The Case for Robotic Surgery Improving Healthcare

The robots are coming and changing even how we train surgeons

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There seems to be this belief in the current medical profession that A.I. will never be able to replace physicians, and while I find that far fetched, how robotic surgeries are done leads me to believe that it’s not probable, but actually inevitable.

However as times goes by, robotic surgery is taking on more complex procedures. Clinical researchers at Nagoya City University in Japan have tested an AI-powered surgical robot in its ability to assist with percutaneous nephrolithotomy, which is a minimally invasive procedure to remove large kidney stones.

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So let’s get into it:

The technique involves accessing the kidney through the skin, and typically requires a highly experienced surgeon. The robot, called the Automated Needle Targeting with X-ray (ANT-X) was developed by NDR Medical Technology, a medical startup based in Singapore. The company reports that the robot can assist with needle placement and can calculate needle targeting in a few seconds, using just one X-ray image. In the trial, the robot made the procedure much easier. This is just one of the examples of the progress in robotic surgery and the impact of A.I. in healthcare.

Even the way surgical trainees assist surgeons is changing due to robotic surgery devices. If we think of surgical trainees before the age of robots it was a starkly different routine as compared to today in 2022.

During routine surgeries, trainees worked with nurses, anesthesiologists, and scrub technicians to position and sedate the patient, while also preparing the surgical field with instruments and lights. In many cases, the trainee then made the incision, cauterized blood vessels to prevent blood loss, and positioned clamps to expose the organ or area of interest.

That’s often when the surgeon arrived, scrubbed in, and took charge. But operations typically required four hands, so the trainee assisted the senior surgeon by suctioning blood and moving tissue, gradually taking the lead role as he or she gained experience. When the main surgical task was accomplished, the surgeon scrubbed out and left to do the paperwork. The trainee then did whatever stitching, stapling, or gluing was necessary to make the patient whole again.

Trainees gained hands on experience in that old system, and perhaps learned a lot more, think about it.

In that old system, trainees were in charge for several hours of each procedure. It wasn’t much different for laparoscopic surgery (sometimes called “minimally invasive surgery”), in which tools and cameras are put into the patient via tiny slits. In those surgeries, trainees did much of the preliminary work and cleanup as well. This system of master-apprentice cooperation was so entrenched that hours spent in the operating room (OR) are still seen as a proxy for skill development.

Age of da Vinci Surgical Systems

That’s not working in robotic surgery. Surgical robots have become increasingly prevalent in hospitals ever since the da Vinci Surgical System was approved by the U.S. Food and Drug Administration in 2000. The da Vinci robot, from the Silicon Valley–based company Intuitive Surgical, dominates the market today. Intuitive has more than 6,700 machines in hospitals around the world, and the company says that in the United States, da Vinci machines are used in 100 percent of top-rated hospitals for cancer, urology, gynecology, and gastroenterology diseases.

That is ISRG if you are into stocks. With a market cap of nearly $75 Billion the robots are indeed coming. The Company's products and related services enable physicians and healthcare providers to access minimally invasive care. The systems consist of a surgeon console or consoles, a patient-side cart, a vision system, and proprietary instruments and accessories. Its da Vinci products consist of five categories, so it’s an entire suite of tools.

Robots are Speeding up Minimally Invasive Surgeries

If you think a physician is somehow augmented by a Surgical robot, the way a physician might be improved by A.I. in other settings, it’s not entirely correct. Once the robotic arms are in place and instruments are inserted, the surgeon “scrubs out” and takes up position perhaps 15 feet away from the patient in the immersive da Vinci control console, which provides a stereoscopic view. The surgeon’s hands are on two multipurpose controllers that can move and rotate the instruments in all directions; by switching between instruments, the surgeon’s two hands can easily control all four robotic arms.

Going back to the Japanese surgical robot, percutaneous nephrolithotomy (PCNL) involves accessing the kidney through the skin of the back. The procedure is challenging and achieving such renal access incorrectly can lead to serious complications, including bowel perforation, serious bleeding, and sepsis. Consequently, surgeons must undergo years of training before performing the procedure routinely. Thus as you can see, Robots doing some of the grunt work will actually mean the next-gen of Surgeons may actually be less skilled.

Robotic surgery and A.I. will gradually change the entire profession of healthcare. The ANT-X robot is designed to assist with the procedure, and potentially make it safer for a less experienced surgeon to perform. There are globally dozens of different robotic surgery systems and hundreds of A.I. startups at the intersection of healthcare. Some will augment the ability of healthcare professionals while others will replace some of the tasks even physicians and surgeons were doing before.

A.I. assisted surgical training is the future, because physicians and surgeons will be working alongside the robots. Learning the way surgeons used to learn has now become obsolete.

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Intuitive has more than 6,700 machines in hospitals around the world, and the company says that in the United States, da Vinci machines are used in 100 percent of top-rated hospitals for cancer, urology, gynecology, and gastroenterology diseases.

As our healthcare systems break down, ER departments close to nursing shortages and other problems, and Covid-19 continues to wreck havoc with wait times for important surgeries, Cancer interventions and a host of other things, we realize more than ever that automation in healthcare will be important to improve the system for a quickly aging population.

Surgical robots and more A.I. in healthcare aren’t the novelty they once were, but just the new normal. A new normal that’s badly needed to decrease the spiral cost of healthcare in many countries.

Hospitals that adopt robotic surgery hospitals and related technology have most often turned trainees into optional assistants in the OR, meaning that they begin practicing as “real” surgeons without enough skill. Meaning there will be problems in how robotic surgery and A.I. influence the next-gen of physicians. Our healthcare platforms of the future will be fast, efficient and improve on the care ordinary physicians would be able to provide. Human error would be reduced and our hospitals would flow better. The demand for physicians and surgeons may even eventually decreases, time will tell.

AI-powered robots in performing fiddly surgical tasks will get better and better and further out-perform humans and physical surgeons. Robots will become more common and their costs will be decreased. A.I. will begin to make more clinical decisions according to more personalized data on each patient and in each situation. Automation in the 21st century will come to healthcare and it will never be the same.

How the Demand for Surgeons will Decrease due to Surgical Robots

Back our Japanese study. This latest study compared the robot with conventional ultrasound-guided PCNL in a group of patients at Nagoya City University Hospital. A single, novice surgeon performed the robot-assisted renal access procedures, whereas multiple experienced surgeons performed the conventional renal access procedures.

Achieving renal access with just one needle puncture occurred 34% and 50% of the time in the conventional and robot-assisted groups, respectively. The robot-assisted group is already vastly outperforming the conventional group.

Moreover, the average number of required needle punctures was less in the robot group compared with the conventional group (1.82 times vs 2.51 times). Strikingly, in 14.3% of the procedures in the conventional group, the surgeon could not achieve renal access, and a different surgeon had to help. This did not happen in the robot-assisted group.  Think about the implications of this study at scale for the rest of the healthcare industry.

You quickly come to the conclusion that an A.I. healthcare system will be cheaper, faster and more comfortable for the patient. The robot-assisted teams of today, may become more and more autonomous as the technology improves. This is scary to some, but also inevitable. Robotic surgery of course is just one such example in the broad healthcare system.

How Will Robotic Surgery Tools Scale?

Surgical robots are marvels of engineering in many ways. The da Vinci system gives surgeons a magnified view and robotic hands that never shake, enabling very precise surgical maneuvers.

The A.I. and automation of healthcare will clearly take several decades, the physicians of today have nothing to worry about. But as the training of physicians is already changing, the future batch of physicians knows that they will be working more closely with A.I. and robotic tools.

But also think about how adoption occurs in the real world. The robots have also been a marketing phenomenon that has led to a robotic-surgery arms race, with mid-tier hospitals advertising their high-tech capabilities.

There are many Surgical robotic companies and stocks to research. Between telemedicine, A.I. companies of drug discovery and robotic surgery stocks there’s a lot of innovation that’s going to occur.

• ISRG

• SYK

• GMED

• SNN

• MDT

• ASXC

• TMDI

• MBOT

And so many others.

There there are genomics stocks as well. Clearly there’s going to be a lot of innovation at the intersection of A.I. and healthcare in just the next two decades.

With America’s life expectancy having some bumps upon the road, we’ll be using A.I. to optimize our life-span in the not so distant future. Not everyone will want to live to 100, but at least it will be a choice.

Artificial intelligence (AI) has been in development since the 1950s, and its use in health care has presented inspiring possibilities for surgical advancement and post-op care. We are only 70 years into it, imagine where we will be in another 70? We are just in the early days of robotic surgery and the impact of A.I. on the healthcare field.

What might be the future of robotic surgery and other applications? So far, AI has proven its capabilities to exceed human functioning in drug discovery, symptom analysis, screening and diagnosis. Even just in the 2020s, there’s plenty more to come.

Reference:

1. https://www.medgadget.com/2022/06/ai-powered-surgical-robot-excels-at-tricky-kidney-stone-procedure.html

2. https://spectrum.ieee.org/robotic-surgery

3. https://www.medtechintelligence.com/feature_article/ai-assisted-surgical-training/

4. https://investingnews.com/daily/life-science-investing/medical-device-investing/surgical-robotics-stocks/

Thanks for reading!

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