The Future of Surgery is Here: Robotics and Artificial Intelligence
By Alexander L Ayzengart MD MPH, Director, Metabolic and Bariatric Surgery, University of Nevada, Reno School of Medicine
For many decades, computer assistance, robotics, and automation have existed in various aspects of our lives, from underwater exploration of Earth’s oceans to the vacuuming of our houses. However, the last three decades have witnessed an exponential growth in medical technology, with robotic platforms entering the world of surgery as one of its most remarkable events. The invention of robotic surgery has revolutionized the approach to numerous surgical fields, becoming a part of a natural and logical evolution of surgery in the direction of ‘lesser invasiveness.’ Robotic-assisted surgery is currently used in almost all surgical disciplines, spreading quickly around the world, and now increasing our capabilities of providing care remotely, even in space.
This technology allows surgeons to perform a wide variety of procedures through small incisions, while minimizing human errors caused by tremors, fatigue, and imprecision. In certain situations, the confined space of the human body poses significant challenges with the maneuverability of the surgeon’s hands and instruments. The addition of robotic-assisted technology has allowed surgeons to visualize the operating space in 3-D and exercise greater control over their movements, thus improving maneuverability, degree of movement, and repeatability of complex techniques. These advantages over traditional laparoscopic (camera-based) or open surgical techniques have delivered significant improvements in postoperative pain, intraoperative blood loss, length of hospital stay, and quicker recovery to complete health. This, in turn, has allowed our surgeons to help a greater variety of challenging patients with complicated comorbidities or advanced illnesses.
With the current pace of progress in the fields of artificial intelligence, telemedicine, and robotics, it’s not unrealistic to expect autonomous surgical robots to enter our hospitals within the next two decades.
The current generation of surgical robots also offers an opportunity to train surgical residents (future surgeons) and medical students in a simulated setting before any contact with patients occurs. Already in 1927, one of the fathers of American surgery – William Mayo – declared: ‘‘There is no excuse today for the surgeon to learn on the patient.” Such forward thinking has eventually resulted in the development of robotic simulators that provide highly realistic virtual reality programs where trainees can hone their surgical skills before applying them in real-life scenarios. The newest of these simulators are now being designed to measure surgical performance in order to allow surgeons to learn from their experience, analyze their mistakes, and refine their skills based on standardized metrics. Deep learning models akin to some forms of rudimentary artificial intelligence are being trained to estimate the performance level and specific surgical skills, which will eventually lead to personalized training paradigms for young surgeons.
Despite their tremendous benefits, current robotic systems have certain disadvantages, such as their large size, cost, cumbersomeness, inability to process qualitative information, and lack of haptic feedback. The biggest challenge today is cost, especially the significant upfront investment required to enter the field of robotic surgery. High maintenance and repair costs, as well as disposable equipment costs, also contribute to the financial barrier to entry. This is only exacerbated by the limited field of competition in surgical robotics, largely due to the concentration of the majority of patents in the hands of a few companies. Lack of widespread training in the use of equipment also creates a barrier to entry for some surgeons and physicians. These limitations can make robotic technology less appealing to practicing surgeons and hospitals, thus dampening their enthusiasm for adopting this new technology.
Future generations of robotic systems are expected to incorporate real-time imaging, haptic feedback, and artificial intelligence guidance, enabling surgeons to better understand anatomical complexities. These systems will assist in suggesting appropriate techniques, warning of potential complications, and predicting the location of diseased or cancerous tissues. Additionally, robots will aid in creating 3D models of organs and tissues, facilitating the development of artificial implants and the planning of complex surgical approaches. Surgical and procedural fields will be the highest users of robotic technology in the foreseeable future. However, newer robotic systems are expected to penetrate almost every other procedural medical field, including specialties such as cardiology, gastroenterology, and interventional radiology. These devices can take over menial, repetitive tasks with greater precision than human operators and allow healthcare personnel to concentrate on human-to-human interactions, thus facilitating personalized clinical care. Robots can also eliminate a substantial number of human errors that result in mistakes with medication administration and selection of appropriate procedures.
The final frontier of robotic-assisted surgery will be to replace the human element in the performance of surgery itself. The application of surgical robotics in space and on the battlefield continues to drive this research into surgical autonomy. With the current pace of progress in the fields of artificial intelligence, telemedicine, and robotics, it’s not unrealistic to expect autonomous surgical robots to enter our hospitals within the next two decades. However, whether this is the type of change that human patients will welcome and accept will need to be seen; patients’ trust and acceptance will be crucial in determining the future success and integration of autonomous surgical robots in everyday medical practice.