Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Robotic surgery turns surgical trainees into spectators

spectrum.ieee.org

Post reply on HN
Print view View original

61–70 of 90 posts

Re: Robotic surgery turns surgical trainees into spectators

#61

Post by iancmceachern »

inglor_cz wrote: post #21
elromulous wrote: post #4

Earlier quoted context omitted.

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.

It can, they can plumb things up with pumps to simulate whatever.

This same limitation applies to simulators though, so this application isn't an answer to the parent comments question.

Re: Robotic surgery turns surgical trainees into spectators

#62

Post by iancmceachern »

adolph wrote: post #44
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'll be interesting to see the growth of simulation in other fields similar to that used in radiation oncology [0]. The trick about human bodies is that they aren't all the same and they don't say the same. Once the robot can perform sufficiently similarly in simulation as in real life, then a high risk and cost intervention like surgery will be simulated before performance. An additional aspect of simulation is cal…

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.

Re: Robotic surgery turns surgical trainees into spectators

#63

Post by iancmceachern »

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?

There are a lot of difficult non-obvieous things to watch for and know. It's like an old cardiac surgeon told me, he can walk into a room and know from across the room if the patient has high blood pressure, is this, is that, just by their coloring etc. It's the same way watching the experienced surgeons do their work, they know so much about a patient just by looking around inside, this means that, etc. Wisdom.

To answer your question, basic surgury isn't (difficult). Good medicine is. The more complex the issue, the better medicine you need.

Re: Robotic surgery turns surgical trainees into spectators

#64

Post by iancmceachern »

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…

It's a big marketing driver for centers.

Re: Robotic surgery turns surgical trainees into spectators

#65

Post by arcticbull »

iancmceachern wrote: post #64
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…

It's a big marketing driver for centers.

That was the connection I was thinking it probably had with higher care costs. Expensive, shiny things that don't actually improve outcomes is a good way to bring people through the doors. Like my dentist's LIDAR scanner.

Re: Robotic surgery turns surgical trainees into spectators

#66

Post by actionfromafar »

iancmceachern wrote: post #59
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 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?

Re: Robotic surgery turns surgical trainees into spectators

#67

Post by stephencanon »

senortumnus wrote: post #33

Surgeon here who does the majority of my “major case” work robotically. Author of this article has a coastal-centric point of view. My residency was apprenticeship model and I graduated very confident in my capabilities to perform robotic surgery “skin-to-skin”. The phenomenon he references about trainees no longer being able to start a surgery without the “attending” surgeon present is not related to robotics. It is…

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.

Re: Robotic surgery turns surgical trainees into spectators

#68

Post by stephencanon »

galdosdi wrote: post #34
wincy wrote: post #16

Earlier quoted context omitted.

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…

I imagine the trained surgeon knows what to do when anything goes wrong following those 6 simple instructions, and from thence flows confidence.

Exactly. Wife is a neurosurgeon, and somewhere towards the end of her sixth year of residency, she had the gradual realization that she could handle anything that might happen in the course of an even semi-normal case. That fluency has continued to build since then, of course.

Re: Robotic surgery turns surgical trainees into spectators

#69

Post by ska »

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.

I think this overestimates what Dall-E is actually doing, and underestimates the complexity of the task.

Re: Robotic surgery turns surgical trainees into spectators

#70

Post by jpeloquin »

deelowe wrote: post #56
jpeloquin wrote: post #53

Earlier quoted context omitted.

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?

Not sure how to interpret the question. Using a robot vs. a person doesn't change anything about the physics of how tissue responds to perturbation. You can of course simplify the simulator and correspondingly limit its use to specific learning objectives, probably novice-level. To return to the thread's starting point—we understand flight well enough to make general-purpose flight simulators, we don't understand tissue well enough to make general-purpose surgical simulators. You can still make simple interactive training tools to help someone rehearse the motions of a procedure, but I wouldn't call such a tool a simulator.
Post reply on HN