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Robotic surgery turns surgical trainees into spectators

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Re: Robotic surgery turns surgical trainees into spectators

#21

Post by inglor_cz »

elromulous wrote: post #4
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.

I don't know for sure, but I suspect cadavers are cheap enough and much "higher fidelity" than any sim could ever be.

Yes and no, for example, they have no blood circulation anymore, thus one of the potentially fatal risks of any surgery - bleeding - can't be "trained" there.

Re: Robotic surgery turns surgical trainees into spectators

#22

Post by 0des »

wincy wrote: post #16
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 instructi…

barber chirurgeons

Re: Robotic surgery turns surgical trainees into spectators

#23

Post by sebmellen »

soperj wrote: post #20
quantumduck wrote: post #17

Earlier quoted context omitted.

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.

It is nearly impossible to accurately simulate a “software body“.

Re: Robotic surgery turns surgical trainees into spectators

#24

Post by kingkawn »

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

Not impossible, there are some good new algorithms for soft tissue deformation that aren't CPU killers like even a few years ago. Most of the surgical sim software out now is either so basic that it isn't good for much beyond cursory anatomical review, or it requires some major hardware installed in a permanent space with limited use-cases that nobody ever bothers to use because at the end of a resident shift they just want to go home and sleep.

I'm working for a small company that is trying to bridge the gap and make something good that can run on the consumer VR/AR hardware that's coming out in the next year or three. Lots of interesting problems to solve.

Re: Robotic surgery turns surgical trainees into spectators

#25

Post by DoingIsLearning »

foldedcornice wrote: post #11
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 conventio…

> 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?

Stereotactic surgery in Neurosurgery.

Re: Robotic surgery turns surgical trainees into spectators

#26

Post by spicybright »

soperj wrote: post #19
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.

I'd actually think a surgery simulator is more difficult than a space one.

Kind of like the difference between a kebel space program and an ultra realistic physics and material simulator.

I'd be shocked if there wasn't at least a few "games" to practice dexterity and perform device diagnostics.

Re: Robotic surgery turns surgical trainees into spectators

#27

Post by sarpeedo »

elromulous wrote: post #15
arcticbull wrote: post #10

Earlier quoted context omitted.

> 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.

I think we should solve autonomous driving before jumping multiple steps to autonomous surgery. There are many low hanging fruit in the world of automation; automated surgery is not one of them.

Re: Robotic surgery turns surgical trainees into spectators

#28

Post by pc86 »

ausbah wrote: post #12
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?

Not the GP but my fiance is also an OB and is also qualified on robotic surgeries. Robotic candidates are typically more difficult cases than more traditional surgeries, so even an equal prevalence of positive outcomes would indicate that robotic surgeries are worth the additional training/time/expense/etc.

I think it'd be pretty hard to do a true apples-to-apples comparison. You'd want to find traditional surgeries that were complex enough that robotic surgery would be indicated, yet for some reason they went ahead with traditional surgery anyway. Almost by definition this would push you more toward emergent surgeries which have worse outcomes overall given their acute nature. You could probably find areas where transfer to a facility with a robot would take too long but you're bringing in a lot of other confounding variables (comparing robotic surgeries at a well funded academic institute with lots of residents and fellows to a small poorly staffed hospital in the sticks, for example).

Re: Robotic surgery turns surgical trainees into spectators

#29

Post by whycombagator »

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…

> and believes there are trade-offs -- it depends on the patient condition and what one is trying to accomplish.

I am interested in the trade offs & what it is not a good fit for.

I realize that is a broad “question”. But any insight is appreciated

Re: Robotic surgery turns surgical trainees into spectators

#30

Post by pc86 »

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.

What makes you think they're not readily accessible? They are. Part of the issue is time. If you're a surgeon, one individual surgery is but a small part of your day. There really isn't any spare time to "prep" for a surgery other than reading the specific of that individual case.
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