What's all this robo-surgery stitch-up about - anyhow?

Being served drinks by a robot in a glittering high-tech bar is one thing but would you want one operating autonomously on one of your major organs?

Mercifully, the scalpel-wielding-droid question does not currently arise for patients who are just about to sign the hospital consent form prior to going under the surgeon's knife. But it might in the future.

How come? Well it has already been shown that when it comes to suturing skills robots can stitch-up a patient just as well as and, in some cases, far better than a human surgeon. And we're not talking minor cuts and wounds here.

Experiments have already demonstrated that a robot can stitch together a pig's large bowel during open surgery just as well as any human surgeon.

This is seen as an important development mainly because the bowel is soft tissue which when surgically worked on moves. The robot had to be able to cope with this and still place sutures in precisely the right location which it managed perfectly.

This is a significant finding when you consider that in the United States about 52,000 soft tissues procedures are performed annually.

Currently of course any robotic assisted surgery is supervised by a human surgeon who can intervene and take control at any time. It's known as the da Vinci Surgical System and was developed almost 20 years ago, so it's been around a long time. And it is this situation that robotic and medical professional pioneers are addressing.

They say that unless we move forward with robotic surgery development the whole science stays log-jammed where it is.

However, during that 20 year period hard and software technology has made giant strides and some of these are either currently impacting on the development of robotic surgery or certainly will do in the very near future.

Artificial Intelligence

Not the least of these technological advances focus around Artificial Intelligence (AI) and RoboDoc prototypes exploiting this technology are already being trialled.

One plan is that robot surgical systems will use AI to learn from each other via Internet communications. The RoboDocs will automatically record all their medical data and experiences into a databank where AI algorithms will analyse and indentify what are the most likely gold-standard medical procedures that should be widely adopted. A fundamental logic here is that computer driven robots can store massive amounts of data; far more than us mere mortals. And that data could provide answers for fellow RoboDocs and of course their human colleagues.

Looking into the future it may be possible for robots to perform coronary bypass operations while the patient's heart is still beating. How so? The answer lies in an algorithm called Active Relative Motion Cancellation. Put simply the robot tools using this algorithm sense the heart movement and cancel out the motion of the heart at the point of surgery. This allows the human surgeon controlling the operation to proceed as if the heart was stationary.

Role Reversal

Of course that sort of robotic assistance is very experimental and perhaps closer to reality is how a robot can control what the human surgeon is doing – a kind of role reversal.

Using the electronically created images from MRI and Computed Tomography a robot can see when a surgeon is operating too close to neighbouring parts of the body with the risk of severely damaging neighbouring organs, nerves or arteries. You may ask why the human surgeon wouldn't see them and that's because a lot of operations are performed in very awkward body situations and nearby surgical hazards may be obscured from view. But by using the pre-op electronic images the robot would see them and could then restrict the robotic arm movements that the surgeon is using during the procedure.

Forget Emotions and Egos

Another interesting aspect to robotic surgery is how robots could work together during the same operating procedure. Robots do not have emotions or egos as to which of them may or may not be the best surgeon; unlike some of their human counterparts and such collaborative robotic surgery has already been performed during the repair of spinal factures.

Two different robots were used, the Mazor Robotics Renaissance Guidance System which obviates the need for freehand maneuvers and switches them to purely computer control and the Siemens Artis Zeego Robotic Technology which deals with patient positioning requirements during the procedure.

But possible future robotic surgery wont all be about Artificial Intelligence. Augmented Reality (AR) will have a massive part to play. It has already been used to create 3D images of tumours which means surgeons can identify, evaluate and successfully operate on them even when they are located in surgically dangerous positions in the body.

But not all robotic medical work will involve sophisticated, headline-grabbing surgical procedures.

There is the everyday stuff that robots could handle better than humans. Analysis of medical images is one area. It is estimated that in America over 300 million radiology images are created every year and a robot could potentially analyse individual ones in microseconds and then transmit the clinical findings to the appropriate medical departments. In other words, diagnosis and triage all in one droid.

So make no mistake the march of the RoboDoc droids is well underway. In 2017 there were close to 5,200 working in hospitals and taking part in close to a million surgical procedures.

And its not only medical professionals that are encouraging the development of ever more sophisticated systems. The corporate bean counters are licking their lips at the prospect as well. Why? Well industry analysts are predicting that sales of medical robotics will reach nearly €25billion in less than five years.

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