May 8, 2021

Surgical robotics success

Robotics is a type of technology, not a product. Robots as products could be a good idea if the problem they are solving, the services they provide, truly warrant them. They usually won’t.

Make solutions to problems, not what sounds cool …

Robotics is a type of technology, not a product. Robots as products could be a good idea if the problem they are solving, the services they provide, truly warrant them. They usually won’t. This article by David Cox for WIRED quite nicely tells the story of a robotics technology finding success. Surgeons have found a solution to dealing with Covid-19 patients in the form of robotics (not necessarily a robot). The driving problem is this:

“I had to say to them, ‘I’m really sorry, we need to operate on you, but at this moment I can’t promise you a date. I don’t know what’s going to happen.” -Charles Evans, head of gastrointestinal surgery at University Hospital Coventry & Warwickshire NHS Trust (UHCW)

It’s a very real problem, sitting in front of countless very smart people, that could affect anybody. In the Covid-19 world, hospitals are risky places. Patients who have to recover after operations put themselves at greater risk of getting the virus and take up hospital beds at the same time. Once a hospital reaches capacity, delays start to occur, and more problems start to arise. Curve logic.

They needed a way to reduce the time patients stay around after surgeries. One reason for staying around is that open surgeries result in a high infection rate. So they stay in the hospital to reduce the risk of infection. One smart way to solve this is to improve the precision of the surgery and reduce the effective surface area for infection. Enter robotics technology.

“It seemed like the best way of getting good cancer surgery done safely,” says Evans. “Usually for a prostate cancer operation, they’d be in hospital for four days, but if done robotically, it’s only for a day.”

Robotic surgery has seen numerous successes already. Typically as robotic assistance or for remote operation. And with Covid-19 has come a surge of interest in more precise and remote operations. The problem became more prominent so people looked to step up the solution.

With robotic surgeries previous successes it presents itself as a real solution to a real problem. So it’s no surprise that’s where money has gone. David Cox cites analysts predict the market value of surgical robots to reach $275 billion (£208b) by 2025. And an increasing number of new companies and startups entering the market. Great. But this is where the article does fall down a little. David says:

“Over the coming decade, the ultimate aim for surgical robotics is to introduce a degree of intelligence into these systems to prove real time feedback and enhance decision making mid-operation. (…) image processing and sensors embedded in the robotic tools could be used to guide the surgeon, and detect things that the human eye cannot pick up on its own.

Medtronic and Intuitive are working on developing augmented reality overlaps capable of pointing out structures that the surgeon would want to avoid, or allowing them to pick up changes in temperature or pressure.”

We’re starting to edge slowly into buzzword territory. Products that sound great rather than solve a problem. These could be real solutions. They boil down to essentially providing the surgeon with more data, more data should lead to better decisions or at least the ability to learn from mistakes. That sounds like a safe bet. But AR for pointing out structures that surgeons should avoid? We’re starting to fall off the problem and on to ‘Let’s see what I can get tech to do’.

The algorithms he later describes are much more promising. Technology that after thousands of hours of training could recognise anatomical features and provide ‘no-cut zones’ to prevent surgeons from mistakenly slicing into critical things. Notice how it’s not a robot. And could be provided as images on a screen or light cast on an area.

I’m writing this because I think surgical robotics is an area in which robotics could succeed. Unfortunately, it is also the intersection point of two incredibly tricky industries. Modern robotics is a new industry where a lot can go wrong, and medicine is an old industry that is full of politics and bureaucracy. Surgical robotics companies are going to need to make sure they focus on the problem and the surgeons using their technology, and the medical industry is going to need to bend to this data-driven, modern approach.

I hope they do.