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Robotic surgery turns surgical trainees into spectators

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Re: Robotic surgery turns surgical trainees into spectators

#81

Post by stephencanon »

Dracophoenix wrote: post #80
stephencanon wrote: post #67

Earlier quoted context omitted.

I don’t think it’s so much “coastal” as “big-name (and big) programs”. Wife is an attending at a one-a-year program here in the northeast, and the residents definitely get _way_ more operating experience then they do at, say, Michigan. The skills issue you identify with some big-name programs is a real thing for sure, though.

How long were her shifts as a resident? I remember reading an article about laws seeking to limit resident hours about a decade ago but I'm not of the opinion that anything regarding hours has really changed since the days of William Halsted.

They’ve been pretty successful about capping individual shift length (to a day and change, granted), the real killer is the total hours per week, which can’t really go down without either the government funding more residency slots or hospitals hiring a bunch of PAs to take over some of the workload, but why would they in a privatized system when the residents are paid for and can’t really leave?

Re: Robotic surgery turns surgical trainees into spectators

#82

Post by pineal »

slt2021 wrote: post #31
DoingIsLearning wrote: post #25

Earlier quoted context omitted.

> 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.

Aren't these non-intrusive and done using gamma knives? I read somewhere that computer+radiologist perform the planning of beams and the gamma knive does all the work

Another example is robotic-assisted pedicle screw insertion in patients with challenging spinal deformities

Re: Robotic surgery turns surgical trainees into spectators

#83

Post by pineal »

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?

The difficulty of a task transcends mere mechanics.

A common analogy used in neurosurgery training: "Imagine a wooden plank on the driveway and walk its length -- no problem. Suspend that same board ten stories in the air and try again." The hard part is not the "figuring out" or "execution" but knowing the irreversibility and making the correct decision. Your patient expects you to be correct 10 times out of 10, yet you know that's not possible. Squaring our fallibility with the irreversibility of our missteps is the hard part, and what keeps surgeons up at night. The fly struggles in the web.

Re: Robotic surgery turns surgical trainees into spectators

#84

Post by Dracophoenix »

stephencanon wrote: post #81
Dracophoenix wrote: post #80

Earlier quoted context omitted.

How long were her shifts as a resident? I remember reading an article about laws seeking to limit resident hours about a decade ago but I'm not of the opinion that anything regarding hours has really changed since the days of William Halsted.

They’ve been pretty successful about capping individual shift length (to a day and change, granted), the real killer is the total hours per week, which can’t really go down without either the government funding more residency slots or hospitals hiring a bunch of PAs to take over some of the workload, but why would they in a privatized system when the residents are paid for and can’t really leave?

How many hours a week? How much of it is actual medical work vs being on standby?

Re: Robotic surgery turns surgical trainees into spectators

#85

Post by ashtonbaker »

Dracophoenix wrote: post #84
stephencanon wrote: post #81

Earlier quoted context omitted.

They’ve been pretty successful about capping individual shift length (to a day and change, granted), the real killer is the total hours per week, which can’t really go down without either the government funding more residency slots or hospitals hiring a bunch of PAs to take over some of the workload, but why would they in a privatized system when the residents are paid for and can’t really leave?

How many hours a week? How much of it is actual medical work vs being on standby?

They’re capped at 80 hours per week, more or less. Most residents go over, regularly. But a single report of a work hours violations is a pretty serious deal for a residency program, so that alone means things are better than they used to be. On the other hand, programs tend to use everything from coercion to collective punishment to prevent these reports from being filed. In practice, this seems to work out as residents tolerating a certain amount of extra hours, as a matter of culture (this varies by institution and by specialty), but it doesn’t seem to be as bad as the old days. Just my limited perspective as a partner to a surgical resident.

Re: Robotic surgery turns surgical trainees into spectators

#86

Post by hansword »

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.

Content note: surgery gore

a) thousands of hours is far far far too little data. This is a total ballpark estimate, with only knowledge of the ML and basically zero knowledge of the surgery side, but I would expect three to six orders of magnitude greater, i.e. millions to billions of hours necessary to train a machine learning model to do something like that, to a standard.

b) the big problem is not the procedures themselves, but edge cases and things going a little bit wrong.

c) you are fine with tiny flukes in your generated images, but you won't be very happy with an ML model whose tiny flukes lead to internal bleeding.

d) unfortunately (with contemporary models) we can't easily explore latent space, which might possibly contain regions corresponding to catastrophic robot arm movements. the chance isn't that high, but it's not a chance most'd be willing to take at this point.

Re: Robotic surgery turns surgical trainees into spectators

#87

Post by iancmceachern »

actionfromafar wrote: post #66
iancmceachern wrote: post #59

Earlier quoted context omitted.

It's because the interface console itself is a big part of the cost and complexity of the thing. The simulator requires the console and input manipulators to use, so they can't train on it while it's being used for surgury. Hospitals could buy a second console to use exclusively with the simulator but that's a multi hundred thousand dollar piece of equipment. Surgeons can take a few practice simulations in the Sim, b…

"multi hundred thousand dollar piece of equipment" So, pretty cheap, it sounds like? How much is the hourly rate of surgeons?

Not really.

A surgeon makes on average $115 an hour in California, $280k a year. So the console plus simulator backpack costs a surgeon or two's yearly salary.

https://www.ziprecruiter.com/Salaries/Surgeon-Salary--in-Cal....

Re: Robotic surgery turns surgical trainees into spectators

#88

Post by iancmceachern »

cardiffspaceman wrote: post #75
iancmceachern wrote: post #62

Earlier quoted context omitted.

The thing about simulation in radiation oncology is its more focused on simulation of the physics of the beam delivery, and not so much on simulation of the tissue or human body portion of the equation. This is more the latter.

When I saw the keywords in these posts it reminded me of a job I interviewed for. This was in 1991 and the state of the art was to plot iso-dose contours on top of X-ray images, presumably using facts about the beam and the tissues at hand. The plan was to evolve from there to 3D images, possibly rendering these planing data in arbitrary orientations in real time. The link provided above discusses tattooing the patie…

Yeah, what you describe is common now on systems like cyberknife. etc.

Re: Robotic surgery turns surgical trainees into spectators

#89

Post by meristem »

soontobesurgeon wrote: post #49

I am currently a senior surgical trainee at a major American academic medical center (1 year to go out of 7). Thought I can provide some insight on some of the primary questions I see in the comments: Before addressing anything further, robotic surgery is probably a misnomer, a better classification would be robotic assisted laparoscopic surgery. Once in place and spatial / positional orientation is obtained, the rob…

Ergonomics may seem not a big deal in that list of improvements, however it can make or break surgery technique and a surgeon's career. Many professions that rely on manual dexterity lose practitioners due to long-term inappropriate ergonomics leading to physical damage/pain.

Re: Robotic surgery turns surgical trainees into spectators

#90

Post by Scoundreller »

iancmceachern wrote: post #87
actionfromafar wrote: post #66

Earlier quoted context omitted.

"multi hundred thousand dollar piece of equipment" So, pretty cheap, it sounds like? How much is the hourly rate of surgeons?

Not really. A surgeon makes on average $115 an hour in California, $280k a year. So the console plus simulator backpack costs a surgeon or two's yearly salary. https://www.ziprecruiter.com/Salaries/Surgeon-Salary--in-Cal... .

Only if they're spending 2500hours a year in the OR.
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