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Robotic surgery turns surgical trainees into spectators

spectrum.ieee.org

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Re: Robotic surgery turns surgical trainees into spectators

#11

Post by foldedcornice »

pixelmonkey wrote: post #3

I'm a programmer and my wife is a robotic surgeon who did many, many operations with these da Vinci machines (and also trained with them in residency). Her focus is on what's known as "MIGS", described here: https://en.wikipedia.org/wiki/Robot-assisted_surgery#Gynecol... Glad to ask her any engineering- or programmer-minded questions that HN folks might have about what robotic surgery is like. (I'll collect any that…

I'm curious to learn more about the main advantages of the da Vinci machines in certain contexts, over 'straight-stick' surgery.

The article's author, who is a roboticist rather than a surgeon, paints a picture where robotic surgery does not have a clear advantage over straight-stick surgery due to a lack of training: "In fact, a recent survey of 50 randomized control trials that compared robotic surgery to conventional and laparoscopic surgeries found that outcomes were comparable, and robotic surgeries were actually a bit slower. From my perspective, focusing on education, it’s something of a miracle that outcomes aren’t worse, given that residents are going to their first jobs without the necessary experience. "

To learn from an alternative perspective, what might be an example of a patient condition or objective where robotic surgery may have a meaningful advantage over conventional surgery?

Re: Robotic surgery turns surgical trainees into spectators

#12

Post by ausbah »

pixelmonkey wrote: post #3

I'm a programmer and my wife is a robotic surgeon who did many, many operations with these da Vinci machines (and also trained with them in residency). Her focus is on what's known as "MIGS", described here: https://en.wikipedia.org/wiki/Robot-assisted_surgery#Gynecol... Glad to ask her any engineering- or programmer-minded questions that HN folks might have about what robotic surgery is like. (I'll collect any that…

how would your wife respond to the claim in the article that the outcomes between robotic and traditional surgeries appear the same?

Re: Robotic surgery turns surgical trainees into spectators

#13

Post by quantumduck »

musingsole wrote: post #6
quantumduck wrote: post #5

Earlier quoted context omitted.

It's easy to simulate the robotic manipulators - the dynamics are well known and they are rigid objects. On the other hand, simulating say skin/muscle/blood or anything that closely resembles human body is near impossible. Without that, a simulator is pretty much useless and it'll probably easier to train the surgeons on real robot + some animal like pig

But don't we now have thousands of hours of real-use? Surely in the age of Dall-e, a system to use that as input to ape if not fully simulate the surgical environment is within reach.

While DALL-E might seem like something out of the world, what it outputs at the end of the day is pretty basic: a 2D image.

To run a high-fidelity simulator of human body that is useful for surgeons, you need a LOT more. And I doubt it can be data-driven. Data-driven simulators for things like autonomous cars are just coming up, and these are way simple as the agent (the autonomous car) doesn't directly change the environment when it's driving around (as in, you don't have to simulate the car colliding into a traffic pole and then breaking it, etc.)

To simulate a human body, you need to be able to capture the material properties of different layers, some of which are fluids, and then also the interaction between them and how different organs react to a surgical operation. It's a very hard problem.

Why do all that when you have animal corpses readily available? There's no need to create a problem that doesn't exist.

Re: Robotic surgery turns surgical trainees into spectators

#14

Post by deelowe »

quantumduck wrote: post #5
catgary wrote: post #2

I’m a bit shocked that simulators aren’t made readily accessible to surgeons. I thought that would be the biggest advantage of robotic surgery - a surgeon could prep with a few practice surgeries on the sim, while being taken through a few “sometimes this is what goes wrong, here is how you recognize/recover”-scenarios.

It's easy to simulate the robotic manipulators - the dynamics are well known and they are rigid objects. On the other hand, simulating say skin/muscle/blood or anything that closely resembles human body is near impossible. Without that, a simulator is pretty much useless and it'll probably easier to train the surgeons on real robot + some animal like pig

Is a physical object even required? Why can't it be like a flight sim and just be controls and some screens?

Re: Robotic surgery turns surgical trainees into spectators

#15

Post by elromulous »

arcticbull wrote: post #10
oneoff786 wrote: post #9

Earlier quoted context omitted.

I wonder if they’re more expensive though?

> The cost of the da Vinci robot was obtained from Intuitive Surgical. This analysis utilized the $1.5 million da Vinci-S robot. The cost of the robot was amortized over 5 years; thus, the robot costs $300,000 per year and the service contract is $112,000 per year. So it adds the cost of one extra surgeon, for the same outcomes, but slower? Here's a list of advantages. [1] [1] https://www.ncbi.nlm.nih.gov/pmc/article…

So I suspect we're in a stage similar to where early muskets were vs bows. Barely better, possible even worse. But we're on a path that let's us unlock many advancements. i.e. autonomous surgery.

Re: Robotic surgery turns surgical trainees into spectators

#16

Post by wincy »

oneoff786 wrote: post #8

Question: is surgery hard? I’m aware you need to be steady. I’m aware it can take a great deal of time and focus and endurance. But how hard is it to figure out a surgery, and execute it?

I think it depends on the surgery. Farmers neuter their own pigs and cattle all the time which is a type of surgery.

My daughter had brain surgery and we found the actual medical paper describing how to perform the procedure. It’s basically 6 sentences long. Cut here, make an incision, use a tool there. All while being sure not to accidentally sever an infant’s spine and make them a quadriplegic. The actual instructions were simple enough that I could understand perfectly well how to do the procedure based on the document. However, I’m sure if I actually attempted the surgery I’d be a nervous wreck. I’d guess confidence is probably another part. But maybe a doctor will chime in.

I just tried to find the paper but am not sure where we dug it up or I’d just post it here.

Re: Robotic surgery turns surgical trainees into spectators

#17

Post by quantumduck »

deelowe wrote: post #14
quantumduck wrote: post #5

Earlier quoted context omitted.

It's easy to simulate the robotic manipulators - the dynamics are well known and they are rigid objects. On the other hand, simulating say skin/muscle/blood or anything that closely resembles human body is near impossible. Without that, a simulator is pretty much useless and it'll probably easier to train the surgeons on real robot + some animal like pig

Is a physical object even required? Why can't it be like a flight sim and just be controls and some screens?

What do you mean? In a flight simulator you have your controls controlling a plane (right body, dynamics are well known) in the sky (simple environment, dynamics are reasonably well known, even with different atmospheric conditions like wind). The output is visualized on the screens as a rendering of the scene.

In the case of robotic surgery simulator, you are using the controls to control the arm, but to interact with what? If you just want to move the arm around and maybe interact with some rigid objects sure that's easy. Would that add any training value to the surgeon? Probably not. You can get value only when the simulator includes a simulation of something the surgeon would have to face eventually - organic mass of the human body. Simulating that is hard, and I doubt anyone would invest much into it when you can train surgeons on alternative physical objects like pigs.

Re: Robotic surgery turns surgical trainees into spectators

#18

Post by lostapathy »

oneoff786 wrote: post #9
arcticbull wrote: post #7

> Many people assume that patient outcomes must be better with robotic surgery. It’s not obvious that’s true. In fact, a recent survey of 50 randomized control trials that compared robotic surgery to conventional and laparoscopic surgeries found that outcomes were comparable, and robotic surgeries were actually a bit slower. Fascinating. I definitely assumed that the robotic surgeries had better outcomes. I wonder ho…

I wonder if they’re more expensive though?

Or is there a bias that harder cases end up on robots, so they even “equal outcomes” is a big win for that cohort?

Re: Robotic surgery turns surgical trainees into spectators

#19

Post by soperj »

pixelmonkey wrote: post #3

I'm a programmer and my wife is a robotic surgeon who did many, many operations with these da Vinci machines (and also trained with them in residency). Her focus is on what's known as "MIGS", described here: https://en.wikipedia.org/wiki/Robot-assisted_surgery#Gynecol... Glad to ask her any engineering- or programmer-minded questions that HN folks might have about what robotic surgery is like. (I'll collect any that…

Is there someway for the trainees to do simulations on these machines? You'd think if they can simulate landing the space shuttle, you could simulate doing a surgery.

Re: Robotic surgery turns surgical trainees into spectators

#20

Post by soperj »

quantumduck wrote: post #17
deelowe wrote: post #14

Earlier quoted context omitted.

Is a physical object even required? Why can't it be like a flight sim and just be controls and some screens?

What do you mean? In a flight simulator you have your controls controlling a plane (right body, dynamics are well known) in the sky (simple environment, dynamics are reasonably well known, even with different atmospheric conditions like wind). The output is visualized on the screens as a rendering of the scene. In the case of robotic surgery simulator, you are using the controls to control the arm, but to interact wi…

it would control a software arm operating on a software body, just like a flight sim controls a software plane.
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