Budny, 10:00am
R13
IMPLEMENTING ROBOTS INTO EVERYDAY SURGERY
Chen Su (chs161@pitt.edu)
WHY ROBOTIC SURGERY IS BENEFICIAL
INTRODUCTION: IMPROVING
TECHNOLOGIES IMPROVES MEDICINE
Robotic surgery may sound dangerous, but it can only be
as dangerous as the surgeon behind the console controlling
the robot. The benefits of implementing robot technology
into more surgery rooms greatly outweigh the benefits of
sticking to traditional hand surgery. Through using the da
Vinci tool patients are guaranteed to have smaller lacerations
due to the smaller size of the tools used by the robot. Also,
in correlation with smaller lacerations, there will be less pain
and faster recovery for patients. Furthermore, the use of the
da Vinci tool has proven to reduce infection after surgery,
and surgeons can conduct a surgery that normally would
take one day to complete and shorten it to less than four
hours [1]. Not only will the time of surgery be shortened but
also the surgeon will be less fatigued and the patient will
have significantly less blood loss [3]. Even Dr. Hyung Kim
agrees that using the da Vinci tool for surgery “is less of a
slug and a strain” [4] After 10,000 plus robotic surgeries, the
medical community can confidently state that the da Vinci
tool is effectively doing what it was designed to accomplish,
-speed up the surgical process while increasing precision too
[1].
Throughout the last century technology has made great
advances allowing humanity to progress forward more
quickly than ever before. From the creation of the X-ray to
the invention of the laser, both vastly used tools in most
hospitals around the world, new technologies have allowed
surgeons greater capability in the operating room. Recently,
however, an entirely new advancement known as Robotic
Surgery has entered the medical field. Over the past few
years, engineers from the mechanical, biomedical, and
computer engineering fields have allowed this milestone to
happen.
When visualizing robotic surgery one may think of an
unmonitored robot conducting an intense surgery just as
robots on an assembly line assembles cars; however, robotic
surgery is actually a surgeon controlling a robot that has the
necessary tools to be more precise and accurate in order to
minimalize human error and increase the effectiveness of the
procedure. This tool, commonly known as the da Vinci
surgery tool, is renown for its ability to out match traditional
laparoscopic surgery, which is surgery meant to minimalize
size and number of incisions made to the patient [1]. Also,
the da Vinci tool is only the first generation of robotic
surgery instruments, which may have raised some questions
and ethical concerns, but in the years to come engineers may
elaborate on this technology and eventually reduce cost and
completely rule out human error during surgery.
CONS OF ROBOTIC SURGERY
Although the robotic surgery poses phenomenal
efficiency improvements, there are some downsides to such
accomplishments. For example the robot doesn’t make
judgments for doctors, the results still rely completely upon
the person behind the controls [5]. This suggests that even if
injury occurs within the operating room it is most likely due
to human error. The machine was built to minimize such
errors, but it cannot eliminate them due to the operator being
human. Some surgeons speculate the reason behind these
human errors is due to the loss of human touch since the
surgeon is operating from a machine control panel [5]. Also
there have been reports of several injuries occurring, but the
injuries related to the type of surgery being conducted were
an expected risk even without the use of the robotic device
[3]. One concern of purchasing a da Vinci machine is the
cost, which ranges between 1 to 2.25 million US dollars with
a 140,000 maintenance cost per year and this does not
include the 2,000 dollars of replacement parts needed for
each surgery [2]. The cost may be high but the main
concern of surgeons is that some say the loss of the natural
feeling can be detrimental to the surgical process, suggesting
that some doctors can do better without the da Vinci tool [4].
Finally, there is a learning curve involved in the usage of the
da Vinci tool. This means doctors need to spend more time
RELEVANT TECHNOLOGY
The only relevant technology of robotic surgery is the da
Vinci tool. Introduced in the year 2000 by Intuitive
Surgical, this technological masterpiece had out competed
and bought out early competitors and is now the most widely
used robotic surgery tool in the U.S [2][3]. It is a robot with
four mechanical arms, each with a different type of surgical
tool attached. The tools are replaced after each surgery in
order to enforce sanitary conditions. This mechanical portion
is then wired to a console where the surgeon sits and uses a
screen and joystick that replicates the surgeon’s movements
[4]. Perfect for simple procedures and some complex
procedures such as minimally evasive cancer removal. To
accomplish procedures such as this, the robot must be steady
and incredibly precise. There is little room for mistake.
University of Pittsburgh, Swason School of Engineering
October 28th, 2012
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Chen Su
and money away from patients in order to learn how to use
the new technological advancement [3]. However, the fact
that none of the cons are procedure related goes to show how
well this piece of technology was engineered.
engineering field because it gives me a better idea of what I
should expect on the job and real-world situations. Also, it
does not hurt to be more knowledgeable because the more
one knows, the more prepared he/she can be. Just about any
information is good information. And for the field of
engineering it is imperative that we continue to acquire more
knowledge because in this field of study it is constantly
adapting to higher standards. Meaning we engineers must
keep up with these advancements by continuously learning
more in order to be an effective member of society.
Therefore, Penn State students should model Pitt students in
order to benefit their future needs to become a successful
and responsible engineer.
ETHICS OF ROBOTIC SURGERY
As an engineer, one is obligated to abide by a code of
ethics. For the engineering society, all engineers must
follow the “Code of Ethics for Engineer” instituted by the
National Society of Professional Engineers (NSPE), and
more specifically for biomedical engineers, the “Biomedical
Engineering Society Code of Ethics” provided by the
Biomedical Engineering Society (BMES). Both codes
specifically state under the first Fundamental Canon to “hold
paramount safety, health, and welfare of the public” [6][7].
This clause means to say that no matter the goals of a
project, an engineer may never jeopardize human safety
through any means, especially personal needs. Just as the
University of Pittsburgh requires students to act at the
highest level of integrity, the NSPE also demands,
“Engineers to be guided in all their relations by the highest
standards of honesty and integrity [6]. In other words, the
Engineering society is built upon the trust that the engineer
can be held accountable for his/her own designs and the
safety for the users.
Also, under the BMES Code of Ethics Health Care
Obligations section, “Biomedical engineers involved in
health care activities shall consider the broader
consequences of their work in regard to cost, availability,
and delivery of health care” [7]. As engineers we should not
be thinking about profits or our rewards, but instead our
priorities should be creating technologies that allow
universal access to health care for as low as possible costs.
The da Vinci tool may be a significant advancement in the
biomedical industry, but in this situation evidence provides
us reasons to believe the tool is too costly to maintain to be
universal, at least for now. Technology such as the da Vinci
tool is geared to be more accessible to larger hospitals with
greater capital and patients. In this regard, the engineers of
the da Vinci tool failed to fulfill availability of this
technology while accomplishing enhanced surgery.
WHY I CHOSE/SUPPORT ROBOTIC
SURGERY
When I was young I watched a show about a doctor
operating on a patient’s brain, and my young imaginative
self thought what if the doctor was bumped or did not have
steady enough hands to operate on the patient? So much
trouble could ensue. Back then I thought I would be a
doctor, but now I would rather be an engineer behind the
creation of robots that can do these surgical tasks for us.
The fact that biomedical engineers can play a role in
assisting doctors and surgeons in saving human lives is
fascinating. I believe that through furthering my studies in
biomedical and mechanical engineering I can hopefully play
a part in saving lives. I believe that one-day surgeons will
not need to conduct the simplest operations on people
because robots will be able to make decisions on their own.
As controversial as this may sound, it would be absolutely
amazing to see a robot conduct a complex surgery without
the assistance of a surgeon. And I continue to imagine the
limits of medicine being pushed further and further. For
example, one day it may be possible to have a surgeon robot
that can perform any type of procedure along with
diagnosing a patient; unlikely but not impossible. With all
that said I am completely for the full integration of robots
into operation rooms.
WHAT DOES ROBOTICS IN SURGERY
MEAN FOR THE FUTURE
“Should Penn State Students Do What I/We
Just Did?”
The possibility that robots may have the ability to
conduct self-automated surgeries on live patients is
fascinating. However, realistically the closest advancement
for robotic surgery would be “to deliver ever smaller, ever
smarter technology” and “take human error out of the
equation” [1]. Through these advancements the list of
benefits will grow including the uses for such technologies.
Even though the price of this technology would be very
costly, possibly even greater than the current value, it makes
sense because the manufacturer will need the best and
newest technology on the market.
At University of Pittsburgh’s Swason School of
Engineering, freshman engineers are required to write a
paper on an ongoing engineering issue relative to the past
five years. We were also required to add a code of ethics of
engineering for our individual engineering disciplines. From
my research thus far, I have learned of information that only
would have been brought up through a research project like
this one. I found the information I came across during my
research process to be beneficial to my future studies in the
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Chen Su
Also, as a side note, the minimization of robotic
technologies can mean advancement in the nanotechnology
aspect of bioengineering. It is somewhat tangent to robotic
surgery but the two technologies may work together, one at
the cellular level and one at the surface level in order to
accomplish new goals in medicine. A more in depth study
of nanotechnology may provide ways to cure cancer because
engineers may be able to program nano-bots to do specific
jobs when injected into the blood stream. The nano-bots will
seek out the affected area and remove the cancerous cells
[1]. Nano-bots could even be reprogrammed through sound
waves; imagine consuming a pill containing nano-bots
designed to eradicate cancerous cells then one day down the
road an artery becomes clotted. Simply reprogram the nanobots and viola, problem(s) solved [1].
Advancing
technologies means redefining the limits of medicine.
[4] Dance, A. (2011, October 17). Robotic surgery grows,
but so do questions. Los angeles times. Retrieved from
http://articles.latimes.com/2011/oct/17/health/la-he-roboticsurgery-20111017
[5] Sonj, V. (2010). Da vinci robotic surgery: Pros and
cons.Studyhealth,
Retrieved
from
http://www.steadyhealth.com/articles/Da_Vinci_Robotic_Su
rgery__Pros_and_Cons_a1259.html
[6] National Society of Professional Engineers. (10, 2012
29).Nspe code of ethics for engineers. Retrieved from
http://www.nspe.org/Ethics/CodeofEthics/index.html
[7]Biomedical Engineering Society. (10, 2011
19). Biomedical engineering society code of ethics .
Retrieved from
http://www.bmes.org/aws/BMES/pt/sd/news_article/52746/_
self/layout_details/false
CONCLUSION
ADDITIONAL SOURCES
I believe the argument is greatly in favor for the
implementation of robotic surgery over traditional surgery
because the only noticeable cons were the unethical high
cost of this technology and the loss of natural touch.
However, besides the extra cost and loss of natural touch,
the da Vinci robot allowed surgeons to cut down time spent
in surgery, in recovery, and human error dramatically. The
extra cost for better technology and research for furthering
improvements of these technologies seem like an obvious
trade off with human life. This is where I believe we may
look past the high cost because paying a little more money is
better than running the risk of losing a life. The safety and
health of a patient is paramount according to NSPE’s
Fundamental Canons [6]. Although robotic surgery may
seem of concern to only a small group of patients being
performed on, robotic surgery should be of concern to
anyone who cares about human safety in the operating room.
In the end technological advancement is meant to further
new effective medical practices and benefit civilization.
daVinciSurgery. (2012). Frequently asked questions.
Retrieved from http://www.davincisurgery.com/davincisurgery/frequently-asked-questions.html
ACKNOWLEDGEMENTS
I’d like to thank the librarians at the Engineering Library
for assisting me in my research process and the engineers on
my floor for being so dedicated to each other’s success.
Also a special thanks to Emelyn for clarifying the formatting
and focus of writing this paper. And thanks to the people
who enjoy distracting me from finishing this paper. I really
enjoy staying up later than I have to.
REFERENCES
[1] Schwartz, S. K. (2010, June 18). Surgical robots draw
fans and controversy. Consumer new and business channel.
Retrieved
from
http://www.cnbc.com/id/37492822/Surgical_Robots_Draw_
Fans_and_Controversy
[2] Singer, E. (2010). The slow rise of the robot
surgeon.Technology
Review,
Retrieved
from
http://www.technologyreview.com/news/418141/the-slowrise-of-the-robot-surgeon/
[3] Carreyrou, J. (2010, May 4). Surgical robot examined in
injuries. The wall street journal. Retrieved from
http://online.wsj.com/article/SB10001424052702304703104
575173952145907526.html
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