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.
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…
Any beginning woodworker quickly learns how much of the job is not just making a straight cut but juggling a whole ton of shit you didn't think about.
And that's all without getting into things like how much of a grace period you have between the first cut and the last fastener, which you don't have with a living organism.
It is nearly impossible to accurately simulate a “software body“.
Why? Couldn’t one model the various tissues and bones, fluids, surface tensions, resistance to cutting etc?
Yes, you can produce a model incorporating nonlinear elasticity, viscosity, plasticity, frictional contact, subfailure damage, and fracture / cutting. Repeat for each tissue involved. Some of those methods are well-developed, others are not. Damage and failure in particular is poorly developed, and simulating deformable body contacts can be tricky. Then you have to estimate parameters for all of that, validate that the model produces realistic outcomes, and get it to run in real time.
You can ignore most of the complexity and make approximations, like treating everything as an isotropic linear elastic material, setting cutting resistance to a fixed value per tissue, treating the scalpel like a lightsaber, and accepting that contact will be imperfectly enforced (surfaces may interpenetrate). A crude simulation can still be good enough to be useful as a learning tool though, but it tends to work more like a video game than a true physics-based simulation. We'll still eventually get the kind of accurate simulation you're asking for, probably.
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
I’m not even thinking of anything as grandiose as a full simulation of the human, it could be as simple as mimicking the movements from a previous surgery using an overlay of the simulated robot arms.
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 can't speak to how hard surgery is to perform but I will say, from talking to surgeons, it sounds like deciding when to operate (and to what extent) is more difficult than actually performing the surgery in a lot of circumstances.
Why? Couldn’t one model the various tissues and bones, fluids, surface tensions, resistance to cutting etc?
Yes, you can produce a model incorporating nonlinear elasticity, viscosity, plasticity, frictional contact, subfailure damage, and fracture / cutting. Repeat for each tissue involved. Some of those methods are well-developed, others are not. Damage and failure in particular is poorly developed, and simulating deformable body contacts can be tricky. Then you have to estimate parameters for all of that, validate that t…
I was specifically constraining the discussion to robotic surgery. Do all these variables apply in that case?
When I rotated through surgical oncology as a 3rd year medical student, a lot of the cases were robotic.
For a 5 hour surgery, the fellow got to drive the robot for about 90 minutes. He spent the rest of the time watching.
The resident made incisions to introduce the robotic instruments and then closed at the end. This took about 15 minutes at the start of the case and and another 15 at the end. She spent the rest of the time standing there and watching.
I wasn't even allowed to scrub in - not enough space with the robot docked. I had to stand in the corner of the room for 5 hours watching the surgery on a monitor. And of course the circulating RN wouldn't let me stand in a place with a decent view.
I would have had a better learning experience watching a YouTube video of a surgery. What a colossal waste of time for all trainees involved.
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’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 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, but it's just that doing so ties up the robot from doing real cases at that time also.
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