From a console in St. Joseph’s Hospital in Hamilton, Canada, Mehran Anvari operates on patients who are located almost 250 miles away. Controlling a robot surgeon with joysticks, Anvari, a physician, applies his expertise as the machine slices and stitches human tissue. Today, remote robotic surgery has become a standard operating procedure, but fully autonomous surgical robots do not yet exist. The scalpel is still controlled by the human surgeon, not the robot. Will this change in the future as technology advances? Will we see “smart” robots performing entire surgical procedures without human oversight, making complex decisions in response to real-time feedback? Recent developments in robotic surgery and artificial intelligence (AI) certainly suggest so. Robots are now beginning to perform some procedures autonomously, albeit with physician oversight. Today, the limiting factor for remote surgeries is network bandwidth and speed, restricting such procedures to hospital environments or locations where wired or highspeed WiFi connectivity and network bandwidth are non-issues. The start of the 5G network rollout promises a fast and secure platform for robots augmented with AI, which, once mainstream, could facilitate an increase in surgical efficacy, efficiency, and access to specialized surgical procedures.
Robotic surgery today
The da Vinci robot has perhaps garnered the most attention in the medical sphere, as it allows surgeons to deftly manipulate robotic limbs in order to perform surgeries with high precision and minimal invasion that would be impossible to do with the human hand. Surgery represents the apex of high-risk patient procedures because it’s invasive and extremely dependent on the physical state of the surgeon at the time of the procedure (i.e. hand tremors, lack of concentration, fatigue, and vision problems). The da Vinci robot blends the best of two worlds—a human surgeon’s intelligence, foresight, and sound judgement with the technical precision and mastery that only a machine can offer. Still, in the most complex surgical procedures such as neurosurgery, where extremely sensitive maneuvers are necessary, robots are less dexterous than human surgeons.
A newer generation of smaller, less expensive surgical robots are bringing the technology into mainstream use. The da Vinci robot is large and exorbitantly expensive, costing $2 million for the equipment and up to $170,000 a year for maintenance. Today, the continual miniaturization of electronics is enabling smarter circuits that can be fitted into smaller, lighter, and more versatile robotic arms. CMR Surgical recently introduced Versius, a robot that comprises a set of five independent arms, each with its own base. Each arm contains intelligence and sensing capabilities that allows it to move in response to a surgeon’s commands as well as respond to the touch of the assisting surgical staff. Versius offers surgeons greater operational flexibility and customization during surgery. Because the arms are small and light, surgeons can easily move the different arms from one operating theater to another as well as tailor the number of arms used in the procedure at hand.
Augmenting robotic surgery with AI and remote monitoring
While today’s robotic surgery is still performed with complete surgeon oversight, the future could see machine learning play a large part, with robots learning how to perform entire procedures autonomously after “training” with living surgeons. Machine learning uses algorithms that have the capacity to acquire and respond to data, improving their performance as they react to feedback. Verb Surgical, founded in 2015, hopes to build robots that can learn from one another and advise surgeons on best practices. The robots would collect data and videos of every procedure they perform, and this data would then be fed to machine-learning algorithms for analysis to determine what works best. Eventually, Verb Surgical hopes the robots could start helping surgeons to determine sick tissue from healthy, or what to do in unexpected situations.
The first step towards fully autonomous robotic surgery lies in replacing the surgeon’s hands with supervision instead. Shademen designed a Smart Tissue Autonomous Robot, or STAR, which consists of tools for suturing, fluorescent and three-dimensional imaging, force sensing, and submillimeter positioning. Using STAR on a soft-tissue surgery, the creators of the robot successfully demonstrated that supervised autonomous surgery was superior to that provided by expert surgeons. The system relies on an autonomous suturing algorithm, and a computer program generates a plan to complete complex surgical tasks on deformable, or disfigured, soft tissue, such as suturing and intestinal anastomosis, (the union of parts or branches such as blood vessels). Autonomous robotic surgery augmented with artificial intelligence could extend the benefits currently offered. Robots that could make sound decisions in response to real-time feedback would eliminate the need for live surgeons, at least for less complicated procedures. As a result, more patients would have access to high-quality surgical procedures without having to contend with a wait-list to benefit from a specialized surgeon’s skills.
Intraoperative benefits aside, autonomous robotic surgery could comprise an entire system of pre- and postoperative patient care, in which remote monitoring and artificial intelligence could combine to provide real-time diagnostic feedback to maximize patient throughput and improve patient outcomes. Before surgery, patients could be remotely monitored in real-time, providing autonomous surgical robots with the necessary information to accurately identify potential issues that might arise during the surgical procedure, and improve diagnostic accuracy. Post-surgery, patients could be monitored in real-time at-home. A recent research study suggests that nearly 50 million patients suffer postoperative complications each year; cardiovascular complications are a major source of adverse outcomes with conditions including arrhythmias and heart attacks. Luckily, remote, real-time monitors are now gaining traction and are crucial for post-operative care to flag life-threatening complications, reduce recovery times, and decrease the hospital readmission rates for postoperative patients.
Cellular connectivity: A new future for remote robotics
The advent of the 5G network is particularly exciting for remote surgery. While remote surgery performed with devices like the da Vinci robot allows surgeons to deftly manipulate robotic limbs with high precision and minimal invasion, the current bandwidth of cellular networks limit the scope and location of surgical procedures that can be performed. Wired and high-speed wireless connections are not readily available in rural or expanded suburban areas, limiting remote surgical accessibility. The higher speeds of 5G networks could enable more complex procedures in more remote locations, extending access. Faster and more secure cellular connectivity will also be crucial for robots augmented with artificial intelligence. For these robots, making quick and accurate decisions in response to real-time and unforeseen events will require a short feedback loop; disrupted connectivity could be life-threatening for patients.
Robotic surgery powered by artificial intelligence is still just a whispered suggestion for obvious reasons—surgeries are by very nature complicated and unpredictable—and robots may never have the same exposure to repetitive feedback as seen in industrial robotics. And yet we continue to march steadily towards this long-awaited goal. Current robot-assisted surgery brings enhanced efficacy, efficiency, and access to surgical techniques. With quicker and less invasive treatments, patients recover faster. Surgeons are less prone to make errors, and the need for repeat operations also declines. These benefits could be made even greater with artificial intelligence. The technology and science are developing rapidly, but the principal issue is whether patients will be comfortable entrusting surgical procedures entirely to robots. Perhaps the biggest question we ought to be asking ourselves now is, “Would I trust a robot to repair my heart?”
Waqaas Al-Siddiq is founder and CEO of Biotricity, a biometric remote monitoring products and services company.
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