Faith Hall

Malcolm Campbell
UWRT 1103
April 10th, 2016
Out with the old, in with the new: Robotics changing medicine
Are robots really advancing medicine or are they actually making it worse? In spite of
advancement, the upcoming debate centering on this question continues. We are surrounded by
evidence of differences between robotics now in medical field. Even though it has become a
normalcy to now see automated computers in use, the temptation to seek an explanation in terms
of differences, between whether or not robotics in medicine are beneficial or harmful, remains a
powerful one (Mursashov, Hearl, Howard). On one end of the spectrum robotics have helped solve
many human errors and have created an extremely fast work environment. On the other hand,
robotics have taken jobs from people, lost the relationship with patients, and have caused a shift
in curriculum for medical students. With the natural and robotic beings working among side
hospitals, medical advancements are growing; however, with robotic surgeries just now being
explored, there is still question about using these computerized machines.
The advancement of computers and other technologies have opened up wide doors for the
medical field. With the advances of the 21st century, much surgical equipment now includes
robotic machines controlled by a single doctor. Many are skeptical about if these procedures are
dangerous or more beneficial to the patients undergoing the surgery. However, in a pilot case report
study on a robot assisted training of the upper limb, they found that after sensorimotor training

provided by robotic devises, a patient improved his sense of position. This meaning that the
muscular sense of position and attitude of the body are recognized. There were no harms done and
the robotic training did not have any errors (Colombo). Before the advancement and development
of the da Vinci system (a robot that performs laparoscopic procedures) the surgeons were having
to perform only open surgeries creating many scars and incisions for the patient. With this system
alone it has changed surgery greatly. On their article covering how to work safely with robot
worker, Murashov says, In the last 5 years alone, the robotic platform has gained popularity in
general surgery where patients have decreased receiving open procedures while increasing in
laparoscopic surgery (Murashov, Hearl, Howard). Nowadays, many devices make modern
medicine more effective since medicine is developing constantly; the introduction of robots is very
promising. Modern operating rooms are equipped with up to date equipment, allowing doctors to
make operations more accurately and with less risk to the patient, according to Kuznetsov. The
robotics increasing in the health care system has provided opportunities with faster treatment,
smaller surgical incisions, and more accurate incisions. However there are still researchers
contradicting the positives of these advancements and who believe robotics are a recipe for
disaster.
For doctors, the robotics increasing in medicine have affected them greatly, from their
salary, the work that they are doing, to even the change in their curriculum as medical students.
The robotic curricula has been described as effective; however, they are mostly limited to specific
areas of study such as urology and gynecology training programs, writes Finnerty. Development
of robotic curriculum that sets up a successful daVinci surgery program is only in the beginning
stages, and it also remains unknown whether general surgery residents are gaining robotic skills
through their residency. This has caused questioning regarding the safeness and usefulness of

robotics in medicine as of right now. If the doctors are not receiving the proper education to use
these robots then are patients in harms way? The training programs are beginning to develop
therefore in the next couple of years there should be better education provided for doctors on proper
use of the robotics. It takes vigorous training to be able to control the devices that are now being
used in laparoscopic surgery which is why it is important for doctors to have the proper education
on the equipment. Since this market is still growing and constantly changing, creating a curriculum
to teach the doctors in residency right now is very challenging.
What do the doctors have to say?
The change of relationships between the patients and doctors have become more noticeable
that computerized instruments are in most offices and hospitals. Many more doctors have begun
re-evaluating the field that they are entering into and whether or not it is something that they are
wanting to do. Some doctors agree that the advancement of robotics has reshaped and helped the
medical field while others explain how it has ruined it. An article provided from an online medical
blog gives multiple responses from doctors themselves on their thoughts regarding robotics in
medicine. These responses demonstrates the split between these two sides. Barry Kisloff, M.D
from Pittsburg, Pa. wrote his reasoning on how computers and robotics are beneficial to the system.
The increasing use of computer-based medicine (CBM) is rarely driven by providers. A
considerable impetus is political diktat, thanks to bountiful donations from rich Silicon
Valley enterprises to political campaigns. The introduction of CBM on a broad scale may
well result in better clinical outcomes, but only at a significant financial cost. Robots will
broaden the differential-diagnoses list available to clinicians and thus, given the current
and seemingly uncontrollable medical-malpractice environment, compel further diagnostic
testing, with the concomitant costs and risks of false positives. False or misinterpreted lab

testing will then spawn more and often dangerous, not to mention costly, diagnostic
testing.
Although automation can often guide smarter clinical decisions and turn dollars more
efficiently it still doesnt provide a patient with the comfort and care that a human would be able
to give. Robots, however, may be the only ones willing to deliver care in the future because
doctors have begun opting out. In a 2012 study, nearly half of 5000 surveyed physicians said they
hoped to be out of medicine within five years; nine out of 10 said they would not recommend
entering the profession (Tufecki). Dr. Watson, a M.D from Austin Texas, responded to the topic
of robotics and how they are not as beneficial as people have believed them so to be:
The problem is not only that programming computers to practice medicine is very
difficult; it is also that doctors spend little time just pondering diagnostic possibilities. Most
of their time is spent on data entry and patient assessment. People who believe that a
computer will not miss diagnoses fail to understand how much serendipity is involved in
hitting upon the right diagnosis in the first place. Medicine is no longer a profession but a
commodity where its central purpose is not improving the health of patients but
maintaining the health of the system
Watson claims that this new age of robotics in medicine has changed this field for the worst.. He
focuses on the fact that robotic devices can have errors too and make mistakes just as humans.
Now according to Watson, with the technology and robotics, doctors and patients often do not
develop meaningful, trusting relationships but more of formal negotiations.
For growing countries the robotic future holds many concerns and wonders. Catherine
Mohr in her Ted talk, explains how important robotic and other surgical devices have evolved over
the past hundreds of years. She focuses on how surgeons now have the opportunity to perform

whatever they desire to and the way that robotics have opened that door for them. Being a surgeon
herself she says, For surgeons, it is almost like being an artist where the robotics have now
become our paint brushes (Mohr). The da Vinci robot, created in 2000, has been developed to put
wrists on the instruments that go inside a human body. In her Ted Talk, she explains the way
that doctors use this robot to go inside the human body laparoscopically. With these advances, this
device has been able to go into tumors that would have ultimately been impossible to do with an
open surgery. Now doctors are able to remove a prostate gland with an incision that is less than an
inch wide.
The da Vinci robot has now developed into an instrument that has a camera, a traction, and
sewing device all in one. She says, Yes there are limitations, yes there are challenges, but the
robotics have given us the capabilities to write the script of the next revolution in surgery. As we
take these capabilities we get to go to the next places and decide what our new surgeries are going
to be. There are certain types of tumors that cannot be seen, as they are below the surface, and
without the robots used today, there would be no way to see or remove these tumors. With the da
Vinci robot, doctors are able to light up an unnoticeable tumor from a kidney, a liver, a lung, etc.
With the flexible microscopic probes of the da Vinci robot, we can reach it all and we can see it
all, we can heal the disease, and we can leave the patient whole and intact and functional
afterwards. These robotics have been able to hold the key for new discoveries, new cures, and
new medicines.
What does the future hold?
Other than the da Vinci robot there are other significant surgical robots that are found in
operating rooms. In 2001, the FDA cleared ZEUS to assist in the control of blunt dissectors,
retractors, graspers, and stabilizers during laparoscopic and thoracoscopic (biopsy) surgeries.

Zeus has three robotic arms that are mounted on the operating table. One of these arms is the
AESOP (Automated Endoscopic System for Optimal Positioning Robotic System). The
AESOP is a voice-activated robot used to hold the endoscope, which is, the instrument used to
examine the interior of a hollow organ. The FDA cleared AESOP to hold and position
endoscopes in 1994, however, the voice activation was added later. The difference between the
ZEUS and the da Vinci system is that the AESOP part of ZEUS responds to voice commands.
Like the da Vinci system, the other two arms of ZEUS are the extension of the left and right
arms of the surgeon; the surgeons sits at a console that creates a three-dimensional image of the
patient. On September 29th, 2006 the ZEUS robot system performed a fully endoscopic
fallopian tube reconnection procedure. The resulted in, the worlds first child born ever after
this kind of reversal operation, had been successfully delivered. The ROBODOC, in 1992, was
the first robot assisting in a human total hip arthroplasty or replacement; making it the only
active robotic system cleared by the FDA for orthopedic surgery. The ROBODOC surgical
system allowed surgeons to pre-operatively plan their surgery in a 3-D virtual space and then
finish the surgery exactly as planned in the operating room. The Acrobot was developed after
the ROBODOC to improve the speed, accuracy, and reproducibility of joint replacement. With
this robot, the patients post-operative recovery time can be reduced and discomfort can be
minimized.
The future holds many opportunities for robotic surgeries and new advancements are still
being tested to be cleared by the FDA. As of right now, the ZEUS system is being tested for
remote, wireless surgery in underwater experiment aimed at eventually enabling similar
procedures in space (All bout Robotic Surgery). The hope is that eventually astronauts in
need of surgery will not have to return back to Earth but instead be able to stay and have the

procedure done in space. The SRI International, a non- profit research development company,
developed the M7 that was the first ever medical procedure in zero-gravity flight for NASA.
The goal of using robots in medicine is to provide improved diagnostic abilities, more
comfortably experiences for the patient, and the ability to do smaller and more precise
interventions (All about Robotic Surgery). Robots have shifted from only being used for prostate
surgery, to being used in hysterectomies, joint replacements, and open-heart surgery. Along with
improved patient care, another aim for medical robotics is to cut down on medical costs. However,
some of these systems cost more than 1 million dollars and over $100,000 a year to maintain. This
means hospitals must evaluate the cost of machine vs. the cost of traditional care. There is money
saved in terms of the number of days the patient stays in the hospital; In contrast, extensive training
time is required for physicians to learn to program and operate the machines.
Medical robotics is still a very new idea and there is a lot of work to be done. It is still very
expensive, which can make it not accessible for many health-care centers. There are also still issues
to the time lapse between the moments when the physician moves the controls and when the robot
responds. Human error can still happen as well if the physician incorrectly programs the robot
prior to surgery. As surgeons become more familiar with using robots for surgery and as more
companies provide medical robots, there will come a day when robots are used in almost every
hospital. However, this is still far off in the future.
In conclusion
There is a huge market for robotics in society, which is why this is an important factor to
consider. What is it going to be like going to a hospital ten years from now? What new surgeries
will be discovered? Among our society it makes sense to have robotic devices; they cannot quit,
forget, or get pregnant. They are cost efficient and have minimal errors which is why there is a

problem with unemployment and now with advances in the medical field there are many doctors
losing jobs as well as cuts in salaries. Whether experts lean toward the more pessimistic view of
new technology or the most optimistic one, many agree that the uncertainty is vast. Not even the
people who spend their days making and studying new technology say they understand the societal
effects of the new digital era. This is why there is such controversy over if robotics in the medical
system benefit more than they hurt. There is no way to tell what the right answer is but that is not
going to stop robotics from advancing more and more each year. The developments will continue
to shock the medical field but also keep changing it at the same time. Only time will tell what these
advancements will do to this field and what benefits and harm they have for the patients as well
for the doctors.

Works Cited
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Cain Miller, Claire. Smarter Robots Move Deeper into Workplace. (cover story). New York
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Finnerty, Brendan. General Surgery Training and Robotics: Are Residents Improving Their
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Feb. 2016
Kuznetsov, D.N and V.I. Syryamkin. Robotics in Medicine. AIP Conference Proceedings
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Mohr, Catherine. Surgerys Past, Present, and Future. Ted Talk, Feb 2010. Web 4 Apr. 2016
Murashov, Vladimir, Frank Hearl, and John Howard. Working Safely With Robot Workers:
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Robots and Healthcare Saving Lives Together. Robotics online. Ed. Tanya Anadan. Robotic
Industries Association. Web. 26 Apr. 2016
Tufekci, Zeynep. The Machines are coming. New York Times 19 Apr. 201: 4. Academic Search
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Samadi, David, M.D. Robotics in Medical Surgery. Prostate Cancer Treatment with David
Samadi, MD. Web. 29 Apr 2016