15 June 2019 | New Scientist | 21Robotic surgery opens the door
to surgeons performing delicate
operations from remote locations.
In 2001, a gall bladder removal
was performed in a patient in
France remotely by a surgeon in
New York, thanks to fibre-optic
cables that allowed appropriate
control from such a distance.
More recently, a surgeon in
China is reported to have carried
out the world’s first remote-
controlled robot operation over
a 5G cellphone network. This
technology could lead to robotic
operations on the battlefield and
in remote parts of the globe –
maybe even in space.
The ability to beam the
knowledge of expert surgeonsacross great distances could be
a powerful tool for improving
outcomes for people outside
major cities. The obvious question
is whether an internet link will
provide a secure and reliable
enough connection between the
surgeon and the robot operating
on the patient.
In 2015, doctors in Florida
tested lag times over the internet
when performing remotely
2000 kilometres away on virtual
patients in Texas, and found they
were undetectable. Nevertheless,
technology enabling surgeons to
get touch feedback from devices
is more sensitive to lags and
may pose challenges for remote
surgery in future.The doctor won’t see you now
▲ Finland
The Nordic nation has
pledged to go carbon
neutral by 2035 – not
bad for one of the coldest
countries in the world.▲ Robert Downey Jr
The Hollywood star says
he wants to solve climate
change with robots.
Details are scant, but
come on, he’s Iron Man!▼ iTunes
Millions of people are
rejoicing as iTunes
shuffles of this mortal coil.
Apple says the long-hated
app will still survive on
Windows, however.▼ Robot artists
Forget “my kid could draw
that” – now robots are
producing bad art. Works
“created” by robot Ai-Da
are set to be exhibited at
the University of Oxford.▼ Chernobyl
The HBO TV series is a
critical darling but Russia
says it isn’t Putin up with it
anymore – a homegrown
version on pro-Kremlin
NTV will pin the nuclear
accident on US spies.million per system – not to
mention ongoing servicing fees
and replacement parts – they may
not be the best use of healthcare
system funds.
The FDA’s warning about
robotic surgery also cited the
potential for the devices to cause
harm. One randomised trial and
one observational study indicated
that minimally invasive surgery,
including robotic surgery, could
lead to shorter survival times in
people with cervical cancer.
The randomised trial found that
women having a particular kind of
minimally invasive hysterectomy
were at a raised risk of the disease
coming back, death from cervical
cancer and death for any reason
over the study period, compared
with those undergoing an open
surgery. Open surgery was also
associated with longer survival
times in the observational study.
Meanwhile, the FDA has also
received reports of broken pieces
of instruments falling into people,
electrical faults, uncontrolled
movements and video or imaging
problems. It also says there have
been reports of injury and death
related to the devices.
Medical devices are often
introduced to the market without
having to provide regulators with
the same level of high quality
evidence around their safety and
efficacy as for medications. But
building this evidence base will be
essential to understanding which
conditions robotic surgery is best
suited for, according to Dimick
and Sheetz.
Controversies around harms
caused by medical devices such as
vaginal mesh implants and breast
implants have prompted some
governments to set up registries
where surgeons input information
on all of their procedures and the
outcomes. Maybe it is time to do
the same for robots. ❚where robot use is most prevalent,
the results are debated. A two-year
follow up of almost 300 men in
Australia found that harm to
urinary and sexual function as a
result of prostate ops were similar
for both open and robotic surgery.
Sydney urologist Eric Chung
says commercialisation of this
procedure is a problem, as peopleare over-promised on the results
and can get disappointed when
they face side effects at similar
rates to conventional surgery.
For hospitals and surgeons,
being able to offer robotic surgery
can be a marketing tool. It signals
to the patient that they are getting
the most cutting edge technology.
But with a price tag of around $2A 2017 study of almost 500
people randomly given either
regular laparoscopic surgery or
robotic-assisted surgery for rectal
cancer found that the use of robots
didn’t lead to fewer complications
or any other benefit.
Despite this, robot surgery took
an average of 37.5 minutes longer
and cost an average of $13,668
compared to $12,556, due to longer
times in the operating theatre
and instrument costs. This is
before the high upfront costs of
the robots and maintenance fees
are factored in.
Meanwhile, a study of
23,800 people having surgery
for kidney cancer found that the
rates of robotic surgery jumped
from 1.5 per cent in 2003 to 27 per
cent in 2015. Yet there were no
reductions in major post-operative
complications. As in the first
study, robot surgeries took longer,
and direct hospital costs were
$2678 more per person.
Even in prostate cancer surgery,
Working
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The cost of a robotic
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