of Massachusetts Board of Registration in Medicine. (2013) also stated that a patient was scheduled to have a proctosigmoidectomy for a certain part of the body. The next day, it was discovered that some resected tissue could not be detected by the visual scanning and was left inside the body. The programmed description in the robot might not have matched the condition of the resected tissue in the body at that time; therefore it went unnoticed by the robot and thus the surgeon from the indirect view of the patient. The patient had to undergo another surgery the next day to take out the unwanted tissue. The investigation of this mishap concluded that the use of robotic device added complexities to the procedure and the surgeon had to pay more attention to every little detail which would not be the case in a laparoscopic surgery. It was also advised that a laparoscope should be used in the future to perform the scanning activity before closing the patient. Lack of training in the new technology also tends to creates hurdles in the achievement of successful results. New York Daily News (2013, April 9) reported that Food and Drug Administration (FDA) has granted approval to Da Vinci surgical robots only for soft tissue surgeries. Soft tissue surgeries tend to include all types of surgery, excluding any procedure related to bones, joints, heart or the nervous system. The reason for such limited approval might be the sensitivity and immaturity of the technology. 3. Data Analysis The common acceptance of robots in the 21st century has leaped mankind to such times where one has a choice of risking his life in the hands of a human or a machine. Many have opted for the latter in the past few years and the instances of unsuccessful cases have been significantly higher than expected. Intuitive Surgical, being the producer of the surgical robots, Da Vinci Robots, are currently dealing with 26 lawsuits that have been filed by people who underwent Da Vinci robotic surgeries. The grievances that these patients included in their lawsuits involve injury in the blood vessels and initiation of sepsis (an infection in the operated organs that can prove to be fatal sometimes). Naish (2013, October 21) reported that Food and Drug Administration (FDA) has received almost 500 complaints about this California based company and the product that they are promoting in the market since 2012. The significant degree of complaints against robotic surgery in the short span since its emergence has raised concerns about its viability and reliability. Naish also pointed out a common concern that is being reported to organizations like Food and Drug Administration (FDA) of the possibility of electric current travelling from the robot onto the patient’s body. Sheena Wilson, a 45 year old patient, who underwent robotic surgery, filed a lawsuit against Intuitive Surgery in 2012 for knowing about the risk of the travelling of the electric shock into her body but still letting the surgeons use it for surgical procedures. 4. Conclusion Alongside changes in every experience in the modern world, even centuries old relationship of a healer with his patient has been altered with the interception of technology. The instantaneous decisions required by a surgeon are being replaced with a surgical robot operating on the patient while giving the surgeon an indirect view through scanning devices in the surgical robot. It is not an unusual instance for a surgeon to physically touch the organs, tissues with his own hands to predict its condition during an operation. This kind of physical examination is not possible with Da Vinci robots assisted surgeries since the surgeon sits at a different location than the operation on a platform that resembles a game console controlling the surgery. The concept of smaller incisions and greater accuracy has been made possible with robotic surgeries; however these positive aspects do not seem to guarantee successful surgeries all the time. On the contrary, robotic arms and components attached to the machine are also known to cause tissue damage or injury in different organs. Even the 3D scanning integrated in the Da Vinci surgical robot has not been able to deduct the presence of unwanted tissues in some cases that caused longevity in the recovery time of the patients. The initial investment to setup a space viable for performing robotic surgeries requires an enormous amount that only large organizations shall be able to afford. Annual maintenance of these robots also proves to be an ongoing medical expense. 5. Recommendations In the light of the research conducted, it is recommended that Da Vinci robotic assisted surgeries should only be carried out for simpler surgeries. The approval by FDA to only undertake soft tissue surgeries with robots speaks volumes about their lack of complete reliance on the respective technology. Every case should be analyzed in detail for the possibility of any complication arising in the middle of a robotic surgery since the results of complex robotic surgeries are not very convincing. The case studies that have been included in this research reflect that complex surgeries do not deliver the expected results of precision and reduction of patients’ recovery time. In addition to such precautionary measures, surgeons and medical attendants should also attain effective training regarding this state of the art technology. References Advincula, A., et al. (2007), A Consensus Document on Robotic Surgery, SAGES – Society of American Gastrointestinal and Endoscopic Surgeons. Berger, J. S., et al. (2013), Anesthetic Considerations for Robot-Assisted Gynecologic and Urology Surgery, Anesthesia and Clinical Research, Vol. 4, Issue 8, http://dx.doi.org/10.4172/2155-6148.1000345. Intuitive Surgical Inc., 2013, http://www.intuitivesurgical.com/company/history/ Leddy, L. S., Lendvay, T. S., Satava, R. M., (2010), Robotic surgery: applications and cost Effectiveness, Dove Press Journal: Open Access Surgery. Naish, J., (2013, October 21), Would YOU put your life in the hands of a robot surgeon?, DailyMail UK. Quality and Patient Safety Division: Commonwealth of Massachusetts Board of Registration in Medicine. (2013). Advisory on Robot-Assisted Surgery. Massachussets, USA. The Associated Press, (2013, April 9), Surgical robot da Vinci scrutinized by FDA after deaths, other surgical nightmares, New York Daily News. University of South Carolina. (2013). Robotic Surgery, Healthwise, Spring 2013. Read More