Are Robots Taking Over Medicine?

Robotic surgery debuted in 1985, when the first surgical robot, PUMA 560, was used in a brain biopsy procedure. One might be surprised to find out that the idea of robotics being utilised during surgery was thought of as early as in 1967, considering the first robot was invented only a decade prior. Although the technology has been under constant development for a significant amount of time, scepticism towards robots in healthcare appears to be deeply-rooted in the essence of general public opinion.

This sense of scepticism may very well stem from anything from negative associations with the term “robot” to a lack of knowledge concerning the technological aspects of the procedures. The leading question which one must ask in order to form a nuanced opinion on the matter is what does the presence of a robot in the operating room entail practically, and furthermore, what are the ethical implications of robots being involved in our healthcare systems? 

Technology - What’s the deal? 

Robotic surgery, also referred to as robot assisted surgery, is most commonly associated with minimally invasive procedures. We identify minimally invasive procedures as those where the surgeon operates through tiny incisions as opposed to traditional open surgery. The most significant benefits to minimally invasive surgery (MIS) include shorter recovery time, less pain inflicted on the patient, and the absence of disfiguring scars. Adding robots to the equation of MIS enables the surgeon to perform a variety of complex procedures with greater precision, flexibility and control. Additionally, the robot provides a clear view of the area, which allows the surgeon full supervision of the ongoing surgery. 

It is a common misconception that robotic surgery is performed by an independent and self-managing robot, but in reality, the robot has no independent power and is never the one in control. A more accurate way of describing the robot would be to refer to it as a robotic system which is entirely controlled by the surgeon who is actively performing the surgery.

The system consists of a set of robotic arms with mini instruments attached to them, a special camera that provides a high-definition, magnified 3D view of the surgical area, and a computer console from which the surgeon controls the arms and camera’s every move. The technology is highly advanced and customised specifically for its purpose.  In simple terms, the robot does not run on “auto-pilot” and it has no “mind” or “consciousness” of its own. The robot functions merely as a tool;  a tool that requires extensive training and in-depth knowledge of how it ought to be used before one has the permission to use it.  

There are a multitude of courses on MIS involving robotic surgery, and the surgeons who perform these types of procedures are highly educated and well experienced within the field. Robotic surgery is performed within a variety of medical specialities such as cardiothoracic surgery, colorectal surgery, gastroenterology, gynecology, and neurology, to state a few.

Evaluation - Benefits and disadvantages 

The technology has undeniably been revolutionary, as it has enabled surgeons to perform life-saving operations in a more effective way, in addition to granting potential for further medical research. The major benefits of robotic surgery are linked to those of minimally invasive surgery,  where the robot facilitates the procedures immensely. The technology has allowed for quicker procedures, shorter recovery time, and a proven decrease in complications post-surgery. If we were to evaluate robotic surgery from a technological standpoint, its impact has been almost exclusively positive, as it benefits both patients and surgeons. Additionally, it all adds up to favouring the hospitals in the long run, as more patients can be treated within a shorter amount of time, without having to re-enter the OR for reoccurring or resurrecting medical issues. 

However, high technology comes at a high cost. Generally speaking, the robots are not easily accessible, and currently, robotic surgery is offered almost exclusively at larger hospitals that can afford the costs. Today, the most commonly used system is the Da Vinci Surgical System which is worth approximately 2.6 million USD per robot. The additional costs of personnel training and maintenance must also be taken into consideration. Therefore, the economic outlook varies depending on who you ask. Some argue that the prices are unrealistic as the benefits don’t outweigh the heavy cost, whereas others have stated that the long-term benefits do, in fact, make up for the hefty price tag. The economic issue is partially responsible for preventing the technology from becoming more mainstream within modern medicine.     

Ethics - The big question

Despite the many advantages of robotic surgery, criticism seems to be nearly inevitable from a moral standpoint. How do we account for the ethical implications that follow when we allow robots to interfere with healthcare? Who is to be held accountable if a robotic procedure doesn’t play out according to plan? Because the unsettling aspect of robotic surgery, from a public point of view, is that the inhumane characteristics one associates with robots doesn’t correspond with the humane nature of medical practice.

A patient is perhaps at their most vulnerable as they undergo surgery. It is a procedure unlike any other. To go under the knife requires an immense level of trust. This trust usually does not stem from a close and personal relationship with the surgeon. Rather, it is based on the assumption of being able to rely on the existence of empathy.

It is a form of trust based on human solidarity. The same trust could therefore never be established with a robot. Robots may be programmed to carry out various physical tasks, including recognizing emotional cues and responding accordingly. However a robot could never be taught the fundamental quality of human consciousness, which at its very core could be regarded as empathy. 

Although this ought to be taken into consideration as technology advances, one mustn't regard the inhumane nature of robots as a disadvantage when evaluating the current surgical robotic systems. The current systems have no need for any humane qualities such as compassion, empathy, or a general sense of solidarity, as they lack the ability to function independently. As previously disclosed, the so-called robots utilised during surgery are not pre-programmed to carry out any series of actions automatically. They are comparable to a car. In the occurrence of a car accident, the vehicle could never be held accountable. The same principle could be applied to robotic surgery. The robot could never be, and has no reason to ever be, held accountable; the responsibility will always lie in the hands of the surgeon.