“robodoc”. the new era of the medical world

Robots in Medicine 1

“Robodoc”. The New Era of the Medical World.

Merey Sabdenaliyeva

Dr. George Rueckert

24/04/2012

Outline


I Introduction

1. Historical background

2. Patients’ stories

II Body

1. Modern misconceptions:

a) why people are afraid of robots

b) robots in literature and movies

c) results of the survey

2. What we have to know about robots:

a) very first medical robots

b) the Da Vinci Surgical System

c) expert’s opinion

d) field of usage

e) advantages and disadvantages

III Conclusion


Abstract

We are living in the twenty first century, which is the century of technological

development, new ideas and great inventions. Modern medicine is also developing, robotic

surgery is a new chapter in it. Robot-assisted surgery has a lot advantages for patients as well

as for surgeons. However, not everyone gets acquainted with it. There are still so many people

who do not trust robots, and consider that robots are something evil and dreadful. The lack of

information and disinformation are the main reasons of such thoughts. The purpose of this

research paper is to introduce medical robots and to show all benefits and drawbacks of them.


Everybody knows that the twenty first century is a century of innovation, new ideas

and technology. In the twenty first century we are beginning to see that the boundaries of

science are farther than we imagined. Today, people can proudly say that artificial intelligence

has already been created in our life. Since ancient times, human beings have been trying to

make their lives easier and more comfortable. For example, we have learned to make fire,

domesticated animals, and built whole civilizations. This list can be endless, every time we

discover and make something new, because the life itself is a progress. Today, we are on the

threshold of the new world, because one of the best inventions that man ever made has

become intelligent. Nowadays, automatic machines or robots play very significant role in

different spheres of our life. At present there are many types of robots, based on their use.

Modern robots are irreplaceable in military service, industry, science, entertainment and

medicine. The last field of their usage is a completely new tool of the medical world.

What is happening today in medicine really captures people’s attention. Scientists

work on developing technology and methods to make medicine better for providers and better

for patients. The twenty first century modern operating room with medical robots is not

science fiction. To see and understand its reality and importance we can always refer to our

past experience. Now it is even hard to imagine how people made their first operations in a

Stone Age, or how they simply made cuttings without knowing if it was right or wrong. After

inventing anesthesia, it gave them the possibility to experiment with human body, people got

the opportunity to delve deeper in it. Using antiseptics during operation in order to prevent

infection was another revolution in the history of medicine (Gerhardus, 2003). So, step by

step we got to this point when it is time to accept robots. Robotic surgery is a new chapter of

modern medicine that has had a huge impact on many patients’ lives, including, for example,

Cathy Cloud, who had breast and ovarian cancer. Cathy was very surprised when her surgeon

offered her robotic-assisted surgery with less pain and a faster recovery period than the


traditional method. “He was right,” she said happily. “On a pain scale of one-to-ten, I rated

my pain a one. I mean, I had absolutely no pain!” added Mrs. Cloud. Another breathtaking

story from real life is the story of John Burpee. He is a typical seventy-five year old. When

John experienced everyday difficulty breathing and pain in his chest, he thought that the

reason for those symptoms was his age and lifestyle. Unfortunately, it was a tumor in his

heart. John’s cardiologist recommended a robotic-surgical removal of the tumor, saying “I

have three jobs: one job is to save your life, the other is to take the tumor out, and the last is to

do it as little invasively as possible.” Finally, John’s surgery required only three small

incisions without opening his chest. “A week after my surgery, I was home. My recovery was

much faster and easier,” he concluded (Gerhardus, 2003).

The fact that robotic surgery is growing worldwide can be proved not only by patients’

stories, but also by real statistics. The number of people undergoing robotic-assisted surgery

has dramatically grown from 152 in 2004 to 803 in 2007 only in Australia and New Zealand.

At present, “there are more than 300 robotic systems installed worldwide. Around 800

systems are installed in US and Europe” (Murphy et al., 2008, pp. 1076-1081). All the major

cancer centers and major teaching hospitals have robots. Although robotic surgery is the latest

evolution in surgical technology with a great value, there is still a feeling of fear to be

operated on by a robot. How would you feel if you knew that your operation was going to be

performed by a robot instead of a human? Would you agree to be operated on by a robot?

Does robotic surgery have the future? Yes, it definitely has. Knowing more about robots,

about the advantages of robotic surgery, and about unbelievable results will instill confidence

in people’s hearts. Humanity will trust them completely.


Modern misconceptions.

Why people are afraid of robots.

Almost everybody agrees with the fact that “to live” means “to move, to go ahead, to

develop”. It is impossible to find a person who would say that progress is bad, however not

everybody is ready to make the first step in order to change the world around us. It is a great

responsibility to make this step, because it will certainly influence next generations. For

people born in the twenty first century it is twice as difficult.

Intellectual creations like robots were the subject of human dreams from ancient times.

Even very powerful and flourishing civilizations, like Egypt, Babylon, Rome and China,

could only dream about super powerful men who had the ability to do everything and never

die. Today’s scientists make that dream come true. Now robots take place not only in

imagination, but also in reality. They are not heroes of fairy-tales any more. Humans have

been dreaming about it for ages, but modern society is not in a hurry to welcome robots,

especially medical robots.

What is the barrier between robots and patients? In order to answer the question, why

people are afraid of robots and are not ready to accept them, we have to take into

consideration human’s psychology and the influence of the movies, mass media, and fiction.

Unfamiliar things and objects always seem dangerous and scary to people. Why

humanity is afraid of a robot-assisted surgery is quite clear. Because, people simply do not

have enough information to trust them. We are afraid of changes, developments, and

strangers. And robots are like strangers for us, because they were invented not so long ago.

We are afraid of darkness. It is our nature, because when there is no light, we cannot see

anything, we do not know what to do and how to behave ourselves. The same thing is

happening when new inventions and creations enter our life. In case of robots, they just were

not introduced correctly.


Robots in literature and movies.

The word “robot” comes from Czechoslovakian language. “Forced labor” is the

meaning of the Czechoslovakian word “robata”. This word was invented by Karel Capek. He

was a writer and used the word in his plays (Gerhardus, 2003). Nowadays, it has many

definitions. Dictionaries and encyclopedias explain it as “any automatically operated machine

that replaces human effort” (Rosen at el., 2004, pp. 985-986). The first person who tried to

find an association between robot and man was Professor Lee Dai Gil. He claimed that human

beings are also “direct-drive robots”. We (people) have muscles instead of motors (Gerhardus,

2003).

The creative writings of Isaac Asimov also involve robots. His science-fiction stories

were about robotics and their laws. Later, Isaac Asimov was considered as “the best

‘imagination’ of the world”. His writings were very popular and brought him great success

(Rosen et al., 2004).

It is obvious that, nowadays, movies, cartoons and fiction have more power and

influence than scientific projects, researches, different programs. Nobody will read tons of

special literature dedicated, for example, to medical robots, because instead of this boring

occupation, they can entertain themselves by watching TV or reading something.

Unfortunately, society became acquainted with robots through Hollywood. It is hard to find

someone who does not watch “I am robot”, “Terminator”, “Transformers”, and “Robocop”.

Robots in these movies are bad heroes, a lot of people suffer because of them, they are even

ready to fight against people and destroy the Earth. What viewers remember is, of course, that

robots are evil, they have bad reputation. For people they will be associated with negative

meaning. People will not pay attention to the fact that medical robots are not those dreadful

monsters from the TV. Thus, human’s attitude toward robots is simply based on movies and

stories.


Results of the survey.

Unfortunately, the result of the survey, which was conducted among KIMEP students

during four days from 5th March 2012 to 12th March 2012, confirms this fact once again. One

hundred students from different faculties with different age and gender took part in that

survey. The purpose of the survey was to discover the level of the knowledge about new

medical equipment and surgeries among students and to reveal if they are ready to trust them.

The survey was conducted with the help of a questionnaire that was given to the

students to fill out. The list of questions consisted of three parts with five questions in each of

them. The first part was connected with the general information about human inventions. The

second section was dedicated to robot-assisted surgery, the last one – to media influence on

people’s opinions.

According to the first section’s questions, 88% of the students are sure that some

human inventions are dangerous for people in their usage, 63% answered that they are afraid

of robots, moreover 52% claimed that someday people would lose control over them. In the

second section there is 95% “no” answer to the question “Would you agree to be operated on

by a robot”. 100% of all students prefer ordinary surgery rather than robot-assisted one. On

the open question about advantages of medical robots only 19% gave the answer, like less

number of scars and less invasive. In the last section, not surprisingly, 100% watched films

like “Terminator”, “Blade Runner”, and “Transformers”, “I am robot”. 48% like science

fiction.

If we start analyzing this survey, we will come to the following conclusion. KIMEP

students are not enough informed about the latest medical technologies, most of them have

“Frankenstein complex” that is “fear of artificial human beings”. Their knowledge about

robots in general is based on films and movies. Also nobody of the students will choose

robot-assisted surgery in case they need it. According to the survey there is one other


conclusion: society, nowadays, knows very little about medical robots, they cannot even

imagine the number of advantages and positive consequences, and Hollywood really has a

very big influence.

What we have to know about robots.

In order to get acquainted with robots closer, it is better to start with origins. Why did

that technology appear in our life? When was the first robot invented? What are the basic

advantages and disadvantages of robots?

The fact that man does not have perfect abilities to see, to hear, and to feel makes

human beings not satisfied with their skills. “Necessity is the mother of invention”, because of

this, the XX century was the period when people tried to create a lot of tools in order to

compensate those limits. Using robotic technologies was an evolutional step of the medical

world, which could offer a high amount of new options for patients and doctors.

Very first medical robots.

The field of robotic usage is endless. However, medicine takes a very serious position

in this list. 1980 was the year when surgical robots first appeared in hospitals. Such robots

were used in neurosurgery and orthopedic surgery. Impressive results of using robots in these

two spheres encouraged other surgeons, thus robots became common in urology and

otolaryngology. The first medical robots, PUMA 560 and PROBOT, were used during brain

biopsy and prostatic surgery.

The Da Vinci Surgical System.

Farther history of robots in medicine was directly connected with the Da Vinci

Surgical System. “One of the most advanced robots used today in operating rooms is the Da

Vinci Surgical System” (Cepolina et al., 2004, pp. 21-23). This system consists of three main

elements, four robotic arms, camera with 3D vision system, a surgeon’s console. The name of

the system is connected with the Italian painter and sculptor, Leonardo da Vinci, because he


was also a bright engineer of his century. He created several different flying machines, some

of which had great success. Moreover, he studied human body and was interested in anatomy.

The first pictures of the human skeleton belong to him. Da Vinci system is very valuable

because of its accuracy. The direct link between surgeon and patient provides the best

interaction between them (Cepolina et al., 2004).

Expert’s opinion.

Health is the most valuable thing in our life. People are equal in terms of health.

Yesterday we were born, today we live, and tomorrow we will die. But everyone wish to live

happy and healthy life. Information that is taken from producers’ creations cannot be

considered as credible. We cannot rely on them when we face problems with our health.

Robots in medicine and their acceptance is a big issue that requires professional view. In

order not to have an error of judgment, it will be better to take into consideration an expert’s

opinion. Special interview with the representative of the medical world gives us such a great

opportunity. According to the cardiologist of #12 Almaty Hospital, it is not a secret that our

(Kazakhstani) medicine is not perfect and is not on the first place. There are a lot of things to

improve. For example, our city needs more hospitals and doctors, our patients need more care,

the equipment and tools that we have are not in the best conditions. The whole world also

tries to improve medical service and possibilities. The world medicine is developing. Today,

robots are used in different surgical procedures. Modern surgical systems are really advanced

technology, operations made with the help of them are non-invasive. Patients with serious

illnesses could only dream about this.

While working with patients and seeing their fear and pain, you are starting to

understand the worth of life and the difficulties that are connected with the decision making

process. It is so hard to make a decision, especially when you deal with something new and

unfamiliar for you. But if you are terribly ill, you have no choice, you will do everything in


order just to stay alive. It is so scary to face such situation and to overcome it. However,

people are starting to understand that the thing you offer to them is right and good, as they get

more acquainted with it. The more information they have, the more they trust you and your

methods. It is directly connected with time and knowledge.

Filed of usage.

There are two types of robots used in medicine, active and passive. Passive robots are

controlled by the physician, active ones by the computer. The field of their usage is very huge

and impressive. Medical robots proudly find their places in general surgery, cardiology and

electrophysiology, gastrointestinal surgery also gynecology and urology.

Nowadays, it is hard to imagine how surgeons would make, for example,

gastrointestinal laparoscopic operations without medical robots. The most widespread system

for general surgery is Da Vinci system. Cardiac surgeons also use Da Vinci system. Using

robots during such operations increases the chances of success and decreases the morbidity.

Robotic technology’s 3D cameras show the whole picture of the heart. Robotic surgery in

gynecology also is becoming more and more popular. “Using the robotic system, gynecologist

can perform hysterectomies, myomectomies, and lymph node biopsies” (Dharia et al., 2005,

p. 7). Several robots are currently used in neurosurgery. Operations on the brain demand a lot

of accuracy, because brain tissue is very sensitive. Surgeons in the United States of America

especially appreciate medical robots in urology, because of the difficulties in anatomic access

to organs. In addition, there are almost no cases when robot-assisted surgery in urology has

negative consequences or results. Medical robots are very important in orthopedic surgery,

because it is hard to make operation on bones (Horgan et al., 2001).

Modern medical robots have other different applications. One of them is training.

Medical robots can be used instead of real patients. It is a good simulator for surgeons, who

have just graduated and do not have enough experience. So, they can practice and develop


their skills. Medical robots also are a good decision for disabled people who want to stay

independent or who do not have family and relatives. For example, robots are really

irreplaceable for deaf and blind people. There are also good solutions for children with mental

deficiency, for example, educational robots. The last type of application is telerobotic

echography (Horgan et al., 2001).

Advantages and disadvantages.

Surgeons all over the world always try to minimize the pain of their patients during the

surgery. Minimally invasive operations become real with medical robots’ appearance, because

it is the most important advantage of robot-assisted surgery. The reason is that robotic cutting

instruments and camera are very small, that is why the surgeon, who performs the operation,

does not need to make large-size incisions. Moreover, the problem of “shaky hands” is also

solved, because robots make very accurate cuttings. Surgeon with a help of robot’s arms

moves in the direction that he needs and does not touch other organs, that is does not make

additional trauma. There is a good example with heart bypass surgery. Traditional method

requires sternotomy, which involves opening the chest and stopping the heart beating.

Unfortunately, it is very dangerous and can lead to morbidity. In the case of robot-assisted

surgery, surgeon does not open the chest that is he does not make eight-inch to ten-inch

incision. Instead of this, he simply “cuts three one-centimeter incisions in between the ribs to

insert the two robotic arms and an endoscopic video camera” (Rogozea et al., 2009, pp. 23-

24). Less invasive operation leads to positive consequences like reducing patient’ s death as

well as fewer and smaller scars, because patients often care about them and their look.

Moreover, it is not the only advantage of robots in medicine. The small risk of

infection, blood transfusion and other complications are the greatest benefits of such

operations. Another advantage is connected with the time, because robot-assisted surgery

makes recovery period faster. Patients leave the hospital approximately after one week, when


patients who choose usual operation spend half a month in the hospitals. Because of faster

recovery period patients return to their normal life, job and other activities sooner (Preising et

al., 2008).

Robot-assisted surgery is also very beneficial for pediatric patients. Sometimes little

children or even babies may have serious health problems and need difficult operations. But

there another problem appears. Because of their bodies’ size, some operations are extremely

dangerous or even impossible. However, this problem is easily solved with a help of medical

robots.

Robot-assisted surgery gives the opportunity for developing of telesurgery. As a result,

surgeons from different countries will work together, will share with their knowledge and

experience. It is a good chance for working at distance (Rogozea et al., 2009).

For physicians it is also better to use robots because robots allow the surgeon to have

the full view with a help of 3D displays. Camera gives the opportunity to see places that is

impossible to see. Finally, surgeons have the full control over their robot assistant. Also

control board is very sensitive, so the robot repeats all the movements after the surgeon.

From financial point, robots are very beneficial for hospitals. Patients with fast

recovery period and little scarfs do not need additional nursing care. Medical robots replace

different assistants, thus, they reduce the number of medical staff. Also hospitals will be able

to help more people with diseases, and they will not wait their turn until they become worse

(Lobontiu et al., 2007).

Unfortunately, with all the advantages there are also some disadvantages. The first one

is connected with the procedure of learning the working mechanism of such a machine. It

must require additional time for surgeons to get acquainted with these surgical systems. Forty

hours of training sometimes is not enough for the surgeon, because “practice makes perfect”.


There is no guarantee that during this short time they will be completely ready for operations.

It is really risky, because it is connected with someone’s life and health.

Another drawback that the physician faced is losing sense of touch. Control panel

cannot replace human’s arms. During ordinary operation surgeon can feel what he is doing, he

can measure and count the pressure and power of his movements. Although 3D monitors are

so accurate and advanced, sometimes it is hard for surgeons to look at his patient through all

these systems and mechanisms. Robot-assisted surgery sometimes looks like unreal, and

surgeon always has to keep in his mind that six feet away there is a person, whose life

completely depends on him. One more drawback is connected with the fact that such systems

are very expensive, around $750,000 to over $1 million, not all countries can afford such

robots and not all patients can pay for such operations, because the price of the surgery is also

extremely high. However, a lot of people believe that soon the prices will become lower

(Rahbar et al., 2007).

Conclusion.

When we talk about people’s health and life, there is no place for faults and errors,

because even the smallest of them may cost someone’s life. No one in this world has the

power to turn time back in order to correct mistakes that is why it is better not to make them

at all. But here a logical question appears: who is that person with perfect abilities, like super

vision, no shaky hands and accurate cutting instruments? It is not a secret that people are

always dissatisfied with their skills, because they are sure that their abilities to see, hear and

feel are limited by their nature. It is unfair to claim that doctors have no rights to go amiss,

because they are human beings too, but it is also wrong not to pay attention to medical errors.

Maybe it is time to think about an alternative way of solving this problem? Maybe it is time to

accept something new?


Medical development means not only the improvement of existing methods and tools,

but implementation of absolutely new technology. Now we can answer the question above

about that perfect creation. The answer is simple: it is a robot. However, robots were not

invented and created yesterday, they have been with us for a long time, so why are they not so

widespread, why are there still so many doubts about their usage? Robots in general do not

have a good reputation, because they were not introduced correctly. People know them

through films and movies; robots become “bad heroes” very often. People believe that robots

can capture our earth and destroy our life, however they forget that the most powerful thing is

an idea, the power of believing in something. Unfortunately, this power stops progress and

does not allow our life to develop. This simple unconfirmed idea deprives so many patients of

successful surgical results.

Nowadays, doctors and surgeons use robots for diagnostics, assisted surgery and

rehabilitation. Medical robots return people their hope to continue living after difficult

operations. They help patients with disabilities to be independent, and they allow doctors to

find exact reasons of the diseases. Huge iron machine becomes a fragile link between

surgeon’s arms and patient’s life.

People all over the world have the right to know about the latest medical advances, as

well as the right to live and to get the best medical service. Their knowledge must not be

based on unbelievable film producer’s imaginations and fantastic stories. People have to

know everything about the advantages and disadvantages of such technologies, because they

are directly connected with their health. They can make decisions and choose the best option,

only when they are completely acquainted with robots in medicine. People will have an

opportunity to weigh all the pros and cons of modern surgery and choose the type of

operation, ordinary or robot-assisted, with no doubts.


The lack of information generates fear. We are afraid to go to unknown places, we are

afraid to trust strangers, the darkness frightens us. On the question what you will feel if your

operation is going to be performed by a robot instead of a human, everybody will answer that

they will be afraid. It is a normal human reaction, a common biological instinct.

Disinformation is also a problem, because it makes people think in the wrong way. It is even

worse than the lack of information, because when you do not know anything, you have no

ideas. When you have incorrect information, all your thoughts will be based on it, and it will

be twice as difficult to change your opinion. Knowing more about robots, about the

advantages and disadvantages of robotic surgery will create confidence in people’s hearts.

The future of robots in medicine depends on people, however people have already

made their choices when they used robots for the first time. Medical robots have a long

history, from the moment when they were just the subjects of dreams till the point when they

were installed in operating rooms. Maybe it is hard to believe, but their future has already

started. Robots hold strong positions in the medical world, because they are really helpful and

irreplaceable. In addition, robot-assisted surgery is not the final destination of modern

medicine; voice-controlled equipment is the next step.


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“robodoc”. the new era of the medical world

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