Robots already build our cars, clean our homes and keep us safe. Within the next decade they may even autonomously transport us around. But can we trust them enough to allow them to perform hospital surgery, literally putting our lives in their hands?
Robotics is having an impact on our healthcare system, delivering benefits across a range of areas from medical imaging and diagnostics to rehabilitation and assistive care. But the operating theatre is perhaps where medical robotics has made its biggest mark to date. Robotic surgeons such as the Da Vinci surgical system have been used on more than three million patients worldwide, for instance.
A Relief to Strained Health Systems
The cost of caring for a growing aged population has hit the budgets of many advanced economies including Australia, where the federal government has sought to slash hospital funding by AU$57 billion over the next decade, potentially affecting emergency room waiting times and surgical waiting lists.
The situation is particularly dire in rural areas, where doctor shortages and the difficulty and expense involved in accessing medical assistance are lowering life expectancies.
Medical robots are expected to offer potential solutions to each of these issues by improving the speed and accuracy of surgical procedures, and reducing post-operative recovery times and the likelihood of catching hospital superbugs. This could eventually lead to increased patient turnover and a significantly cheaper and more efficient public health system.
But Can Medical Robots Be Trusted?
A recent survey by insurance provider Budget Direct found nearly 80 per cent of Australians would trust a robot to operate on them, if it had a proven record of success.
Llynlly Fensom, a recent cancer patient who underwent a pancreatectomy and splenectomy in Brisbane’s Wesley Hospital in 2015, says she would only trust robots with minor procedures, however.
“I would be happy for a robot doctor to remove skin cancer or perform other simple tasks, obviously with a doctor’s close supervision,” she said. “But I would be a bit reluctant for a robot to do anything more invasive or complex.”
A review of medical robotics by the Royal Australasian College of Surgeons concluded that while robotic-assisted surgery offers “a number of key advantages compared with conventional surgical approaches”, its high initial purchase cost and ongoing maintenance and training-related expenses may limit its reach in the short term.
The review consulted seven surgeons, with only one reported case of technical malfunction among them, which caused a rescheduling of the surgery. Most also reported they had not yet needed to perform a follow-up surgery due to unsatisfactory results from the initial robotic procedure.
However, a far larger study in the US looking into the safety of surgical robots found at least 144 deaths, 1,391 injuries and 8,061 device malfunctions were reported in the more than 1.7 million procedures examined between 2000 and 2013.
According to the paper, reports of broken or burned parts falling into patients, uncontrolled movements, spontaneous power failures, electrical sparks and system errors are cause for concern. These unresolved issues explain why robots are expected to maintain a ‘slave’ role in surgical procedures for the foreseeable future, with surgeons micromanaging their tasks.
The Possibility of Remote Ultrasounds
A more positive development is haptically enabled robotics, developed by Deakin University’s Institute for Intelligent Systems Research and Innovation in partnership with telecommunications company Telstra, which allows medical professionals to engage in ultrasound imaging with patients in remote areas from where they are. The images can be used in the diagnosis of numerous conditions including abdominal pain or abnormal liver function.
The robotic system also has the sensitivity of human touch, allowing doctors to assess the tenderness of an area as if they were applying pressure themselves, in addition to being equipped with a two-way audio-visual communication system.
Brisbane-based radiographer Malcolm Lau believes the technology may play a crucial role in assisting rural patients.
“There is a shortage of qualified sonographers in Australia, which disproportionately affects rural patients,” he said. A sonographer is a medical specialist trained to diagnose ultrasound.
“While a human operator can deal with unexpected issues immediately, and communicate with and assure a patient far more effectively in person, remote sonography is a far better alternative to no scan at all,” Lau added.
Nevertheless, there are significant barriers to overcome before the technology sees widespread adoption, particularly in liability and cost. Who will be liable if the probe or imaging fails to identify a fatal issue a doctor would easily have spotted? How will the technology be distributed to remote areas without incurring prohibitive costs?
Until these questions are answered, robot doctors are unlikely to replace humans any time soon, although the robotics revolution is here to stay.