The Remote Robotic Surgery - Coursework Example

Robotic Surgeries Contents Introduction 3 History of Robotic Surgery 3 Analysis of Cost to Benefit in Robotic Surgery 4 Acquisition Cost 4 Instrumentation 4 General Benefits 4 Maintenance of Equipments 5 Operating Room Time 5 Risks of Robotic Surgeries 5 Mechanical Risks 6 Institutional Risks 6 Benefits of Robotic Surgeries 6 Benefits for the Surgeons 6 Benefits for the Patients 7 Robots vs. Humans 7 Robot Strengths and Weaknesses 8 Human Strengths and Weaknesses 8 Legal and Ethical Issues associated with Robotic Surgeries 9 Conclusion 10 Introduction With recent advancements in the field of science and technology, robots are conquering the world of surgery. The most important reason is that machines have a higher level of precision and stable responses of hands and fingers. Also there is reduced risk of causing infections to the patient’s body. Miniaturization is also one of the top advantages of robotic surgeries. Now minimal invasive techniques have been adopted with the help of the skilled robotic surgeons even in complex surgeries like cardiac, genecology, orthopaedics, neurosurgery and urology etc. Famous kinds of robotic systems to date are Aesop, Hermes, da Vince and many more. Currently, robots are not capable enough to handle surgeries autonomously; they are usually assisting the surgeons. They are basically used as assisting tools to extend the surgical skills. History of Robotic Surgery The first time a robot was used in a surgery was back in 1985 when Puma 560 was used to place a needle in a hip replacement surgery. Later, Intuitive Surgical System introduced a better and advanced robot for surgical use named da Vinci in 1995 followed by Zeus, Aesop and Computer Motion as surgical systems. The first time a Robot was used in prostatic surgery in England in 1988 and this robot was PROBOT. In 1992, ROBODOC was introduced by Integrated Surgical Systems. ROBODOC was specifically designed to handle precise and delicate fittings in the surgery. Recently, in 2001, Zeus robot was also used as a robotic surgeon. In January 99, the first every kidney transplant was carried out by a robot in New Jersey. The same team of surgeons performed similar kidney transplants with full robotic support in the next six months. Recently, in 2010, the Eindhoven University of Technology declared that a Sofie surgical system will be developed there which was claimed to be the first every robot to utilize force feedback. (Rosen& Satava, 2011) Analysis of Cost to Benefit in Robotic Surgery There are a lot of complex variables involved in cost/benefit analysis of robotic surgery. The costs of surgical robots involve acquisition costs, team training expenses, instruments with limited use, equipment maintenance operating room setup etc. Since the field of robotic surgeries is not mature enough it is too early to conclude if the patient’s length of stay, complication rate or the recovery period of the patient ahs any affect due to robotic surgeries. A brief analysis is presented below based on several factors: Acquisition Cost The capital acquisition cost may differ from institution to institution. In some institutions, the capital purchase cost is included in the cost analysis whereas others do not add it in the capital cost. Multidisciplinary team trainings and acquisition of the robots are the basic costs involved in robotic surgeries. Instrumentation The number of robotic instruments that are used in robotic surgeries depends on the severity and nature of the surgery. Current instruments are limited to a specific number of uses however; repeated use of the instruments may save cost. General Benefits Stability of the environment, excellent visualization, motion scaling and tremor reduction are the attributes required of a therapeutic robotic system. If these factors are taken into account, the weaknesses can be overcome and highly effective robotic system can be manufactured. Enhancements in precision may also add in the efficient use of robotics in surgeries. Maintenance of Equipments The cost of repairing, maintaining and servicing of these complex devices include a significant cost. According to experts the maintenance cost of these surgical robots is 10% annually of the acquisition costs involved. However, as a future goal this cost should be reduced significantly. Operating Room Time The operating room time’s cost analysis includes factors like setting up the operating room, draping and docking the robot, undocking or storage time, skin to skin procedure time etc. These factors can be improved to a greater extent, by appropriate team training and careful patient selection. The overall operating time and cost increases when additional staff is required and when complicated patients are selected. Risks of Robotic Surgeries Currently, the surgical robots are operated by experienced surgeons and cannot work autonomously on their own. They do not possess independent functioning features or artificial intelligence to take decisions on their own. The robot is actually used as a high-level sophisticated tool used by surgeons to carry out surgeries and other treatments. However, with various advantages robotic surgeries have there exist a few risks too. The risks can be generally classified as those pertaining to the use of robots and general risks of operative processes. Mechanical Risks Since all electronic or mechanical devices are prone to failure, the risk is present with surgical robots too as the surgical robots are merely complex systems which rely on sophisticated interplay of software and hardware. Currently, the robotic systems are designed with minimal potential failures by adding features like system redundancy, fault tolerance, system alerting and just-in-time maintenance. Institutional Risks Credentialing guidelines should be developed by hospitals and health care institutions which offer robotic surgeries. Appropriate training for the staff and the doctors should be made necessary when commencing a high level program like robotic surgeries. Each institution needs to maintain a policy to remain consistent with the robots manufacturers’ guidelines. Benefits of Robotic Surgeries Greatly improved benefits are obtained from Robotic surgeries from both the surgeon’s and the patient’s points of view. The constant technological advancement in surgical robots have made it easier for both the doctors and the patients to carry out surgeries weather Urology or gynaecology, prostatic or orthopaedic nearly all kinds of surgeries can be performed with robots with the following benefits: Benefits for the Surgeons Tremor Filtration Improved precision, control and range of motion of minute instruments Magnified 3D visualization for optimum viewing Improved access to the patient’s body Improved manipulation or organs, nerves and tissues. Benefits for the Patients Reduced Pain Shorter stay at the Hospitals Shorter recovery period Smaller incision, resulting in reduced infection risks Minimal scarring and less blood loss Robots vs. Humans Recently, there has been the first completely robotic surgery that took place at the McGill University Health Centre (MUHC) in Canada. It was a successful collaborative surgery of two robots. Though Robots have various advantages of greater precision and computerized memories, but still they have mechanical risks involved. Robot-assisted surgeries result in less blood loss and high rate of recovery. According to a recent report, during the last two years up to 73,000 American men went through robotic prostate surgeries. (Rosen & Satava, 2011) Although the Robots are able to repeat extremely sophisticated and delicate procedures with exceptional precision, they are controlled by human doctors. According to (Mussa, 2010), Robots cannot replace doctors but they can assist them incredibly to perform to the highest standards. Even if advancements in technology make them capable enough to carry out surgeries autonomously, there is always the risk present of something going wrong with the robot. However, humans are also not perfect they are prone to making mistakes too but with robots the risk is higher. If psychological perspectives are taken into consideration, patients tend to be more comfortable with human doctors as compared to machines surrounding them. This lessens their anxiety and nervousness of going through a surgery. Robot Strengths and Weaknesses Robots are undoubtedly an amazing invention of the human race, which function like no less than humans with only software and electricity involved. These machines can work for long hours without getting tired or exhausted and can work non-stop to complete a surgery no matter if it success or fails. According to (Hyland, 2008), robotic systems like da Vinci are stable, and untiring and are capable to perform as complex as heart surgeries in less than an hour’s time without blinking. They do not have the risks involved of infecting the patient with Aids or other diseases and are resistant to radiation. Moreover, they have exceptional geometric accuracy and are able to use diversified sensors (like chemical, acoustic and force etc) in surgeries. Besides their strengths, there are also some shortcomings basically in the areas of human characteristics. Like humans, they are not capable of thinking and analyzing for them, at least this is not possible in the current era of technology. According to (Mussa, 2010) robotic surgeons have terrible judgements, limited dexterity and hand to eye coordination. These are some of the simple human characteristics that have been in humans naturally. Robots are weak in these areas for which the humans have to make them efficient enough for surgeries. Important to note that though these robots are designed to perform complex surgeries yet they cannot be relied upon in basic procedures like mending broken bones. Surgical robots have amazing advantages but since, they are still in their infancy they cannot replace human doctors. Human Strengths and Weaknesses The strengths of human surgeons are the weaknesses of robotic surgeons and vice versa. Humans are exceptionally dextrous and have a naturally balanced and efficient hand to eye coordination. Humans are adaptive, flexible and possess great judgement capabilities. Human surgeons can integrate and understand qualitative information quite easily which is not possible for Robots. Human surgeons can be easily instructed and debriefed unlike robots. As far as the weaknesses of humans are concerned, humans are prone to tremor and fatigue, which can cause serious issues in an ongoing surgery. Humans do not have fine geometric precisions and naturally the hands are not developed to make subtle and fine movements. Finally, human body is susceptible to carry various germs and diseases which may cause infections. Legal and Ethical Issues associated with Robotic Surgeries Though there are numerous advantages of a robotic surgery for both the doctors and the patients, there exist some legal and ethical considerations. For example, there arise many questions on jurisdictions particularly related to robotic surgeries. According to (Hyland, 2008), legal concerns arise when a consultant in jurisdiction A, who diagnoses and conducts treatment for a patient in jurisdiction B, is in practice. If a robot is involved in a mistake, there is no one to blame for the resulting harm to the patient. The product liability laws are greatly at stake and untested in robotic surgeries. As with the case of military robots, there is a list of people held accountable on the harms caused by the robots. However this is not the case with surgical robots. To control and reduce the potential risks associated to robotic surgeries, the robots must be designed to obey a set of rules and policies as developed by humans. However, this is definitely not an easy task. A proper code of conduct should be followed by surgical robots in future. According to (Faraz & Payandeh, 2000) if a surgery carried out by a robot goes wrong, the patient is entitled to sue the manufacturer company of the robot and even the hospital or the particular surgeon. This involves a bit of hesitation among the doctors for using robots in their surgeries. Security concerns are also a debatable topic for robotic surgeries. Since computers or other mechanical arms are used in robotic surgeries, the patient’s information should be kept confidential. However, security concerns are unavoidable but with the use of modern technologies like robotic surgeries, the patient’s right should not be interfered. Conclusion Though still in their infancy, Surgical Robots offer a cutting-edge development in the field of surgery. With contact improvements in precision and dexterity, this technology allows human surgeons to conduct operations which were not acquiescent up to past few years. With the numerous benefits of robotic surgeries, there are a few disadvantages too like high cost. Robotic surgeries cannot be cost-effective but they have been found to be really effective in safety and success rate of the surgeries. With the method of minimal invasive surgery, there is lesser loss of blood, and reduced risks of infection. Better visualizations and fewer tremors, makes the surgeries smooth and successful. The flexible robotic arms can perform many tasks at the same time. Hence, like all other fields robots are playing a very important role in surgeries and adding a new dimension to the field of surgery with their tremendous benefits. References Faraz, A., & Payandeh, S. (2000). Engineering approaches to mechanical and robotic design for minimally invasive surgeries (MIS). Boston, Mass. [u.a.: Kluwer. Hyland, T. (2008). Scientific and medical robots. North Mankato, Minn: Smart Apple Media. Kakar, Prem N, Das, Jyotirmoy, Roy, Preeti Mittal, & Pant, Vijaya. (n.d.). Robotic invasion of operation theatre and associated anaesthetic issues: A review. Medknow Publications. Mussa, A. (2010). New technologies in surgical oncology. Dordrecht: Springer. Rosen, J., Hannaford, B., & Satava, R. M. (2011). Surgical robotics: Systems applications and visions. New York: Springer. Read More