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12 January 2018

Could robotic surgeons be the key to speeding up NHS waiting times?

By Sanjana Varghese

Robots performing surgery might sound like the plot of a science fiction movie – but it’s more fact than fantasy. Recent figures show that a third of all hospitals in the U.S.A have at least one kind of robotic console  which typically enable surgeons to carry out specific operations with more precision and far quicker.

It’s come over the pond too. Guy’s and St.Thomas Hospital in south London has carried out over 300 robot-assisted surgeries.The Royal Marsden NHS Trust in Chelsea has been using the industry standard Da Vinci model for over a decade, and introduced another model in 2015. They recently announced their plans for a robotic surgeon fellowship, training surgeons cross-speciality about how to use these consoles.

Much has already been made of how automation will affect  and change many of our industries, through literally taking human’s jobs, but it’s also worth considering how they may make those jobs better for everyone involved. Robotic – assisted surgery could help bolster the health of the ailing NHS, which has seen the effects of underfunding and a shortage of personnel reach their breaking point over the last few months.

In the short term, winter, and its associated illnesses, NHS waiting times have spiked too, often exacerbating illnesses. With no major changes planned, it seems as though the situation may only worsen.

Some of those issues – such as the cuts and increasing pressure on doctors on shift – are structural and cannot be ameliorated with the introduction of robotic assistance. However, there may be hope for improvement on specific issues, such as cutting waiting times, if robot assisted surgery was to become more widespread.

Robots won’t be replacing NHS staff just yet. Most of the common models need human control. The  industry standard Da Vinci model, from the company requires a surgeon to operate, like a puppeteer and marionette. The four robotic arms manipulate, cut and peel away tissue in the same way as a surgeon would, but the surgeon in question sits feet away and uses controllers, like a video game console to move those arms. Procedures like keyhole surgery, can be performed in a minimally invasive and even more accurate manner.

Other kinds of robotic surgeons have been trialled, often to great success. In Baltimore in 2016, a Soft Tissue Autonomous Robot was able to sew up separate parts of a pig’s bowel tissue by itself physically, but there was supervision from surgeons to keep it on the correct path and it took several times as long as a surgeon.

Even though automated surgery could be vital to improving the NHS, there are several other factors that influences its proliferation. So far, robot-assisted surgery is only common in specific hospitals in London, often because these are the best funded –  these devices are expensive, at around $30,000 – and these facilities have the resources and staff necessary to adequately learn how to use these consoles.

These concerns have also lead to fears that surgeons in training won’t be as skilled as their predecessors. A paper from Michael Beane at the Massachusetts Institute of Technology demonstrated that the influence of robotic assistance had already started to shape the learning experiences of medical students, as Beane discovered in the course of two years watching these processes.

The traditional method of learning how to perform a surgery follows the norms of ‘watch one, do one, teach one’ – namely, watch how a procedure works a number of times, perform that operation a number of times, and  then teach how to perform that procedure a number of times to other people.

However, robotic surgery led to less engagement time with all the aspects of surgery that are informally required to become a surgeon, such as being ‘hands in patient’ to assist a more senior surgeon. The extreme magnification of the cameras on the consoles made instructors micro-manage more than they would have ordinarily, and the difficulty of gaining competency with the robot was exacerbated by how much time it took to become fully proficient.

As a result, residents became very good at robotic surgery, or traditional open surgery, but rarely both, which could have potential impacts on the kind of surgeries that they are actually able to perform in the future. This kind of issue would probably be exacerbated in the NHS, where junior doctors are already under immense amounts of pressure once they finish their training.

While we are a while away from robots performing open-heart surgery autonomously, the prospect of some automation in healthcare seems increasingly valuable. This kind of technology could inspire more confidence in healthcare professionals and decrease human error, in addition to increasing efficiency. There would be initial difficulties with training and operation, but they could become a normal part of the NHS too. As more doctors were trained to use them, the more efficient they would become, which would surely increase the number of patients that doctors could see without compromising their health.

When the computer and the mobile phone started becoming a feature of everyday life, critics and moralists worldwide feared that people everywhere would forget how to write by hand. Of course, that never happened (at least not to that extent), because people typed based on instincts generated from writing. In the same way, even an autonomous robotic surgeon would probably still need some kind of human guidance before it can even get started. Given that human involvement is vital for the robotic surgeon, for the near future, hospitals staffed by robots will probably remain fiction, not fact.

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