Da Vinci robot surgeon removes inoperable tumor, saving patient’s life
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The medical professionals are the real heros here. If the da Vinci system had just come out and this was some new capability I would understand. In this case the headline should say "surgical staff saves life of inoperable patient using standard surgical quality of care and using device that has been available on the.market for 15 years".
It's one thing to say "new Invention of the automobile saves life of first ambulance passenger" and another to say, today, the same thing.
There are two sides to this coin.
It's the classic do we want to keep a human in the loop, or not. By your same point we could argue that robots are more efficient killing machines, so let's make autonomous killing robots.
Back to surgery, there are lots of reasons you want a surgeon in the loop. There are lots if things that robots can do better too (like your tremor example). The key, like many things, is in the shade of grey in between, not the extreme arguments on both sides.
I stand by calling that surgical staff heros, and also think that the future of (good) surgery lies in the combination of skilled medical professional and machine, not the replacement of skilled professionals by machines.
Disclaimer: I work in this space
I think that this is not ethics or something that stops us from doing that, but rather the poor state of robotics.
The second we can, we will have autonomous killing robots à la Terminator (but better because they are not really optimal by looking like us)
It is always an afterthought and depending on who wins, the horrors of war that fall outside the "that's ok" category are either completely ignored, or someone is waving a finger, or there is a trial which finishes or not with actual punishments.
If you clock in at your schedule time, go through your motions, clock out, what you're doing isn't heroing, you're doing your job. This isn't any sort of attack whatsoever on the profession, I have lots of respect for them, but I know plenty of surgeons and they'd all cringe at this hero talk.
This was no run of the mill lap choli or gall bladder removal.
And I'm sure we'll get to autonomous surgery at some stage, but we can't even get autonomous driving right, and I feel like surgery is even more precise and potentially dynamic.
We’re realistically (many) decades away from this in the earliest case. AI is cool, but literally giving one a scalpel and allowing it to excise a tumor is so far beyond both what our present technology and regulatory safeguards will realistically facilitate within most of the lifetime of anyone alive.
I do admire your optimism, but I can’t help but think it’s a little misplaced. We have collectively billions of miles driven for self-driving cars and they still can’t reliably distinguish a red light in suboptimal conditions. And somehow a machine is going to slice us open and perform a surgery than even our most skilled surgeons are not reliably performing (let alone generating training data for). Not to mention the human body is an insanely complex, variable, and messy environment where even little mistakes can be life ending.
I understand that exponential growth in AI is difficult to comprehend. But fully autonomous surgery is just likely not on the bingo sheet for this century. It’s several orders of magnitude more complex and high stakes than just about every other task AI can take on.
I’m glad this patient was helped but there is absolutely nothing interesting otherwise about this.
The kind of amazing where untold millions of people can't afford basic healthcare in the same country that we have a robot surgeon?
If DaVinci hadn’t developed the robot, would more people be able to afford health care?
Da Vinci is famously not better. There isn't a single study showing its better. It's also not less expensive, and doesn't reduce staffing needs in the OR.
What is it? A marketing tool. Surgery centers and hospitals can drive increases in patients and patient throughput, improving their bottom line. It's marketing and throughout.
They have a classic razor razor blade model. The surgical instrument are proprietary and locked in with eeprom chips in the disposables. They only last a handful if cases and then must be replaces. Intuitive made something like 80 billion last year and has had no real competition in their market for decades. As a result they've been able to pretty much write their own checks, choosing how much stuff costs and achieving huge margins on lots of very expensive equipment and supplies.
Source- I've worked on and lead the design teams for surgical robots for several companies in the field.
I have questions though.
Is the davinci amazing? I have heard that it is.
Why doesn’t someone else make a similar product? Is there technology that is hard to replicate?
Others have been trying for years. The latest big player is J&J who faces an existential threat due to robotic surgery overtaking conventional surgery, and therefore one of J&J/Ethicons core business. They bought Verb and Auris and a few other smaller companies in the space and smashed them together. There are others in the space trying to do the same.
Ultimately Intuitive has a pretty big moat. They have a lot on the technical/IP side, but also just business wise. These hospitals and surgery centers pay millions for a robot, then need to keep it busy doing cases for several years to pay it off. There is a lot of risk and not really any clear advantages to changing to a new challenger. That new challenger would need to demonstrate some key advantage, which they have yet to do.
It's hard, its akin to trying to compete with space x or similar, starting now.
Not better than surgeons with competing devices, or not better than surgeons without these tools?
From a patient point of view it is a big difference. Hospital stay is really expensive even if you have insurance. Hospitals charge like 10000$ per day and copayment foe hospital stay is usually hundreds of dollars.
Of course, it means that hospitals can process more patients and generate more profit, but it also reduces surgery wait times, which is critical for a patient with a tumor, because the longer your wait, the more likely for the tumor to spread
That's the rub, what I'm highlighting. We all just automatically assume the robot is better because it's a robot. The proof is in the pudding.
Yes, there is no statistically significant evidence yet that it is better, but there is no statistical evidence that it is worse. I don't think it is beneficial to stop using this technology based on cost effectiveness.
I happened to had a tumor on my kidney 6 month ago, so I actually had to make a decision between regular laparoscopy and Da Vinci. Tge surgeon who did not have access to the robot system said that robot is just marketing BS and he would do a surgery just fine. However, because the tumor was on the back side of the kidney it would require rotating kidney out of the place and would be a bit challenging. But he was confident that it could be done
THe surgeon with robot said that tumor position is not a problem for a robot whatsoever. So I went with the robot.
So, back to OP, the robot is better because it allows to perform surgery in places where it is not possible to go with non robotic instruments.
I also have plenty of anecdata from people who had similar surgeries performed on them with different techiques. It terms of post op recovery da Vinci wins unanimously. I had surgery on Tuesday and was back to work next Monday
Many of the positives you highlight are true for any modern laporoscopic surgury, not just Da Vinci. In most indications, manual laparoscopy is by far the market volume leader for lots of reasons. Reasons like big surgical systems like Da Vinci are huge and require dedicated large ORs that are expensive. Meanwhile they still need to get surgury done in the smaller, more common, more cost effective ORs. Don't get me wrong, Da Vinci is a modern marvel, as I've said in other comments here it's truly a remarkable work of engineering. Its also a monopoly that makes a ton of money, and also far from how every surgery is done or should be done. Those two things don't go together, monopoly and shouldn't be the whole market. That's all I'm saying. It's not the panacea it's made out to be often.
All kinds of things have been designed to "specifically give to an X profession a better instrument".
That's just a mission statement at best, marketing promo at worst. Doesn't preclude them not meeting that target.
"it's better because it has been specifically designed to be better" is circular reasoning.
First you have to trust the surgeon not to be shilling in his report.
The link you provide below says
"When it comes to prostatectomies, urologists have found the outcomes for da Vinci robotic surgery to be much better than for laparoscopic surgery and use this method in more than 90% of these procedures [...] Robotic surgery also appears to provide clinical benefits for some, but not all, types of head and neck surgery."
It also reports negative value overall for gynecological surgeries.
The evidence you provided suggests it's better for some things and not others, which seems like the expected case.
Good stuff happening shouldn’t make you miserable.
Of course.
There are many things in a person's emotional life that a person does not have any control over (at least not in the short term and without spending lots of time and money on, e.g., psychotherapy). I think it is commendable that you understand your own emotions well enough to perceive this self-hatred, and I do not think any less of you because of it.
If there are many people who share your emotional reaction to inequality, that would have explain a lot of things that so far have been puzzling to me.
What is your opinion of those who have things that others lack, but do not hate themselves for it? Is there something wrong with such non-self-hating lucky one in your eyes?
Da Vinci is telecontrolled. The robot does nothing but imitate the exact motion its commanded to by the surgeon.
The headline should read " Surgeon saves patients life using surgical tool that has been widely available an on the market for decades"
The medical professionals deserve the credit. If this was 20 years ago, yeah, we should celebrate the technical achievement and advancement, but there isn't one here. It's old news.
Source- I've designed several (surgical robots)
Not a new concept by any means, but still worthy of continued praise and admiration.
Times change, technology advances, and when those advances become 'old' they cease to be interesting for the most part.
So it was doable but as the article states "no one was lining up"
Not to diminish this case at all but people kinda misinterpret how surgical robots operate. They are less like CNC robots where you program in a control path before hand and the robot follows it. Rather they are like a set of "prosthetic" tools that allow you to stabilize your movements and shrink them down to extremely small motions beyond the precision human hands are capable of.
It still takes an extremely skilled human surgeon at the controls at all points of the surgery to make this possible, these are just tools that give those surgeons more fidelity and stability in their motions.
No less amazing in the slightest but make no mistake that this surgery was performed by a human, just with a far more advanced kit of scalpels and forceps.
No, even if you consider the surgeon. The article talks about that the robot is able to do maneuvers that a human hand cannot, drastically simplifying the surgery.
I'm well aware that the robot is controlled by a human, and I don't think anything in my comment indicates I wasn't.
The robot is more dextrous and thinner and can do the surgery without breaking the jawbones.
In other words, I agree with what you are saying.
https://www.cbc.ca/news/canada/newfoundland-labrador/first-p...
A columnist got surgery done for case with some complications. Next some other publication wrote article to generate articles. Essentially showing where we are. Mildly interesting things get circulated.
* "Without me, my rifle is useless. Without my rifle, I am useless."**
It's the man and the machine together as a super-organism.
** https://en.wikipedia.org/wiki/Rifleman%27s_Creed
Disclaimer: I played with a Da Vinci prototype sewing grapes but I'm definitely no surgeon. My hands shake more than someone with Parkinson's. I cannot fathom subsequent generations of refinements in steadier hands with surgical experience. Clarke's third law applies here. Although, I wonder before how long AI and mechatronics will receive credit for simple veterinary surgeries as a testbed on the path to a truly miraculous, sci-fi "surgical chamber".
The die binders that I used to use had physical motion reduction systems - are there more general versions of these available?
There should be, but no idea
On other hand, multi-axial CNC machines and various welding robots are quite amazing.
Is this remarkable? I would imagine that it saves thousands of lives a year.
https://www.theguardian.com/world/2022/may/11/canada-cases-r...
Source: my wife participates in these surgeries.