Speaker 1: Brought to you by Toyota. Let's go places. Welcome to
Speaker 1: Forward Thinking. Hey there, everyone, and welcome to Forward Thinking,
Speaker 1: the podcast that looks at the future and says, doctor, doctor,
Speaker 1: give me the news. I'm Jonathan Strickland, I'm Lauren, and
Speaker 1: I'm Joe McCormick. So, um, I heard you guys had
Speaker 1: a movie scene that you wanted to talk about. But
Speaker 1: it's a movie. It's a movie I have not actually watched,
Speaker 1: so I don't know what you're talking about here. You're
Speaker 1: gonna have to tell everybody what you Jonathan. It's an
Speaker 1: R rated film. That's why I wasn't able to get in.
Speaker 1: You're not allowed to go to those. It was the
Speaker 1: movie Prometheus, which I, like a lot of people had
Speaker 1: some questions about. It involved a lot of really shady
Speaker 1: plot lining. I hear. It was a beautiful film. Oh,
Speaker 1: it was very pretty, and its vision of the relatively
Speaker 1: near feature was really interesting in a number of ways,
Speaker 1: some of which um are terrible and some of which
Speaker 1: are are genuinely fascinating. There was one scene in particular
Speaker 1: that I thought might be kind of relevant to this show,
Speaker 1: and that scene is a horrifying, uh kind of body
Speaker 1: violation scene featuring a dramatic surgery performed uh spur of
Speaker 1: the moment, kind of entirely by a robot, right, not
Speaker 1: by a human at all. It's automated, so one of
Speaker 1: the surgery pod things I've heard about, right, right. Yeah,
Speaker 1: the character hops into a big glass coffin and then
Speaker 1: some knives pop out and start doing their thing. So
Speaker 1: I guess this leads us into a discussion about robotic
Speaker 1: surgery and how that's uh, that's a real thing, but
Speaker 1: not necessarily a real horror show thing like what you
Speaker 1: have just briefly described, right, No one would hope that
Speaker 1: in real life robotic surgery is not quite so scary
Speaker 1: and is in fact a good thing. Um though, I
Speaker 1: guess we can debate that as it comes up. Sure, now,
Speaker 1: this is not a new idea. It's not that robotic
Speaker 1: surgery has debuted in the last year or two. It's
Speaker 1: actually been around for a while. In fact, the first
Speaker 1: documented case I could find was a case back in
Speaker 1: five and it was using a surgical arm called the
Speaker 1: Puma five sixty uh, used during a neurological biopsy. Now
Speaker 1: this particular, in this particular case, the robot, as I
Speaker 1: understand it was not performing the surgery, but was being
Speaker 1: used in conjunction with this biopsy. UH. As the years
Speaker 1: went on, you started to see more and more use
Speaker 1: of robots because people were like engineers and doctors were
Speaker 1: saying there was a lot of potential there. Other doctors
Speaker 1: were very hesitant because we're talking about very delicate procedures.
Speaker 1: This is in many cases a life or death situation,
Speaker 1: and you don't want to take any liberties with that
Speaker 1: kind of thing obviously, UM. But over the next couple
Speaker 1: of years they started using them in other procedures robotic arms.
Speaker 1: That is, for laparoscopic procedures, for example, which usually means
Speaker 1: there's some uh your sing a flexible optic camera as
Speaker 1: well for minimally invasive surgery in order to UM to
Speaker 1: be able to handle things inside the body without having
Speaker 1: to make a huge open cut, right and uh, laparoscopic
Speaker 1: procedures can be performed by hand. Sure, I want to
Speaker 1: make clear that's not something that's necessarily unique to robots.
Speaker 1: So there are a lot of surgeons who have trained
Speaker 1: in this art of trying to make small incisions in
Speaker 1: the body and stick in their instruments and sort of
Speaker 1: do what they need to do in there without making
Speaker 1: big open cuts. But of course there are limitations to
Speaker 1: what you can do by hand in that sense, and
Speaker 1: we can talk about that more in a minuture. And
Speaker 1: then we had other robots, and clearly one called robo Doc,
Speaker 1: which is probably my favorite name, UH was the first
Speaker 1: robot approved by the f d A, and they also
Speaker 1: approved the STOP robotic system for endoscopic surgeries back in UH.
Speaker 1: These the SAP led into another development. There was another
Speaker 1: robot called Zeus, which followed a SUP and after use UH,
Speaker 1: the work that went into ESOP and Zeus later informed
Speaker 1: engineers who built the Da Vinci systems, which are probably
Speaker 1: the best known robotic surgery tools out there right now.
Speaker 1: They're the ones that if you read a story about
Speaker 1: robotic surgery nine times off ten, it's a Da Vinci
Speaker 1: system that we're talking about. Sure, they were finally approved
Speaker 1: for FDA use in the year two thousand and UH.
Speaker 1: We've even seen some transcontinental surgeries performed using robots because
Speaker 1: one of the other things we'll talk about is that
Speaker 1: using a robot assistant essentially or a robot, you know,
Speaker 1: think of the robot as a replacement for the surgeon's
Speaker 1: actual hands means that the surgeon could potentially perform that
Speaker 1: surgery while not even being present within the room. They
Speaker 1: could be and that, like in this case, on the
Speaker 1: other side of a continent. So that's kind of exciting. Um,
Speaker 1: So we're gonna talk about all of that, but we
Speaker 1: should also mention that it's not this using robots and
Speaker 1: surgeries not something that was immediately embraced, and still to
Speaker 1: this day, it is a controversial subject. It's one of
Speaker 1: those that has there are a lot of both advantages
Speaker 1: and disadvantages, and you have to weigh them very heavily
Speaker 1: before you can say outright is it a good or
Speaker 1: bad thing? Especially you know, it may be particular case
Speaker 1: to case basis. But a two thousand four report in
Speaker 1: the Annals of Surgery urged caution and skepticism about robotic surgery,
Speaker 1: saying that this is a direct quote, robotic surgery is
Speaker 1: a new and exciting emerging technology that's taking the surgical
Speaker 1: profession by storm. Up to this point, however, the race
Speaker 1: to acquire and incorporate this emerging technology has primarily been
Speaker 1: driven by the market. In addition, surgical robots have become
Speaker 1: the entry fee for centers wanting to be known for
Speaker 1: excellence and mentally invasive surgery despite the current lack of
Speaker 1: practical applications. Therefore, robotic devices seem to have more of
Speaker 1: a marketing role than a practical role. Whether or not
Speaker 1: robotic devices will grow into a more practical role remains
Speaker 1: to be seen. Uh And in fact, the report went
Speaker 1: on to suggect us that it's possible that by the
Speaker 1: time robot surgery would be practical enough for it to
Speaker 1: be universally adopted, something better would come along, which is,
Speaker 1: you know, another thing to consider. Yeah, well, one thing
Speaker 1: this brings up. The first thing I would say to
Speaker 1: note is that that was from two thousand four and
Speaker 1: things have come a long way since then. But the
Speaker 1: other thing to note, I think is that it's pretty
Speaker 1: much inarguable that in the future robotic surgery will offer
Speaker 1: big benefits. So the big questions are does it currently
Speaker 1: offer big benefits now? And I think that's where most
Speaker 1: of the controversy lies. Well. And like I said, there
Speaker 1: is also that possibility that by the time robotic surgery
Speaker 1: can demonstrably show that it is beneficial, that something else
Speaker 1: comes along by that point. But I expect that they're
Speaker 1: going to be at least a few surgical procedures that
Speaker 1: will still benefit from robotic surgery even if something else
Speaker 1: comes along. I can't see, and granted this might be
Speaker 1: uh short sightedness on my part, but I can't see
Speaker 1: some magical techniques sweep in and revolutionized surgery across the
Speaker 1: board to the point where the robotic surgery progress we
Speaker 1: see right now ends up being futile. Well, nanobots, rot
Speaker 1: healing fog um. Well, that brings up a good point, actually,
Speaker 1: which is something that I want to clarify before we
Speaker 1: move on. We keep saying robotic surgery, and that's often
Speaker 1: the term people use when they're talking about these existing systems.
Speaker 1: But if you have in mind the definition of a robot,
Speaker 1: one thing that should be pretty central to that is autonomy,
Speaker 1: something that that's often the case. Yeah, I think I
Speaker 1: think for a lot of us, when we hear the
Speaker 1: word robot, we think of some form of autonomous being
Speaker 1: that is capable of of following instructions from a human
Speaker 1: but is able to do so on its own. It
Speaker 1: doesn't have to necessarily have human oversight or control every
Speaker 1: step of the way. Now that's not the case with
Speaker 1: all robot but it's the ones like like when we
Speaker 1: think of manufacturing robots, they're automated, right, It's not someone
Speaker 1: who's actually moving levers so that a giant arm is
Speaker 1: going to to weld a card door onto a frame.
Speaker 1: That's not how that works. It's all automated. That's not
Speaker 1: necessarily a case with surgery. With surgery, what we're generally
Speaker 1: talking about is what should probably be called robot assisted surgery,
Speaker 1: at least for today, meaning that what happens when you
Speaker 1: go in for robot surgery is a surgeon sits down,
Speaker 1: a human surgeon sits down at a terminal and controls
Speaker 1: a device that cuts you and does all kinds of
Speaker 1: wonderful things inside your body. That was such a magical description.
Speaker 1: Uh yeah, So usually you have a combination of things.
Speaker 1: In fact, you you you really do need a combination
Speaker 1: of things, including you have to have some sort of
Speaker 1: camera view inside the patient, usually so you have a
Speaker 1: monitor that gives you a view of what you're doing.
Speaker 1: From what I understand, using these monitors is incredible challenging
Speaker 1: for people, and the reason for that is that one
Speaker 1: your your actions maybe in reverse to what you're seeing
Speaker 1: on the monitor. Right, It's not like a mirror where
Speaker 1: if you move right, the instrument moves right. Uh, if
Speaker 1: you're doing this by hand. So let's say that you
Speaker 1: have your you're using tools that are inside the patient.
Speaker 1: There's a camera inside the patient, you're watching a monitor,
Speaker 1: and you are moving based upon what you see there.
Speaker 1: So if you move the instrument right, you may see
Speaker 1: in the monitor that the instruments moving left, So that
Speaker 1: could be very confusing. It can be difficult to coordinate
Speaker 1: your hand eye coordination so that you don't cause any problems.
Speaker 1: It requires practice, like anyone who's had to change the
Speaker 1: button configuration on on their Xbox. It's like that, but
Speaker 1: times a million, and with a person. So and then
Speaker 1: you also have the issues of you might not have
Speaker 1: the right kind of haptic feedback while you're working within
Speaker 1: the patients, so it's harder for you to judge if
Speaker 1: you are cutting into healthy tissue, or if you're cutting
Speaker 1: into anything at all, or especially if you don't want
Speaker 1: to be cutting into something. Um There's also the challenge
Speaker 1: of the fact that you're working within a three dimensional
Speaker 1: environment a patient's body, and you're looking at it on
Speaker 1: a two dimensional screen. These are all challenges that we
Speaker 1: humans have to overcome in order to be able to
Speaker 1: do this successfully. And and of course there are some
Speaker 1: surgeons out there who are really really good at it.
Speaker 1: But the idea was that maybe with robots and UH
Speaker 1: and offloading some of that control over to an automated system.
Speaker 1: Will not maybe automated, but a robotic system could minimize
Speaker 1: some of those challenges or at least make them easier
Speaker 1: to overcome. Certainly, and some some code developing technologies are
Speaker 1: making this easier. For for example, we have the ability
Speaker 1: to put stereoscopic cameras inside patients these days and create
Speaker 1: and on the spot three D model of what's going on.
Speaker 1: So so that kind of thing can can vastly improve
Speaker 1: the experience of the doctor and the patient who are
Speaker 1: going through this kind of surgery. Another thing that's developing
Speaker 1: is the idea of the force feedback. Yeah, you can
Speaker 1: um with these robotic systems. The controls you have in
Speaker 1: your hand have the potential to give you resistance so
Speaker 1: that you feel as if you're actually cutting right. So
Speaker 1: you and you can also up from some of these
Speaker 1: systems having barriers so that once you reach a certain level,
Speaker 1: like if you have if you have designated certain tissue
Speaker 1: as being healthy, and your your robotic UH instrument is
Speaker 1: getting closer and closer to cutting into that you start
Speaker 1: encountering more resistance, which essentially tells you to back off
Speaker 1: until the point at which I mean, like some some
Speaker 1: of these robots will actually stop if they hit one
Speaker 1: of these barriers that you have defined to make sure
Speaker 1: that they will not cut open something that they're not
Speaker 1: supposed to, right, So in this case, you know, it's
Speaker 1: it requires that you have to define these areas. It's
Speaker 1: not that the robot automatically necessarily knows uh that something
Speaker 1: is healthy tissue versus not healthy. Although we're seeing some
Speaker 1: other technologies come out that are pretty cool that could
Speaker 1: aid in that where if you were to pair those
Speaker 1: technologies with the robotic systems, we could eventually get to
Speaker 1: a point where we have robotic tools that can on
Speaker 1: the fly determine whether or not the tissue you're working
Speaker 1: with is healthier diseased. Are you talking about the vaporizing
Speaker 1: I knife. Absolutely, that's a cool thing, different technology, not robotic,
Speaker 1: but very cool for surgery. The ideas you're cutting on um,
Speaker 1: say you're trying to exercise a tumor. This is a
Speaker 1: knife that. Uh, it burns the tissue as it's cutting
Speaker 1: it and then sniffs the smoke to tell if the
Speaker 1: place you're cutting is cancer us or not. And that
Speaker 1: allows you to know almost instantly where the margins should be,
Speaker 1: so you could understand, I mean you could you could
Speaker 1: easily imagine a robotic system that incorporates some sort of
Speaker 1: technology similar to that and being able to aid a
Speaker 1: doctor even if you're not able to ahead of time
Speaker 1: determine exactly what zones are good zones versus bad zones.
Speaker 1: So um, Yeah, we're talking a lot about what we'll
Speaker 1: talk mostly about the Da Vinci line think because again
Speaker 1: that's probably the most popular I would imagine. UM. It's
Speaker 1: it's built. Like I said, upon the success of previous
Speaker 1: UH projects like ESOP and Zeus, Um, it's one that
Speaker 1: you can, you know, if you hear about robotic surgery, UH,
Speaker 1: it tends to be the systems that pops up. I
Speaker 1: mean occasionally you might run into some of the older ones,
Speaker 1: but this is the one that I think is considered
Speaker 1: the state of the art these days. Yeah, I was wondering, well,
Speaker 1: what kind of procedures are done with robot assisted surgeries
Speaker 1: these days? I think a big one is prostate surgery. Yeah,
Speaker 1: that's that's the one. A lot of the studies have
Speaker 1: been around prostate surgeries in particular. In fact, I've read
Speaker 1: several statements that it's basically becoming the norm in prostate surgery,
Speaker 1: like these days, you're just likely to get a robot
Speaker 1: assistant procedure if you go in for a prostate act
Speaker 1: to me, yeah, this is this is one of those
Speaker 1: deals where uh, it's it's been shown to be an
Speaker 1: effective means of of performing surgery. Uh. In fact, we'll
Speaker 1: talk a little bit later about a study that specifically
Speaker 1: looked at cases of people who underwent prostate surgery and
Speaker 1: had a you know, the ones that had robotic assisted
Speaker 1: prostate surgery versus the ones that we're going to just
Speaker 1: strictly human surgeons. And it's an interesting result, actually very
Speaker 1: promising for the future of robotic surgery in general. But
Speaker 1: beyond that, I've also seen that it's being used for
Speaker 1: things like coronary uttery bypasses, gall bladder removal, hip replacement,
Speaker 1: kidney removal or or transplants, hysterectomys, and more, although not
Speaker 1: necessarily with the same success rate as prostate surgery. Right,
Speaker 1: there are questions about all these, but I think before
Speaker 1: that we should talk about what at least are the
Speaker 1: proposed advantages that a robotic system could provide over a
Speaker 1: standard open surgery or a handheld laper scopic surgery. Well,
Speaker 1: it's finally tuned as surgeons hands are. As you were
Speaker 1: saying before, think Joe, robots can can operate at a
Speaker 1: much smaller and more delicate level than than even the
Speaker 1: very best human surgeon. So you therefore have the opportunity
Speaker 1: to make your surgeries minimally invasive. And that just basically
Speaker 1: means having smaller incisions, um you know, in some cases
Speaker 1: for heart surgeries, not having to crack the breastbone, which
Speaker 1: is a terrific boon as you can imagine. Right. Well,
Speaker 1: there are actually two aspects to that. One, I guess
Speaker 1: is the whole minimally invasive approach, and the other is
Speaker 1: just the scaling down of movement in general, which no
Speaker 1: matter what situation you're in, it does give you an
Speaker 1: advantage as a surgeon. To imagine, say you want to
Speaker 1: move your hand one centimeter, but that translates to I
Speaker 1: don't know much smaller measure of the actual tool moving
Speaker 1: maybe one millimeter. Oh sure, yeah, you can. You can design.
Speaker 1: In fact, these these robots systems are designed so that
Speaker 1: they can translate human movements into much smaller like like
Speaker 1: it's a scales it down so much that you can
Speaker 1: make very very precise movements that would be difficult for
Speaker 1: even the most skilled surgeons. Going on with that minimally
Speaker 1: invasive there are a lot of benefits to that, right,
Speaker 1: I mean apart from just the fact that you already
Speaker 1: mentioned one with heart surgery, I mean, not having to
Speaker 1: crack the breastbone is huge. Uh. The fact that any
Speaker 1: time you're going to have minimally invasive, if that's the
Speaker 1: way it goes, you're gonna have smaller incisions, so you
Speaker 1: heal faster. There's a much lower risk of infection. Uh,
Speaker 1: it tends to be people people have reported having better
Speaker 1: quality of life after that kind of surgery. It's less
Speaker 1: trauma to the body, and that overall, especially in the
Speaker 1: case of someone who needs surgery for anything, is probably
Speaker 1: going to be uh pretty important. Right. And again, like
Speaker 1: we said, minimally invasive doesn't necessarily mean that it was
Speaker 1: robotic surgery. A human can do these uh sort of
Speaker 1: procedures too. But robots can do them and a degree
Speaker 1: that we just can't write. The idea is that you
Speaker 1: can go further and further down that rabbit hole of
Speaker 1: of being minimally invasive, even to the point of perhaps
Speaker 1: just having single incision surgeries. I saw a cool uh
Speaker 1: TED talk with a person named Katherine Moore, and she
Speaker 1: was talking about a prototype of a surgical robot that
Speaker 1: would be a single incision surgical robot. So it just
Speaker 1: it inserts, say just a single tube into the patient
Speaker 1: through a single incision, and out of that tube comes
Speaker 1: your camera and several telescoping surgical instruments, so you don't
Speaker 1: even have to come in from multiple directions. That would
Speaker 1: be pretty incredible. Yeah, So the benefits there are pretty
Speaker 1: pretty easy to understand. The idea that you heal faster,
Speaker 1: that you have much lower risk of infection. I mean,
Speaker 1: that's that's huge important news. The precision is also really
Speaker 1: important because again, you can end up having a surgical
Speaker 1: procedure where you get the specific UH outcome that you
Speaker 1: desire with as few side effects as possible, right right.
Speaker 1: And you can also with the precision factor in things
Speaker 1: like a robotic control system for your hands. So imagine that. Well,
Speaker 1: you don't have to imagine. You probably know from experience
Speaker 1: that human hands are not perfectly steady. You know, even
Speaker 1: somebody with the surgeon's hands might have slight tremors in
Speaker 1: their movement, especially after you've been doing a surgery for
Speaker 1: some seven or eight hours. In these procedures are not
Speaker 1: necessarily quick, right, So, uh, what if you have a
Speaker 1: machine that is able to detect unintended tremmors in your
Speaker 1: movement and filter those out? Well, in fact, that's something
Speaker 1: that Da Vinci claims to do with their systems. So
Speaker 1: in other words, uh, the movements that the surgeon makes
Speaker 1: consciously are the only ones that get translated into actual
Speaker 1: surgical procedures. Anything that was an unconscious movement is filtered out,
Speaker 1: and thus you don't end up negatively impacting the patient. Right. Um, So,
Speaker 1: there have been a lot of questions about whether robot
Speaker 1: assisted surgery offers any like measurable bowl net benefit to
Speaker 1: the patient today. Right, Because, as it turns out, one
Speaker 1: of the things we'll talk more about a little bit later,
Speaker 1: these systems are really really expensive. So to justify the expense,
Speaker 1: you have to say, well, what's the actual benefit is there?
Speaker 1: A benefit. Well, we mentioned prostate cancer that that robotic
Speaker 1: surgery is kind of the norm for prostate cancer these days.
Speaker 1: I think that that's the only one that's been proven
Speaker 1: by scientific study to to have an advantage. I don't
Speaker 1: know if it's the only one, that's the only one
Speaker 1: I've seen. Okay, well, well, to to be fair, robotic
Speaker 1: surgery is still even though it started back in it's
Speaker 1: still relatively young, and it's hard to do, uh, studies
Speaker 1: to show continued success because you don't have a lot
Speaker 1: of you don't have a very large pool of patients
Speaker 1: to look at. It's a relatively small sample size, right,
Speaker 1: and very few of them have had robotic surgery long
Speaker 1: enough ago for you to say, look, you know, and
Speaker 1: at five years the success rate was blah blah blah,
Speaker 1: ten years. You know, we don't have enough of a
Speaker 1: size there. But we have had some studies, right. Uh.
Speaker 1: The one I wanted to talk about that you just mentioned, Lauren,
Speaker 1: was the one about prostate surgery. It was a U c.
Speaker 1: L A study. It was published in February in the
Speaker 1: journal European Urology, and it found that prostate cancer surgeries
Speaker 1: performed by robotically assisted surgeons as opposed to the traditional
Speaker 1: open procedures have a superior success rate, like measurably. Uh.
Speaker 1: They measured the cancer margins in excised tissue from these
Speaker 1: removed prostates, and the robotic surgery was quote associated with
Speaker 1: five percent fewer positive margins. So that was thirteen point
Speaker 1: six percent versus eighteen point three percent. And in a
Speaker 1: cancer surgery, you don't want positive margins, you want the
Speaker 1: thing removed. Positive margins means that there was cancer at
Speaker 1: the edge of the thing they took out, which suggests
Speaker 1: that there could still be cancer cells left within the patient, right. Uh.
Speaker 1: And so what's more, the patients who had the robotic
Speaker 1: surgery in these uh in this study had a one
Speaker 1: third reduction in the likelihood of needing to get another
Speaker 1: therapy for their cancer within the next two years. That's
Speaker 1: and that you know, for cancer patients, that's a that's
Speaker 1: huge news too. I mean, obviously, managing cancer is is
Speaker 1: a life altering experience, and uh so any patient who
Speaker 1: would have that kind of um benefit, I mean, it's
Speaker 1: kind of hard to I don't know that you can
Speaker 1: overstate how beneficial it is. So another potential advantage we
Speaker 1: talked about briefly, or a little bit earlier, was the
Speaker 1: ability to perform surgery. A doctor could perform surgery even
Speaker 1: if that doctor is nowhere near the patient using robotics,
Speaker 1: using a telesurgery, right, the idea of telepresence, where the
Speaker 1: doctor's presence is pretty much taken up by this this
Speaker 1: robot that's following the doctor's commands, right, And that can
Speaker 1: be terrific for many different situations. If you've got an
Speaker 1: expert in a certain kind of surgery, um, but he
Speaker 1: or she cannot be in the physical location or cannot
Speaker 1: be there quickly enough to perform surgery, then uh yeah, yeah.
Speaker 1: This is one of those things I often hear about
Speaker 1: for cases where you have people, like say in a
Speaker 1: scientific research center in a really remote location like I
Speaker 1: don't know, Antarctica, and you may or may not have
Speaker 1: someone at that center who has the training and ability
Speaker 1: to perform particular medical procedures. But if you had one
Speaker 1: of these robots and the ability to connect with someone
Speaker 1: who does have that expertise, you could still have that performed.
Speaker 1: You know, you might be in a place and you know,
Speaker 1: Antarctica obviously is an extreme example, but it's also but
Speaker 1: it's also one that's realistic because there are scientific research
Speaker 1: centers in Antarctica and it's not easy to get people
Speaker 1: in and out of them. Right. Well, you can't always
Speaker 1: predict when you're going to need a complicated surgery. I mean,
Speaker 1: what if you're down there and suddenly you need an
Speaker 1: appendeck to me and if that has to happen fast
Speaker 1: and if you don't, you know, if you don't have
Speaker 1: the means of getting someone to come and grab them
Speaker 1: by air and lift them out, and if you know
Speaker 1: that's just not an option, then you really are limited.
Speaker 1: So these are there are definitely cases in extreme circumstances
Speaker 1: where this would be really really useful. Right And though
Speaker 1: we have seen that tested before, telesurgery is more thought of,
Speaker 1: I think as a potential future benefit than as a
Speaker 1: really current benefit. Yeah, there's some big challenges there too.
Speaker 1: As of right now, the latency issue. Even though we
Speaker 1: are getting faster and faster computers and internet connections, um,
Speaker 1: it's still not quite quickly enough that I would personally
Speaker 1: want someone um performing robotic surgery from across the country
Speaker 1: and certainly not from like Antarctica. Right, So latency just
Speaker 1: in case you guys don't know. That's essentially the delay
Speaker 1: between when you take an action and when that action
Speaker 1: is carried out by whatever electronic device you're using, right,
Speaker 1: And so it's really frustrating when you're like playing a
Speaker 1: shooter game online. It could be deadly if you're like
Speaker 1: cutting somebody exactly. Yeah, So it's one of those things
Speaker 1: that we have to get better and better at at
Speaker 1: delivering high speed uh access. And that's we're starting to
Speaker 1: see that happen. But yeah, like you said, Lauren, it's
Speaker 1: it's one of those things that is kind of delaying
Speaker 1: tellusurgery from being a common practice in the present. Though.
Speaker 1: One interesting way around that could be the development of
Speaker 1: more autonomy in the surgical robots themselves, where you've got
Speaker 1: robots that are well trained enough that they can do
Speaker 1: the precision activity on their own with merely kind of
Speaker 1: a supervising human surgeon on the other end, who doesn't
Speaker 1: have to do each individual cut with his or her hand. Well,
Speaker 1: we'll talk more about autonomy and the challenges there too. Uh.
Speaker 1: And then we have one other benefit here that I
Speaker 1: see the idea that a robots can take our jobs. Yeah, no,
Speaker 1: that's a great thing. Um no, No, honestly it is.
Speaker 1: I mean, surgery requires multiple staff members to be on hand.
Speaker 1: I'm sometimes working, as I said before, for very long
Speaker 1: hours under really high degrees of concentration, which can lead
Speaker 1: to a lot of fatigue and honestly medical problems for
Speaker 1: those surgical staffers themselves. UM. Automation could could really allow
Speaker 1: for needing you know, fewer surgeons and nurses on hand,
Speaker 1: thus thus reducing their workload and reducing their personal fatigue. Um.
Speaker 1: And could also increase the number of surgeons capable of
Speaker 1: performing certain complex surgeries. Um. It could it could overall
Speaker 1: potentially reduce the cost of surgeries due to you know,
Speaker 1: needing fewer staffs that staff members on hand. Um. But hey,
Speaker 1: let's talk about that wacky cost thing, because that's kind
Speaker 1: of a big issue. Well, I was going to say,
Speaker 1: because I agree that that is a potential benefit for
Speaker 1: the future, but as of now, these kinds of systems
Speaker 1: are more labor intensive and cost more. Um. So yes,
Speaker 1: it's it's no secret that robotic surgery is mega expensive,
Speaker 1: so of course you know they're going to negotiate prices.
Speaker 1: But to get a ballpark idea, there was a two
Speaker 1: thousand eight New York Times article that reported DaVinci systems
Speaker 1: we're selling for an average of one point three million
Speaker 1: a piece up front, that was And so you take
Speaker 1: that and then you add on hundreds of thousands more
Speaker 1: dollars in service upgrades and components that you have to
Speaker 1: replace after every surgery or at least very frequent right.
Speaker 1: But but but they've got to be cheaper now, right,
Speaker 1: I mean, so today they have to be cheaper, right. Yeah.
Speaker 1: A piece that was published from the Wall Street Journal
Speaker 1: just today. We are recording this, by the way, on
Speaker 1: April first, so hopefully this is not an April Fools joke.
Speaker 1: But but yeah, they reported that the current range for
Speaker 1: da Vinci systems is some one point eight five million
Speaker 1: dollars to two point three million dollars. I don't know
Speaker 1: if those numbers may include some of those other extra
Speaker 1: costs I was talking about rolled in. That's the possibility.
Speaker 1: I I it did not give me specific details it down.
Speaker 1: But so robotic procedures in general are more costly than
Speaker 1: traditional surgeries. Just one example, there's a study published in
Speaker 1: jama in uh and it tried to compare costs for
Speaker 1: US one specific procedure. So it was just looking at
Speaker 1: robotically assisted hysterectomys versus laparoscopic hysterectomies that traditionally you know,
Speaker 1: laparoscopic done by hand among women with benign gynecologic disease.
Speaker 1: That was the title. Uh. And the study found that
Speaker 1: the robotically assisted surgeries and the laparoscopic history ectomies had
Speaker 1: similar morbidity rates, but the robots were more costly. So
Speaker 1: the outcomes were comparable, but the robot procedures were just
Speaker 1: more expensive. On average, the total costs of a robotically
Speaker 1: assisted procedure were two thousand, one and eighty nine dollars
Speaker 1: more than for a laparoscopic procedure. Right, So we're starting
Speaker 1: to see kind of those those criticisms that were brought
Speaker 1: up in that two thousand four report are still, at
Speaker 1: least in some cases, uh, possibly valid. I mean, the
Speaker 1: idea that a robotic assisted procedure may come across as
Speaker 1: more of a marketing tool than a practical will in
Speaker 1: the in the current state of the way the technology
Speaker 1: fairs right now. Right, there's this idea among some surgeons
Speaker 1: that there's this possible illusion of advantage caused by the
Speaker 1: dazzling technology of a robotic surgeon. Um. So, some surgeons
Speaker 1: have alleged that patients seem to want robotic procedures even
Speaker 1: if the patients are told that they cost more, and
Speaker 1: there's no evidence in this particular case that they're better
Speaker 1: than the old surgery. Uh, it's just like they seem
Speaker 1: to see the option of a robot and think, wow,
Speaker 1: that looks really high tech. It must be the best,
Speaker 1: and so they want to go with it, even if
Speaker 1: it's not necessarily the best. If it's just as good
Speaker 1: but costs a lot more, um so that that would
Speaker 1: be a problem. On top of that, The other issue
Speaker 1: or ain't another issue I should say, is that these
Speaker 1: these systems are not small. We're not talking about a
Speaker 1: robotic arm that fits on a little side table and
Speaker 1: you just lay it down next to the patients. It's
Speaker 1: not like inspector gat backpack. No, we haven't reached that
Speaker 1: level yet either. Yeah, these are big, big systems, which
Speaker 1: means they take up a lot of rooms, so you
Speaker 1: have to have the space to to house them and
Speaker 1: be able to move them around. And when you add
Speaker 1: that to the cost, so we're talking about the cost
Speaker 1: of purchasing, maintaining housing this thing, being able to move
Speaker 1: it around the facility. UH, you know those. This means
Speaker 1: that it creates a really big barrier for a lot
Speaker 1: of medical centers to uh, And they have to make
Speaker 1: a tough decision. Do they go and invest in getting
Speaker 1: one of these things and making sure that their facility
Speaker 1: can handle it? Uh? Spending all that money knowing that,
Speaker 1: at least for some procedures, there is not a scientifically
Speaker 1: measurable benefit to having that versus the traditional procedures. Do
Speaker 1: they go ahead and do that anyway? Uh? And and
Speaker 1: by doing that, they know that they're not going to
Speaker 1: be able to use that same money for something else.
Speaker 1: And this is a big issue. A lot of medical
Speaker 1: centers feel pressured to go into getting these robotic surgery
Speaker 1: systems because again, there's this perception that the newest is
Speaker 1: the best, and therefore if they don't have it in
Speaker 1: order to be considered a good center, then they're going
Speaker 1: to need this exactly right. If they don't have it,
Speaker 1: then they're not obviously not a cutting edge medical center.
Speaker 1: So it's kind of this this rough place right now. Now.
Speaker 1: That's not to say that robotic surgery isn't going to
Speaker 1: continue to improve. I fully believe that we're going to
Speaker 1: see it. Sure. I mean robotics overall as a field
Speaker 1: is is improving probably every day and every year. It's
Speaker 1: pretty incredible. I got worse yesterday, but I got twice
Speaker 1: as better today, so it's averaging out. Yeah, we just
Speaker 1: say that the line is on a constant incline. I mean,
Speaker 1: you see some dips here and there, but you know
Speaker 1: the trend is there. Well, you know, speaking of that,
Speaker 1: it's not like these machines are are insusceptible to things
Speaker 1: like recalls, like any other bit of machinery. There was
Speaker 1: a class to recall of Da Vinci models see robots
Speaker 1: in because a friction issue was causing some robots to
Speaker 1: freeze up during surgeries. UM. It was it was determined
Speaker 1: that that probably these machines weren't being tested entirely properly
Speaker 1: before leaving the factory UM, which was causing these small malfunctions.
Speaker 1: It is a it is a small recall in a class.
Speaker 1: To recall a product could cause temporary or medically reversible
Speaker 1: problems in a patient. So it's a voluntary thing and
Speaker 1: the device doesn't need to be taken off the market.
Speaker 1: But you know it's I just wanted to say like
Speaker 1: that kind of stuff does happen, right, Well, there have
Speaker 1: been people who have actually criticized robotic surgical procedures for
Speaker 1: being they think dangerous or there there are legitimate safety questions,
Speaker 1: right right. They may be, they may not always be reliable, right. Uh. Yeah.
Speaker 1: In a small anonymous survey of a hundred and seventy
Speaker 1: six doctors, some fifty seven percent of surgeons who had
Speaker 1: used a da Vinci machine for prostate surgery UM said
Speaker 1: that they had experienced and irrecoverable intraoperative malfunction either before
Speaker 1: or during a surgery, which I'm not positive about the
Speaker 1: definition of that, but I'm pretty sure it's like a
Speaker 1: surgical blue screen of death. Yeah, yeah, that's that's a
Speaker 1: phrase you don't want to hear during any kind of
Speaker 1: medical procedures. Blue screen of death. Absolutely not. And okay, so,
Speaker 1: so surgery has always come with a certain amount of risk.
Speaker 1: You are you are never going to be completely safe
Speaker 1: when people are cutting you open and doing stuff to
Speaker 1: your inside, sure, or just undergoing general anesthesia. Oh absolutely,
Speaker 1: there There are any number of wacky things that can
Speaker 1: go wrong with our bodies at any given moment, let
Speaker 1: alone when we're when we're in a hospital. Um, which
Speaker 1: was probably the cheeriest thing I've ever said on this show.
Speaker 1: But sorry, guys, them's the facts were weird meat machines. Um. Furthermore,
Speaker 1: the under reporting of things going wrong during surgeries to
Speaker 1: the f d A is widely accepted to be an issue. Um,
Speaker 1: I mean not not just in robotic surgery, and in
Speaker 1: any kind of surgery across the medical industry in general. However,
Speaker 1: researchers at Johns Hopkins did a study of the Da
Speaker 1: Vinci surgeries that had taken place between the year two
Speaker 1: thousand and twenty twelve and found evidence that adverse events
Speaker 1: related to these devices maybe and I quote vastly under
Speaker 1: reported and in fact, in question was officially raised by
Speaker 1: the American Congress of Obstetricians and Gynecologists about the usefulness
Speaker 1: of robotic his direct Me procedures. Um. So some one
Speaker 1: in nine women will undergo his direct Me at some
Speaker 1: point in her life. Um. And it's also the type
Speaker 1: of robotic surgery that's apparently the most likely to cause
Speaker 1: a patient harm. Some fort of patient injuries that have
Speaker 1: been reported. Um, we're during this type of surgery in fact, um,
Speaker 1: so you know, they also went into everything else that
Speaker 1: we've talked about with with cost and all of that.
Speaker 1: But but this surgical procedure in particular might have been
Speaker 1: one that was adopted too widely, too soon. Yeah, you
Speaker 1: see that over and over the idea from the critics
Speaker 1: of robotic surgery. They're they're criticizing not so much the
Speaker 1: idea in UH in theory, but just as it's practice,
Speaker 1: were rolling it out too fast. Yeah, and the marketing
Speaker 1: is too aggressive with with the prostate removal surgeries. I
Speaker 1: would say that using robotic surgery in general has been
Speaker 1: rolled up pretty quickly across a lot of different surgical procedures.
Speaker 1: With the prostate removal surgery, as that study from U
Speaker 1: c l A found out, it actually looks like there's
Speaker 1: a demonstrable benefit there and that that's that's fantastic. Whether
Speaker 1: or not that was rolled out too quickly in that surgery,
Speaker 1: I don't know, but it does look like they're uh,
Speaker 1: it is definitely beneficial to have the robotic assisted surgery,
Speaker 1: But in other cases we may not be there yet.
Speaker 1: It doesn't mean we won't get there. It just means
Speaker 1: that the implementation we have right now may not be ideal.
Speaker 1: In fact, it may not even be anything wrong with
Speaker 1: the technology. It may be that surgeons are still learning
Speaker 1: how to use it at its most effective way. So
Speaker 1: there may be some cases where it's I wouldn't call
Speaker 1: it human failures so much as we haven't figured out
Speaker 1: how to leverage the technology in the way that's most beneficial. Right. Well,
Speaker 1: one thing that would obviously be a big benefit in
Speaker 1: the future would be the idea of autonomous surgery, like
Speaker 1: truly autonomous robotic surgery, unless you tick off your autonomous
Speaker 1: robotic surgeon, in which case you know you've got terminator
Speaker 1: all over the place. That actually kind of also comes
Speaker 1: into play in Prometheus because it occurred to incurred to
Speaker 1: me that the ship's doctor is the android character. So
Speaker 1: so you're technically dealing with all robot surgery all the
Speaker 1: time on that ship, and not all of it goes well. Okay.
Speaker 1: So well, here's the thing about autonomous autonomous robotic surgery
Speaker 1: is I think it's a really interesting idea. I think
Speaker 1: it's going to be one of the most challenging applications
Speaker 1: for any sort of autonomous robot. First of all, we're
Speaker 1: really far out from having autonomous robots that could do
Speaker 1: something as delicate as a surgical procedure delicate and important. Yeah,
Speaker 1: without without human uh interaction, without without a human controlling it.
Speaker 1: And the reason why I say that is because not
Speaker 1: only are we talking about life or death procedures, but
Speaker 1: we're also talking about the human body, which does not
Speaker 1: come in one shape and size. Right, There's a lot
Speaker 1: of variation there. Even with a simple, quote unquote simple
Speaker 1: surgical procedure, you can have a lot of complications that
Speaker 1: can crop up, and robots have to be able to adapt,
Speaker 1: to recognize a detective adapt exactly just the way a
Speaker 1: human would, and that's hard to do. But that does
Speaker 1: raise the question of how would you do this? How
Speaker 1: would you program a robot to autonomously performer a surgical procedure?
Speaker 1: And I think one of the things that would be
Speaker 1: really crucial to this would be a learning robot. So
Speaker 1: perhaps a robot that would be connected to the to
Speaker 1: the human controlled system, so it studies what the human
Speaker 1: surgeons do. Maybe you give it ten thou zen surgeries
Speaker 1: to analyze, You select your ten thousand best variations of
Speaker 1: the same surgery, and say learn from these. Honestly, I
Speaker 1: would imagine that it would have to involve a lot
Speaker 1: of work with human cadavers too, you would have to.
Speaker 1: I had an opportunity to talk with some robotics experts recently,
Speaker 1: and uh, then they were showing me robots that do learn,
Speaker 1: and they learned by you showing them that you want
Speaker 1: them to do certain tasks in a certain order, and
Speaker 1: if they make a mistake, you can correct them, so
Speaker 1: that they learned that. All right, that was an exception
Speaker 1: to what I'm supposed to do. I won't do that again.
Speaker 1: And then once they learned the procedure, they'll repeat it
Speaker 1: exactly over and over and over again. However, that's also
Speaker 1: a procedure that involves uniform material that doesn't change from
Speaker 1: case to case. So it's different from surgery. Yeah, so
Speaker 1: so you're going to need to, I mean a just
Speaker 1: like I, like a human surgeon, have a lot of
Speaker 1: practice on things what can't be hurt. Be those be
Speaker 1: those models or cadavers, um and and be incorporate a
Speaker 1: whole lot of sensory technology, like like the most advanced
Speaker 1: room bow you have ever met in your life, that
Speaker 1: that is able to tell from from the inside of
Speaker 1: you what you what its surroundings are. There is a
Speaker 1: lot of potential there for it to really revolutionize the
Speaker 1: way we think about medicine. I mean, right now, medicine
Speaker 1: is a thing you go to, right, you go to
Speaker 1: the hospital, you go to the doctor. But if you
Speaker 1: could have, say a really versatile general robotic surgeon that's
Speaker 1: small enough to fit in a backpack, I mean that
Speaker 1: what a bizarre world that would be that you could
Speaker 1: carry around a limitless supply of medical treatment with you
Speaker 1: where you go. But I would I would let myself
Speaker 1: get critically injured all the time. I mean, as opposed
Speaker 1: to just happening accidentally, and I just you're inviting it. Well,
Speaker 1: you can see how that would make a big difference
Speaker 1: for say, people who are in any kind of exploring capacity,
Speaker 1: so you're exploring space, or you're exploring remote wilderness, or
Speaker 1: a military capacity on things like a triage on the battlefield.
Speaker 1: So now I'm thinking that the quote I should have
Speaker 1: used should have been a movie quota show said pain
Speaker 1: don't hurt, because I didn't realize that that was Lauren's philosophy. Um,
Speaker 1: but you hadn't, this would be this would be pretty phenomenal.
Speaker 1: And these are advances that we do think are quite
Speaker 1: a ways down the road. We don't want We don't
Speaker 1: want anyone to go away from this episode thinking, oh,
Speaker 1: you know, within like a year or two, we're going
Speaker 1: to have these incredible robots. These are these are enormous challenges,
Speaker 1: and not that they are challenges that will never overcome.
Speaker 1: It's just gonna take a lot of work. I expect
Speaker 1: that there will be such a thing. Whether I see
Speaker 1: it in my lifetime or not, I don't know, um,
Speaker 1: but I I certainly hope to see extreme advances in
Speaker 1: this field. I think it's could be incredibly beneficial. One
Speaker 1: of the other interesting things, and we didn't really cover
Speaker 1: this earlier on, is a robotic surg tree is one
Speaker 1: of those fields where there seems to be another issue
Speaker 1: with cost, and that generally speaking with electronics, we think
Speaker 1: the longer something has been around, the less expensive it
Speaker 1: tends to be because we improve on manufacturing processes, materials
Speaker 1: become cheaper, we streamline everything, and so therefore you end
Speaker 1: up saving money down the road. Uh. The one criticism
Speaker 1: I've seen about robotic surgery says that at least in
Speaker 1: these stages, that's probably not going to be true because
Speaker 1: while we perfect means of creating robotic surgery tools, from
Speaker 1: for that we're state of the art like three years ago.
Speaker 1: We're continuously improving all the other technologies that you would
Speaker 1: want to include with the current generation of robotic surgeons,
Speaker 1: thus keeping that price either steady or climbing. Uh for
Speaker 1: the for the near future, Oh, share in medical research alone.
Speaker 1: I mean, I mean the capacity to test all of
Speaker 1: this is very expensive, and that's not going to get
Speaker 1: cheaper ever, right right, unless we can suddenly start cloning
Speaker 1: beings and have absolutely no ethical issues with it. It's
Speaker 1: uh that probably will come after we have robotic surgeons. Jonathan,
Speaker 1: why do you have to end every podcast with the
Speaker 1: idea of cutting up clones? I everybody needs a hobby.
Speaker 1: And on that note, if you guys have any suggestions
Speaker 1: for future episodes of Forward Thinking, let us know. Send
Speaker 1: us an email our addresses f W Thinking at Discovery
Speaker 1: dot com, or drop us a line on Twitter, Facebook,
Speaker 1: Google Plus. We are at all three of those with
Speaker 1: the handle f W Thinking and we will talk to
Speaker 1: you again really soon. For more on this topic in
Speaker 1: the future of technology, visit forward thinking dot Com, brought
Speaker 1: to you by Toyota. Let's go places