20 | New Scientist | 15 June 2019SURGERY performed with the help
of a robot has been billed as the
next revolution in healthcare:
such procedures can be carried out
through an incision the width of
a finger, causing less scarring and
often allowing people to return
to their homes more quickly.
The UK’s National Health
Service recently announced
plans to spend £50 million on
more robotic surgical equipment
for operating theatres, and yet
the benefits of this high-tech
approach are debated. Earlier
this year, the US Food and Drug
Administration (FDA) cautioned
against robotic surgery for cancer,
citing a lack of evidence for its
safety and efficacy.
In Austria, a recent analysis
found that there was little quality
evidence that the devices were
an advantage in thorax and
abdomen operations. The team
sifted through 28 clinical studies
each examining at least 10 people
and found that it was impossible
to know whether robot-assisted
surgery was better than
standard surgery for nine out
of 13 conditions that required
these operations.“Our recommendation is not
to invest in robotic surgery now
[for these conditions] because it’s
still in a very experimental stage,”
says Claudia Wild of the Ludwig
Boltzmann Institute for Health
Technology Assessment in
Vienna, who led the work.
“Every new technology has to
prove first that it’s better than
the given tech, especially if it is
far more expensive.”
Despite these doubts, surgical
robots have become increasinglypopular. The number of
procedures done with these
devices has jumped six-fold
globally in the past decade, and
in the past year alone more than
a million operations were done
worldwide with the da Vinci
surgical system, the market leader.
Robotic surgery seems like
progress because it is an extension
of a technique called minimally
invasive laparoscopic surgery, also
known as keyhole surgery. In the
past, surgeons had to make a large
cut to operate. Keyhole methods
instead allow them to make
several small cuts and insert a thin
tube with a camera and light on
the end to guide the operation.
With robotic surgery, you aren’t
actually being operated on by
a machine. Instead, the robot is
completely controlled by a human
surgeon who sits at a console awayallowing people to leave hospital
more quickly. In the past, people
undergoing hysterectomies
would often have to stay in
hospital for a week, but now half
can go home the same day, says
Felix Chan at the University of
New South Wales, Australia. This
reduces costs and the risks of
infection, he says.
These benefits are similar
to those from other minimally
invasive approaches done without
robots. But a draw for surgeons
is that sitting at a console is also
far more comfortable and less
physically demanding than
manoeuvring around a patient’s
body, which makes it easier for
surgeons to continue working into
older age and to avoid repetitive
strain injury and other
musculoskeletal problems.
“When you train surgeons at a
certain level, the longer you can
get productive and useful work
out of them, the better it is for
the health system, and the better
it is for the patients because they
are getting a more experienced
surgeon,” says Shomik Sengupta at
Monash University in Melbourne,
Australia, who is researching the
ergonomics of robotic procedures.
But critics have questioned
whether robot surgery lives up to
its billing. Surgeons Justin Dimick
and Kyle Sheetz, both at the
University of Michigan, published
a call for safeguards around the
growing adoption of the tools
(JAMA, doi.org/c632). The field
lacks high-quality research
supporting their use, they
wrote: “To date, most studies
demonstrating potential benefits
of robotic-assisted surgery have
been small, single-centered
reports without rigorous controls.”Nurse, pass the robot
The rapid rise of robot-aided surgery ignores the problem that gadgets
don’t always improve treatment outcomes, says Ruby Prosser ScullyMachine arms get to
work in the operating
theatreMedical technologyPE
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from the patient (pictured, below),
watching a screen and operating
the robot with hand and foot
controls – and they don’t even
have to be in the operating theatre
(see “The doctor won’t see you
now,” right). The robot reduces
tremors from the surgeon’s hand
during these procedures, as well as
offering a better range of motion
and zoomed-in 3D visualisations.
Advocates say that, just like
laparoscopic methods, robotic
surgery results in less pain and
less damage to surrounding tissue,“ Our recommendation is not
to invest in robotic surgery
now because it’s still in a
very experimental stage”
Surgeons
operate robots
from a remote
consoleVC
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