Robotic surgery!

Since I had robotic surgery yesterday, I’ve become fascinated with this marvelous innovation in medicine. I’ve looked at a bunch of videos, and found two to post: one with a general introduction to the machines and their use, from the BBC, and the other showing how dextrous the robot is.

When I was wheeled into the operating theater, I asked to see the robot, and I’m pretty sure it was one of the da Vinci machines. It was all covered with plastic, for it had been sterilized, and it was on the other side of the room. (I don’t know whether the surgeon was next to me when he wielded it.)

I can see now why they told me I couldn’t have local anesthesia, as I had requested, to observe my operation: imagine how freaked out you’d be to see those big metal arms descending on your belly! But I wish they’d at least made a video of my surgery.

So here’s a general introduction to robotic surgery from the BBC. Note that this is a general news report, so watch only up to 9:23.

And this shows how good the machine is: a surgery robot sutures a grape. I see now that they put plastic “ports” into the small incisions, and that two arms can operate through a single port.

In many ways this is the future of surgery. I can’t imagine any other way to get an appendectomy.

27 Comments

  1. Karen Hodges
    Posted August 24, 2019 at 12:43 pm | Permalink

    Jerry,

    I am so glad you’re on the mend. Continuing positive thoughts for you.

    I had a parasesophagael hernia repair, my stomach had taken up residence under my left lung, 9 August at Massachusetts General Hospital. My surgeon used the the DaVinci Robot. I had every complication imagined and unimagined including a near fatal drug reaction BUT I experienced very little pain from my 5 tiny incisions. If I had had the traditional surgery I would have been in a lot more pain and it may have made the complications more difficult to manage.

    Peace,
    Karen

  2. Posted August 24, 2019 at 12:56 pm | Permalink

    We possibly don’t recognise it, since it is so much a part of our everyday dives, but we are living within a technological revolution as profound as any taking place in former times -agricultural, scientific, or industrial. As unsettling as certain of the consequences and implications of this progress in information technology, it is wonderfully pleasing to also witness beneficial developments as robotic surgery presented here. I myself am shortly to be fitted with a pacemaker…. a miniaturised but sophisticated microcomputer based system that will adaptively and dynamically insure that my heart continues to remain effective, and even will communicates with my cardiologist for “system tuning” by wifi. I am to become a bionic man indeed!!

    • GBJames
      Posted August 24, 2019 at 1:04 pm | Permalink

      I joined the Brigade of Semi Mechanical Humans a few years back with a complete hip replacement, done the old fashioned way… knives, saws, and big old scar to tell the tale.

      Welcome to the club.

  3. bugfolder
    Posted August 24, 2019 at 1:20 pm | Permalink

    And origami is making it possible to make those surgical tools even smaller, see here:

    https://phys.org/news/2016-03-surgical-tools-smaller-origami-surgery.html

    (Shamelessness warning: one of your faithful readers has a cameo in one of the videos on that page.)

    • Posted August 24, 2019 at 2:18 pm | Permalink

      It’s Robert Lang! What a cool application of origami.

    • rickflick
      Posted August 24, 2019 at 3:40 pm | Permalink

      Very cool indeed.

      • Heather Hastie
        Posted August 24, 2019 at 8:57 pm | Permalink

        That’s exactly the words I was going to use, so I’ll just put:

        +1!

  4. Michael Fisher
    Posted August 24, 2019 at 1:35 pm | Permalink

    The videos: Things have moved on in the short time since. Some robotic assisted surgeons now benefit from haptic feedback & a later da Vinci model [as used by Guy’s & St Thomas’ NHS Foundation Trust in London SE1] has four tool arms enabling two humans to be in there at once. No haptics in their case [I believe] & they use a separate laparoscope before ops to feel out interesting hard lumpy bits!

    IMO it will take decades to generally ramp up unless unit costs plunge, training is sped up/simplified & the process of authorisation for new types of ops is streamlined. Two of the problems are that the teams around each bot have to work flawlessly together [more so than more trad approaches] & it takes hundreds of real [non-simulations] ops to be a proficient operator – at the beginning an operator takes a lot longer than with the cheaper trad approach. Also insurance companies not putting bots into their thinking.

    • rickflick
      Posted August 24, 2019 at 3:43 pm | Permalink

      A comment on the loss of a patient in one of the videos was that the team lacked sufficient experience. Hours of time with simulators is necessary to build experience safely.

  5. Mark R.
    Posted August 24, 2019 at 1:42 pm | Permalink

    If only human politics could advance and improve like human technology. sigh…

  6. ploubere
    Posted August 24, 2019 at 1:50 pm | Permalink

    I’d like to see data as to whether robot outcomes are better than human ones.

    • Posted August 24, 2019 at 2:20 pm | Permalink

      In terms of pain and speed of healing, I think there are plenty of data, and surely less pain and faster healing constitutes a “better” outcome. I know two people who have had both traditional and laparoscopic hernia surgery, and both say there was a world of difference in the pain and in speed of healing. Granted, that’s just N = 2, but I think there are a lot more data.

    • Michael Fisher
      Posted August 24, 2019 at 2:28 pm | Permalink

      “…data as to whether robot outcomes are better than human ones.”

      [1] There are no robot outcomes yet – we are on robot assisted surgery right now.

      [2] A case comparison side-by-side, one on one, comes down in favour of ‘bot assisted. That’s why they’re in commercial production.

      [3] BUT in an ecosystem, global sense where there’s limits on work hours, staff, training & budgets it’s still the traditional laparoscopy techniques that’s best over all. With tried & tested laparoscopy you can throughput more patients for a given budget or staff size which equates to a greater overall well being. And bed stays are not THAT much more with trad laparoscopy. One of these machines & the specialist trained teams required to coax it will swallow up the annual medical budgets of entire hospitals in most of the world. That’s why robot assist is double the cost per op & only catching on [for now] in the first world.

      There’s plenty about all the above on the net if more detail required.

  7. Randall Schenck
    Posted August 24, 2019 at 1:53 pm | Permalink

    This is a short video I found on line to explain the TAVR procedure I had a while back:

    https://mendedhearts.org/video/tavr-procedure-video/

    • rickflick
      Posted August 24, 2019 at 3:48 pm | Permalink

      Amazing. They did not show suturing in the new valve. Is that done via the long line through the artery? Or is the new valve self-attaching?

      • Randall Schenck
        Posted August 24, 2019 at 7:06 pm | Permalink

        Sorry, I did not check back on this. There is no suturing. The new valve just stays in place based on the design. Notice they go in through both left and right arteries and this is done with the organic value only. Not the artificial or metal valve. So how long it last becomes a question. However, if you need another, they can just do it again. The only really strange feeling in the operation is right as the new valve is set and opened. They kind of stop your heart for a few seconds and that is a pretty strange feeling. I’m told this is necessary to set the valve in place. Beats the hell out of open heart surgery and only in the hospital over night.

        • rickflick
          Posted August 24, 2019 at 9:06 pm | Permalink

          That’s got to be a real pleasure to know your life is extended productively by virtue of a simple mechanical invention. I feel elated to live in this time (although people 200 years from now will feel deep sympathy and regret that we had to withstand the things that we do).

          • Randall Schenck
            Posted August 25, 2019 at 7:25 am | Permalink

            Yes, I am very luck to be in the right place at the right time to go this way. I have experienced the big time open heart surgery back in 2009 because of a type A, aortic aneurysm. These are sometime caused when you have the birth defect of the wrong type of valve. I guess it’s unlucky and then lucky.

  8. Jonathan Gallant
    Posted August 24, 2019 at 2:13 pm | Permalink

    During the heroic age of the DNA revolution—say from 1976 (discovery of proto-oncogenes by Bishop and Varmus) to the present day—publicists overemphasized the medical implications of getting DNA sequence information. And, indeed, we impressed our students when we told them all about cancer genes, and showed exactly which nucleotide in the sequence of this or that proto-oncogene led to malignancy. What impresses me more and more is that it is the computer, rather than the DNA revolution, that has affected medical practice. Computer technology has revolutionized imaging, and radiotherapy, and laparoscopic and robotic surgery. At the same time, our knowledge of the nucleotide sequence of oncogenes has not much affected the treatment of a malignancy, which is mostly still based on cutting it out or zapping it, just as it was 50 years ago. But today, both the surgery and the radiosurgery will be computer-guided.

  9. Ken Kukec
    Posted August 24, 2019 at 2:23 pm | Permalink

    Looks like a weapon Ripley coulda used against the Alien.

    • Randall Schenck
      Posted August 24, 2019 at 2:51 pm | Permalink

      That was actually a lift truck or fork lift in Sci Fi. Ripley must have been a warehouse worker in her previous job.

    • Posted August 24, 2019 at 3:35 pm | Permalink

      There is a scene in one of the Alien movies Prometheus (2012) where a robot removes a gestating alien from the stomach of a ships crew member, a voice directed robot and i thought very damn cool.

  10. Posted August 24, 2019 at 2:49 pm | Permalink

    What’s fascinating to me is what’s next. Currently there are human beings at the control surfaces of the DaVinci robot. In the not so distant future, the simple procedures will be autonomous, completely performed by robots. It’s already happening in radiology and pathology where AI learning is creating more accurate diagnoses than humans. How long before we are wheeled in and the robot is parked at the table and performs the entire operation? Who wants to go first? By the way the robot is a wonderful tool but wonderfully expensive. The debate in surgery is whether it is that much better than what we have been doing minimally invasively for years and years. I think it is, but not everyone agrees.

  11. Posted August 24, 2019 at 5:11 pm | Permalink

    Glad you survived!

    As for wanting local anesthesia, how that works out depends on the person. A decade ago my wife had a knee replaced, and she was extremely eager to watch the procedure, so she had only local. I couldn’t do that. She said it was rather odd watching the doctor move the detached lower leg around as he drilled and cut and such, but she really liked watching what was going on.

    • rickflick
      Posted August 24, 2019 at 8:04 pm | Permalink

      As I mentioned somewhere above, you can watch that very same procedure, in full, living, color on YT. I agree with your wife, it would be worth staying awake for.

  12. Posted August 28, 2019 at 8:17 am | Permalink

    I still don’t understand the “they did surgery on a grape” meme.

    -Ryan


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