¶ … speech: Robotics in medicine In the 1950s, robots were envisioned as large, hulking devices with relatively limited capabilities. But "robot, taken from the Czech robota, meaning forced labor, has evolved in meaning from dumb machines that perform menial, repetitive tasks to the highly intelligent anthropomorphic robots of popular culture" (Lanfranco, "Robotics"). Similarly, in the 1980s, video games were primitive and allowed users to manipulate images on a screen with halting, sticky joysticks. Today, it is common to play relatively sophisticated video games via the Internet from around the world. Fusing the modern capabilities of robots and computers has yielded one of the most important developments in modern medicine in recent years: robotic surgery. Robotics can offer people potentially life-saving, less invasive surgery. One day, having surgery performed on you by a doctor in another country may become commonplace. The use of robotic surgery is likely to increase in the future of medicine. This speech will detail the history of robotic surgery; some common procedures and surgical systems; a cost-benefit analysis of the benefits of robotics and the future outlook of robotics.

History of robotics in medicine

According to Brown University's School of Medicine, the origins of modern robotic surgeries can be traced back to 1987 in the form of the first laparoscopic surgeries. This was deemed a breakthrough because laparoscopic surgery allowed for less invasive procedures and shorter hospital stays. There was also a marked reduction in the risk of infection. However, there were also some drawbacks. "The equipment requires a surgeon to move the instruments while watching a video monitor. The surgeon must move in the opposite direction from the target on the monitor to interact with the correct area on the patient so hand-eye coordination, tactile and force feedback, and dexterity aren't compromised" ("History of robotic surgery," Brown School of Medicine). The surgeon, unfortunately, lacks the 'feel' and tactile feedback given by conventional surgery. "Moving the laparoscopic instruments while watching a 2-dimensional video monitor is somewhat counterintuitive. One must move the instrument in the opposite direction from the desired target on the monitor to interact with the site of interest. Hand-eye coordination is therefore compromised" (Lanfranco, "Robotics").

But research on how to improve robotic surgery continued. "Teleprescence surgery…combined virtual reality, robots, and medicine. In the early 1990's, the scientists from the NASA-Ames team joined the Stanford Research Institute (SRA) to develop a telemanipulator for hand surgery" ("History of robotic surgery," Brown School of Medicine). The U.S. Army became especially interested in robotic surgery, since there was a hope that it could bring expert assistance to wounded soldiers in the field of battle. This resulted in the development of the "first non-laparoscopic robot" named the Puma 560 which was used to perform neurosurgical biopsies ("History of robotic surgery," Brown School of Medicine).

These efforts to improve surgery for the Army began to translate into commercial uses, beginning with Computer Motion, Inc. which developed the Automated Endoscopic System for Optimal Positioning (AESOP) "a robotic arm controlled by the surgeon voice commands to manipulate an endoscopic camera" (Lanfranco, "Robotics"). This was followed by other popular forms of robotic surgery, including the Da Vinci and Zeus robotic systems used today (Lanfranco, "Robotics"). The use of robotic surgery in different types of procedures began to expand and today robotics is used for surgeries as diverse as coronary artery bypasses; gall bladder removal, hysterectomies and tubal ligation; kidney removals and transplants; some forms of heart surgery; radical prostatectomy; and hip replacements amongst others (Liou, "Robotic surgery"). "The number and types of surgeries being performed with robots is increasing rapidly as more institutions acquire these systems. Perhaps the most notable use of these systems, however, is in totally endoscopic coronary artery grafting, a procedure formerly outside the limitations of laparoscopic technology" systems (Lanfranco, "Robotics").

How robotic surgery is performed today

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"It can be performed through smaller cuts than open surgery. The small, precise movements that are possible with this type of surgery give it some advantages over standard endoscopic techniques" (Liou, "Robotic surgery"). The surgeon can make much more precise cuts, once again reducing healing time. Furthermore, with the use of robotics "it is easier for the surgeon to use the surgical tools than with laparoscopic surgery through an endoscope. The surgeon can also see the area where the surgery is performed more easily. This method lets the surgeon move in a more comfortable way, as well," reducing physical fatigue (Liou, "Robotic surgery").
Different robotic systems have slightly different methods but a common setup is the so-called 'master slave' system. With this method, "multiple arms operated remotely from a console with video assisted visualization and computer enhancement" (Lanfranco, "Robotics"). For example, in the Zeus system "there are essentially 3 components: a vision cart that holds a dual light source and dual 3-chip cameras, a master console where the operating surgeon sits, and a moveable cart, where 2 instrument arms and the camera arm are mounted" (Lanfranco, "Robotics"). The images generated by the dual cameras are entirely three-dimensional in terms of depth. This "gives the surgeon the illusion that the tips of the instruments are an extension of the control grips, thus giving the impression of being at the surgical site" (Lanfranco, "Robotics").

With the Da Vinci system, another popular system, "the surgeon works from a computer console in the operating room, controlling miniaturized instruments mounted on three robotic arms to make tiny incisions in the patient" while he looks through a 3-D camera magnifying the surgical site" ("Robotic surgery program," UC Health). The surgeons movements are transmitted through the computer system attached to the robot while the surgical team supervises ("Robotic surgery program," UC Health). With all systems, many of the old, traditional problems associated with laparoscopic surgeries are eliminated. In fact, with enhanced vision capabilities and an elimination of surgeon's tremor through the devices, some surgeons have actually come to prefer laparoscopic surgery.

Costs vs. benefits

However, despite these benefits there are also some disadvantages, "with a price tag of a million dollars, their cost is nearly prohibitive. Whether the price of these systems will fall or rise is a matter of conjecture. Some believe that with improvements in technology and as more experience is gained with robotic systems, the price will fall" (Lanfranco, "Robotics"). The systems are also large and cumbersome. "It may be difficult for both the surgical team and the robot to fit into the operating room. Some suggest that miniaturizing the robotic arms and instruments will address the problems associated with their current size… The cost of making room for these robots and the cost of the robots themselves make them an especially expensive technology" (Lanfranco, "Robotics").

However, when one takes a more holistic view of the costs, it could be observed that robotic surgery can actually save a great deal of money. First and foremost, by reducing the size of the incision needed and reducing recovery time, the costs of extended hospital stays can be minimized along with the costly risks of major open surgery in general. Also, tele-manipulated robotics from remote locations can expand access to surgery for persons living in underserved, rural areas as well as soldiers in the field of combat (the original intended beneficiaries of the surgery). By improving the health of underserved populations with expedited surgical methods, costs to the healthcare system as a whole can be reduced.

A more serious objection to robotic surgery is that it is narrowing the skill set of surgeons within certain, specific fields where it is used almost exclusively such as urology and gynecology. In these areas residents are trained "in robotic surgery because we're doing everything robotically or laproscopically. But that means that the residents aren't doing as much open surgery" in contrast to other fields…