WEBVTT - Your Next Surgeon Might Be a Robot 0:00:00.160 --> 0:00:07.240 Brought to you by Toyota. Let's go places. Welcome to 0:00:07.400 --> 0:00:14.680 Forward Thinking. Hey there, everyone, and welcome to Forward Thinking, 0:00:14.760 --> 0:00:17.280 the podcast that looks at the future and says, doctor, doctor, 0:00:17.520 --> 0:00:20.720 give me the news. I'm Jonathan Strickland, I'm Lauren, and 0:00:20.760 --> 0:00:24.239 I'm Joe McCormick. So, um, I heard you guys had 0:00:24.239 --> 0:00:27.280 a movie scene that you wanted to talk about. But 0:00:27.280 --> 0:00:29.720 it's a movie. It's a movie I have not actually watched, 0:00:30.000 --> 0:00:31.480 so I don't know what you're talking about here. You're 0:00:31.480 --> 0:00:34.160 gonna have to tell everybody what you Jonathan. It's an 0:00:34.280 --> 0:00:36.680 R rated film. That's why I wasn't able to get in. 0:00:37.479 --> 0:00:40.720 You're not allowed to go to those. It was the 0:00:40.720 --> 0:00:44.440 movie Prometheus, which I, like a lot of people had 0:00:44.479 --> 0:00:49.040 some questions about. It involved a lot of really shady 0:00:49.240 --> 0:00:52.680 plot lining. I hear. It was a beautiful film. Oh, 0:00:52.720 --> 0:00:55.840 it was very pretty, and its vision of the relatively 0:00:55.880 --> 0:00:59.000 near feature was really interesting in a number of ways, 0:00:59.160 --> 0:01:02.440 some of which um are terrible and some of which 0:01:02.440 --> 0:01:06.040 are are genuinely fascinating. There was one scene in particular 0:01:06.160 --> 0:01:08.800 that I thought might be kind of relevant to this show, 0:01:09.120 --> 0:01:12.759 and that scene is a horrifying, uh kind of body 0:01:12.880 --> 0:01:18.760 violation scene featuring a dramatic surgery performed uh spur of 0:01:18.760 --> 0:01:22.039 the moment, kind of entirely by a robot, right, not 0:01:22.080 --> 0:01:25.240 by a human at all. It's automated, so one of 0:01:25.280 --> 0:01:28.520 the surgery pod things I've heard about, right, right. Yeah, 0:01:28.560 --> 0:01:31.280 the character hops into a big glass coffin and then 0:01:31.319 --> 0:01:34.840 some knives pop out and start doing their thing. So 0:01:35.040 --> 0:01:38.120 I guess this leads us into a discussion about robotic 0:01:38.160 --> 0:01:42.280 surgery and how that's uh, that's a real thing, but 0:01:42.720 --> 0:01:46.680 not necessarily a real horror show thing like what you 0:01:46.800 --> 0:01:50.560 have just briefly described, right, No one would hope that 0:01:50.640 --> 0:01:53.520 in real life robotic surgery is not quite so scary 0:01:53.560 --> 0:01:55.760 and is in fact a good thing. Um though, I 0:01:55.800 --> 0:01:59.080 guess we can debate that as it comes up. Sure, now, 0:01:59.120 --> 0:02:01.880 this is not a new idea. It's not that robotic 0:02:01.920 --> 0:02:04.320 surgery has debuted in the last year or two. It's 0:02:04.320 --> 0:02:06.120 actually been around for a while. In fact, the first 0:02:06.160 --> 0:02:10.080 documented case I could find was a case back in 0:02:10.919 --> 0:02:13.960 five and it was using a surgical arm called the 0:02:14.040 --> 0:02:18.560 Puma five sixty uh, used during a neurological biopsy. Now 0:02:18.560 --> 0:02:21.760 this particular, in this particular case, the robot, as I 0:02:21.800 --> 0:02:24.680 understand it was not performing the surgery, but was being 0:02:24.800 --> 0:02:29.360 used in conjunction with this biopsy. UH. As the years 0:02:29.360 --> 0:02:31.679 went on, you started to see more and more use 0:02:31.720 --> 0:02:35.840 of robots because people were like engineers and doctors were 0:02:35.840 --> 0:02:38.440 saying there was a lot of potential there. Other doctors 0:02:38.440 --> 0:02:42.480 were very hesitant because we're talking about very delicate procedures. 0:02:42.520 --> 0:02:45.639 This is in many cases a life or death situation, 0:02:45.960 --> 0:02:48.160 and you don't want to take any liberties with that 0:02:48.240 --> 0:02:51.640 kind of thing obviously, UM. But over the next couple 0:02:51.639 --> 0:02:54.399 of years they started using them in other procedures robotic arms. 0:02:54.400 --> 0:02:58.240 That is, for laparoscopic procedures, for example, which usually means 0:02:58.280 --> 0:03:02.200 there's some uh your sing a flexible optic camera as 0:03:02.200 --> 0:03:05.920 well for minimally invasive surgery in order to UM to 0:03:06.360 --> 0:03:09.160 be able to handle things inside the body without having 0:03:09.160 --> 0:03:12.639 to make a huge open cut, right and uh, laparoscopic 0:03:12.760 --> 0:03:15.640 procedures can be performed by hand. Sure, I want to 0:03:15.680 --> 0:03:19.240 make clear that's not something that's necessarily unique to robots. 0:03:19.320 --> 0:03:21.480 So there are a lot of surgeons who have trained 0:03:21.480 --> 0:03:24.760 in this art of trying to make small incisions in 0:03:24.800 --> 0:03:27.840 the body and stick in their instruments and sort of 0:03:27.880 --> 0:03:29.919 do what they need to do in there without making 0:03:30.000 --> 0:03:33.200 big open cuts. But of course there are limitations to 0:03:33.240 --> 0:03:35.160 what you can do by hand in that sense, and 0:03:35.200 --> 0:03:37.080 we can talk about that more in a minuture. And 0:03:37.120 --> 0:03:40.120 then we had other robots, and clearly one called robo Doc, 0:03:40.480 --> 0:03:43.600 which is probably my favorite name, UH was the first 0:03:43.680 --> 0:03:46.400 robot approved by the f d A, and they also 0:03:46.440 --> 0:03:53.000 approved the STOP robotic system for endoscopic surgeries back in UH. 0:03:53.120 --> 0:03:56.400 These the SAP led into another development. There was another 0:03:56.480 --> 0:04:00.840 robot called Zeus, which followed a SUP and after use UH, 0:04:00.920 --> 0:04:03.760 the work that went into ESOP and Zeus later informed 0:04:03.800 --> 0:04:07.680 engineers who built the Da Vinci systems, which are probably 0:04:07.680 --> 0:04:11.520 the best known robotic surgery tools out there right now. 0:04:12.120 --> 0:04:14.120 They're the ones that if you read a story about 0:04:14.200 --> 0:04:17.120 robotic surgery nine times off ten, it's a Da Vinci 0:04:17.160 --> 0:04:20.000 system that we're talking about. Sure, they were finally approved 0:04:20.000 --> 0:04:23.280 for FDA use in the year two thousand and UH. 0:04:23.360 --> 0:04:29.120 We've even seen some transcontinental surgeries performed using robots because 0:04:29.200 --> 0:04:31.240 one of the other things we'll talk about is that 0:04:31.680 --> 0:04:34.760 using a robot assistant essentially or a robot, you know, 0:04:34.960 --> 0:04:37.520 think of the robot as a replacement for the surgeon's 0:04:37.560 --> 0:04:41.120 actual hands means that the surgeon could potentially perform that 0:04:41.160 --> 0:04:44.000 surgery while not even being present within the room. They 0:04:44.000 --> 0:04:47.800 could be and that, like in this case, on the 0:04:47.839 --> 0:04:51.320 other side of a continent. So that's kind of exciting. Um, 0:04:51.360 --> 0:04:53.840 So we're gonna talk about all of that, but we 0:04:53.880 --> 0:04:57.880 should also mention that it's not this using robots and 0:04:57.880 --> 0:05:01.479 surgeries not something that was immediately embraced, and still to 0:05:01.560 --> 0:05:05.440 this day, it is a controversial subject. It's one of 0:05:05.480 --> 0:05:08.080 those that has there are a lot of both advantages 0:05:08.120 --> 0:05:10.240 and disadvantages, and you have to weigh them very heavily 0:05:10.320 --> 0:05:13.280 before you can say outright is it a good or 0:05:13.320 --> 0:05:15.880 bad thing? Especially you know, it may be particular case 0:05:15.920 --> 0:05:18.360 to case basis. But a two thousand four report in 0:05:18.400 --> 0:05:22.760 the Annals of Surgery urged caution and skepticism about robotic surgery, 0:05:22.800 --> 0:05:26.599 saying that this is a direct quote, robotic surgery is 0:05:26.640 --> 0:05:30.160 a new and exciting emerging technology that's taking the surgical 0:05:30.160 --> 0:05:32.960 profession by storm. Up to this point, however, the race 0:05:33.000 --> 0:05:37.080 to acquire and incorporate this emerging technology has primarily been 0:05:37.200 --> 0:05:40.680 driven by the market. In addition, surgical robots have become 0:05:40.720 --> 0:05:43.080 the entry fee for centers wanting to be known for 0:05:43.120 --> 0:05:47.039 excellence and mentally invasive surgery despite the current lack of 0:05:47.080 --> 0:05:50.920 practical applications. Therefore, robotic devices seem to have more of 0:05:50.960 --> 0:05:53.800 a marketing role than a practical role. Whether or not 0:05:53.920 --> 0:05:56.640 robotic devices will grow into a more practical role remains 0:05:56.680 --> 0:05:59.280 to be seen. Uh And in fact, the report went 0:05:59.320 --> 0:06:02.200 on to suggect us that it's possible that by the 0:06:02.240 --> 0:06:06.520 time robot surgery would be practical enough for it to 0:06:06.600 --> 0:06:10.800 be universally adopted, something better would come along, which is, 0:06:10.920 --> 0:06:13.560 you know, another thing to consider. Yeah, well, one thing 0:06:13.560 --> 0:06:15.479 this brings up. The first thing I would say to 0:06:15.560 --> 0:06:17.599 note is that that was from two thousand four and 0:06:17.720 --> 0:06:20.000 things have come a long way since then. But the 0:06:20.080 --> 0:06:23.320 other thing to note, I think is that it's pretty 0:06:23.400 --> 0:06:27.919 much inarguable that in the future robotic surgery will offer 0:06:28.000 --> 0:06:31.839 big benefits. So the big questions are does it currently 0:06:31.920 --> 0:06:34.800 offer big benefits now? And I think that's where most 0:06:34.800 --> 0:06:38.000 of the controversy lies. Well. And like I said, there 0:06:38.080 --> 0:06:42.359 is also that possibility that by the time robotic surgery 0:06:42.480 --> 0:06:46.600 can demonstrably show that it is beneficial, that something else 0:06:46.720 --> 0:06:49.719 comes along by that point. But I expect that they're 0:06:49.760 --> 0:06:53.599 going to be at least a few surgical procedures that 0:06:53.680 --> 0:06:56.600 will still benefit from robotic surgery even if something else 0:06:56.640 --> 0:07:00.200 comes along. I can't see, and granted this might be 0:07:00.560 --> 0:07:02.800 uh short sightedness on my part, but I can't see 0:07:02.839 --> 0:07:07.599 some magical techniques sweep in and revolutionized surgery across the 0:07:07.640 --> 0:07:11.120 board to the point where the robotic surgery progress we 0:07:11.160 --> 0:07:16.160 see right now ends up being futile. Well, nanobots, rot 0:07:17.120 --> 0:07:20.440 healing fog um. Well, that brings up a good point, actually, 0:07:20.440 --> 0:07:23.040 which is something that I want to clarify before we 0:07:23.080 --> 0:07:26.080 move on. We keep saying robotic surgery, and that's often 0:07:26.120 --> 0:07:29.840 the term people use when they're talking about these existing systems. 0:07:30.480 --> 0:07:33.600 But if you have in mind the definition of a robot, 0:07:33.800 --> 0:07:37.800 one thing that should be pretty central to that is autonomy, 0:07:38.520 --> 0:07:41.240 something that that's often the case. Yeah, I think I 0:07:41.320 --> 0:07:42.840 think for a lot of us, when we hear the 0:07:42.880 --> 0:07:45.960 word robot, we think of some form of autonomous being 0:07:46.600 --> 0:07:50.960 that is capable of of following instructions from a human 0:07:51.280 --> 0:07:53.080 but is able to do so on its own. It 0:07:53.160 --> 0:07:57.120 doesn't have to necessarily have human oversight or control every 0:07:57.120 --> 0:07:58.800 step of the way. Now that's not the case with 0:07:59.240 --> 0:08:01.400 all robot but it's the ones like like when we 0:08:01.440 --> 0:08:04.679 think of manufacturing robots, they're automated, right, It's not someone 0:08:04.760 --> 0:08:08.120 who's actually moving levers so that a giant arm is 0:08:08.200 --> 0:08:11.000 going to to weld a card door onto a frame. 0:08:11.080 --> 0:08:13.440 That's not how that works. It's all automated. That's not 0:08:13.560 --> 0:08:17.040 necessarily a case with surgery. With surgery, what we're generally 0:08:17.080 --> 0:08:20.680 talking about is what should probably be called robot assisted surgery, 0:08:20.960 --> 0:08:24.760 at least for today, meaning that what happens when you 0:08:24.880 --> 0:08:27.920 go in for robot surgery is a surgeon sits down, 0:08:28.080 --> 0:08:31.920 a human surgeon sits down at a terminal and controls 0:08:32.000 --> 0:08:34.679 a device that cuts you and does all kinds of 0:08:34.720 --> 0:08:39.840 wonderful things inside your body. That was such a magical description. 0:08:40.559 --> 0:08:44.679 Uh yeah, So usually you have a combination of things. 0:08:44.720 --> 0:08:46.840 In fact, you you you really do need a combination 0:08:46.880 --> 0:08:48.599 of things, including you have to have some sort of 0:08:48.720 --> 0:08:53.079 camera view inside the patient, usually so you have a 0:08:53.200 --> 0:08:56.320 monitor that gives you a view of what you're doing. 0:08:56.840 --> 0:09:00.680 From what I understand, using these monitors is incredible challenging 0:09:00.800 --> 0:09:03.320 for people, and the reason for that is that one 0:09:03.960 --> 0:09:07.560 your your actions maybe in reverse to what you're seeing 0:09:07.600 --> 0:09:10.160 on the monitor. Right, It's not like a mirror where 0:09:10.280 --> 0:09:14.240 if you move right, the instrument moves right. Uh, if 0:09:14.240 --> 0:09:16.319 you're doing this by hand. So let's say that you 0:09:16.440 --> 0:09:19.680 have your you're using tools that are inside the patient. 0:09:20.000 --> 0:09:23.120 There's a camera inside the patient, you're watching a monitor, 0:09:23.200 --> 0:09:25.720 and you are moving based upon what you see there. 0:09:26.360 --> 0:09:28.719 So if you move the instrument right, you may see 0:09:28.760 --> 0:09:31.599 in the monitor that the instruments moving left, So that 0:09:31.640 --> 0:09:34.400 could be very confusing. It can be difficult to coordinate 0:09:34.440 --> 0:09:37.840 your hand eye coordination so that you don't cause any problems. 0:09:37.960 --> 0:09:40.920 It requires practice, like anyone who's had to change the 0:09:41.000 --> 0:09:43.880 button configuration on on their Xbox. It's like that, but 0:09:44.000 --> 0:09:46.839 times a million, and with a person. So and then 0:09:47.040 --> 0:09:49.319 you also have the issues of you might not have 0:09:49.480 --> 0:09:51.959 the right kind of haptic feedback while you're working within 0:09:52.040 --> 0:09:54.520 the patients, so it's harder for you to judge if 0:09:54.559 --> 0:09:57.600 you are cutting into healthy tissue, or if you're cutting 0:09:57.640 --> 0:10:00.240 into anything at all, or especially if you don't want 0:10:00.280 --> 0:10:03.960 to be cutting into something. Um There's also the challenge 0:10:03.960 --> 0:10:06.360 of the fact that you're working within a three dimensional 0:10:06.600 --> 0:10:09.400 environment a patient's body, and you're looking at it on 0:10:09.480 --> 0:10:12.480 a two dimensional screen. These are all challenges that we 0:10:12.679 --> 0:10:14.760 humans have to overcome in order to be able to 0:10:14.840 --> 0:10:16.959 do this successfully. And and of course there are some 0:10:17.040 --> 0:10:19.559 surgeons out there who are really really good at it. 0:10:20.040 --> 0:10:23.080 But the idea was that maybe with robots and UH 0:10:23.200 --> 0:10:27.400 and offloading some of that control over to an automated system. 0:10:27.440 --> 0:10:31.560 Will not maybe automated, but a robotic system could minimize 0:10:31.800 --> 0:10:35.040 some of those challenges or at least make them easier 0:10:35.080 --> 0:10:39.080 to overcome. Certainly, and some some code developing technologies are 0:10:39.120 --> 0:10:41.760 making this easier. For for example, we have the ability 0:10:41.840 --> 0:10:45.720 to put stereoscopic cameras inside patients these days and create 0:10:46.040 --> 0:10:48.360 and on the spot three D model of what's going on. 0:10:48.600 --> 0:10:51.880 So so that kind of thing can can vastly improve 0:10:52.080 --> 0:10:54.360 the experience of the doctor and the patient who are 0:10:54.400 --> 0:10:57.240 going through this kind of surgery. Another thing that's developing 0:10:57.440 --> 0:11:00.520 is the idea of the force feedback. Yeah, you can 0:11:00.760 --> 0:11:04.120 um with these robotic systems. The controls you have in 0:11:04.160 --> 0:11:07.120 your hand have the potential to give you resistance so 0:11:07.280 --> 0:11:10.760 that you feel as if you're actually cutting right. So 0:11:10.880 --> 0:11:13.760 you and you can also up from some of these 0:11:13.800 --> 0:11:18.040 systems having barriers so that once you reach a certain level, 0:11:18.160 --> 0:11:21.400 like if you have if you have designated certain tissue 0:11:21.400 --> 0:11:26.079 as being healthy, and your your robotic UH instrument is 0:11:26.080 --> 0:11:28.080 getting closer and closer to cutting into that you start 0:11:28.280 --> 0:11:30.920 encountering more resistance, which essentially tells you to back off 0:11:31.080 --> 0:11:32.959 until the point at which I mean, like some some 0:11:33.000 --> 0:11:35.160 of these robots will actually stop if they hit one 0:11:35.200 --> 0:11:38.120 of these barriers that you have defined to make sure 0:11:38.280 --> 0:11:41.400 that they will not cut open something that they're not 0:11:41.400 --> 0:11:43.319 supposed to, right, So in this case, you know, it's 0:11:43.440 --> 0:11:46.240 it requires that you have to define these areas. It's 0:11:46.280 --> 0:11:50.600 not that the robot automatically necessarily knows uh that something 0:11:50.840 --> 0:11:53.199 is healthy tissue versus not healthy. Although we're seeing some 0:11:53.280 --> 0:11:56.280 other technologies come out that are pretty cool that could 0:11:56.360 --> 0:11:58.679 aid in that where if you were to pair those 0:11:58.720 --> 0:12:01.880 technologies with the robotic systems, we could eventually get to 0:12:01.960 --> 0:12:06.360 a point where we have robotic tools that can on 0:12:06.480 --> 0:12:09.400 the fly determine whether or not the tissue you're working 0:12:09.480 --> 0:12:12.559 with is healthier diseased. Are you talking about the vaporizing 0:12:12.640 --> 0:12:17.000 I knife. Absolutely, that's a cool thing, different technology, not robotic, 0:12:17.120 --> 0:12:21.120 but very cool for surgery. The ideas you're cutting on um, 0:12:21.720 --> 0:12:24.400 say you're trying to exercise a tumor. This is a 0:12:24.480 --> 0:12:27.679 knife that. Uh, it burns the tissue as it's cutting 0:12:27.720 --> 0:12:30.599 it and then sniffs the smoke to tell if the 0:12:30.679 --> 0:12:33.319 place you're cutting is cancer us or not. And that 0:12:33.400 --> 0:12:38.360 allows you to know almost instantly where the margins should be, 0:12:38.640 --> 0:12:40.360 so you could understand, I mean you could you could 0:12:40.400 --> 0:12:43.199 easily imagine a robotic system that incorporates some sort of 0:12:43.240 --> 0:12:47.439 technology similar to that and being able to aid a 0:12:47.600 --> 0:12:50.720 doctor even if you're not able to ahead of time 0:12:50.800 --> 0:12:54.720 determine exactly what zones are good zones versus bad zones. 0:12:55.360 --> 0:12:57.920 So um, Yeah, we're talking a lot about what we'll 0:12:57.920 --> 0:13:01.000 talk mostly about the Da Vinci line think because again 0:13:01.080 --> 0:13:03.959 that's probably the most popular I would imagine. UM. It's 0:13:04.280 --> 0:13:07.400 it's built. Like I said, upon the success of previous 0:13:07.960 --> 0:13:11.839 UH projects like ESOP and Zeus, Um, it's one that 0:13:12.440 --> 0:13:16.160 you can, you know, if you hear about robotic surgery, UH, 0:13:16.559 --> 0:13:19.360 it tends to be the systems that pops up. I 0:13:19.400 --> 0:13:21.360 mean occasionally you might run into some of the older ones, 0:13:21.440 --> 0:13:23.400 but this is the one that I think is considered 0:13:23.440 --> 0:13:26.720 the state of the art these days. Yeah, I was wondering, well, 0:13:26.960 --> 0:13:30.840 what kind of procedures are done with robot assisted surgeries 0:13:30.960 --> 0:13:34.400 these days? I think a big one is prostate surgery. Yeah, 0:13:34.600 --> 0:13:36.959 that's that's the one. A lot of the studies have 0:13:37.080 --> 0:13:40.480 been around prostate surgeries in particular. In fact, I've read 0:13:40.760 --> 0:13:44.800 several statements that it's basically becoming the norm in prostate surgery, 0:13:44.920 --> 0:13:47.760 like these days, you're just likely to get a robot 0:13:47.840 --> 0:13:50.480 assistant procedure if you go in for a prostate act 0:13:50.520 --> 0:13:52.079 to me, yeah, this is this is one of those 0:13:52.160 --> 0:13:56.200 deals where uh, it's it's been shown to be an 0:13:56.280 --> 0:14:01.080 effective means of of performing surgery. Uh. In fact, we'll 0:14:01.120 --> 0:14:03.559 talk a little bit later about a study that specifically 0:14:03.600 --> 0:14:07.839 looked at cases of people who underwent prostate surgery and 0:14:08.040 --> 0:14:10.720 had a you know, the ones that had robotic assisted 0:14:10.760 --> 0:14:13.559 prostate surgery versus the ones that we're going to just 0:14:13.760 --> 0:14:18.280 strictly human surgeons. And it's an interesting result, actually very 0:14:18.320 --> 0:14:21.400 promising for the future of robotic surgery in general. But 0:14:21.840 --> 0:14:24.720 beyond that, I've also seen that it's being used for 0:14:24.800 --> 0:14:29.040 things like coronary uttery bypasses, gall bladder removal, hip replacement, 0:14:29.200 --> 0:14:34.800 kidney removal or or transplants, hysterectomys, and more, although not 0:14:35.000 --> 0:14:39.360 necessarily with the same success rate as prostate surgery. Right, 0:14:39.840 --> 0:14:42.320 there are questions about all these, but I think before 0:14:42.360 --> 0:14:44.360 that we should talk about what at least are the 0:14:44.440 --> 0:14:48.800 proposed advantages that a robotic system could provide over a 0:14:49.120 --> 0:14:54.680 standard open surgery or a handheld laper scopic surgery. Well, 0:14:54.720 --> 0:14:59.160 it's finally tuned as surgeons hands are. As you were 0:14:59.160 --> 0:15:02.640 saying before, think Joe, robots can can operate at a 0:15:02.760 --> 0:15:07.560 much smaller and more delicate level than than even the 0:15:07.680 --> 0:15:10.600 very best human surgeon. So you therefore have the opportunity 0:15:10.760 --> 0:15:14.720 to make your surgeries minimally invasive. And that just basically 0:15:14.800 --> 0:15:18.200 means having smaller incisions, um you know, in some cases 0:15:18.280 --> 0:15:21.400 for heart surgeries, not having to crack the breastbone, which 0:15:21.560 --> 0:15:25.960 is a terrific boon as you can imagine. Right. Well, 0:15:25.960 --> 0:15:28.120 there are actually two aspects to that. One, I guess 0:15:28.240 --> 0:15:31.600 is the whole minimally invasive approach, and the other is 0:15:31.760 --> 0:15:35.200 just the scaling down of movement in general, which no 0:15:35.360 --> 0:15:38.280 matter what situation you're in, it does give you an 0:15:38.320 --> 0:15:41.120 advantage as a surgeon. To imagine, say you want to 0:15:41.440 --> 0:15:46.000 move your hand one centimeter, but that translates to I 0:15:46.040 --> 0:15:48.840 don't know much smaller measure of the actual tool moving 0:15:48.920 --> 0:15:51.840 maybe one millimeter. Oh sure, yeah, you can. You can design. 0:15:52.000 --> 0:15:54.640 In fact, these these robots systems are designed so that 0:15:54.760 --> 0:15:58.840 they can translate human movements into much smaller like like 0:15:58.920 --> 0:16:01.320 it's a scales it down so much that you can 0:16:01.400 --> 0:16:05.360 make very very precise movements that would be difficult for 0:16:05.720 --> 0:16:08.320 even the most skilled surgeons. Going on with that minimally 0:16:08.400 --> 0:16:10.840 invasive there are a lot of benefits to that, right, 0:16:10.880 --> 0:16:13.400 I mean apart from just the fact that you already 0:16:13.400 --> 0:16:15.280 mentioned one with heart surgery, I mean, not having to 0:16:15.320 --> 0:16:18.160 crack the breastbone is huge. Uh. The fact that any 0:16:18.440 --> 0:16:20.680 time you're going to have minimally invasive, if that's the 0:16:20.680 --> 0:16:23.160 way it goes, you're gonna have smaller incisions, so you 0:16:23.320 --> 0:16:26.880 heal faster. There's a much lower risk of infection. Uh, 0:16:27.360 --> 0:16:30.080 it tends to be people people have reported having better 0:16:30.200 --> 0:16:33.360 quality of life after that kind of surgery. It's less 0:16:33.400 --> 0:16:35.840 trauma to the body, and that overall, especially in the 0:16:35.880 --> 0:16:38.520 case of someone who needs surgery for anything, is probably 0:16:38.560 --> 0:16:41.680 going to be uh pretty important. Right. And again, like 0:16:41.800 --> 0:16:44.840 we said, minimally invasive doesn't necessarily mean that it was 0:16:45.520 --> 0:16:48.920 robotic surgery. A human can do these uh sort of 0:16:49.000 --> 0:16:51.720 procedures too. But robots can do them and a degree 0:16:51.800 --> 0:16:54.880 that we just can't write. The idea is that you 0:16:54.960 --> 0:16:57.920 can go further and further down that rabbit hole of 0:16:58.160 --> 0:17:01.520 of being minimally invasive, even to the point of perhaps 0:17:01.640 --> 0:17:05.080 just having single incision surgeries. I saw a cool uh 0:17:05.560 --> 0:17:08.159 TED talk with a person named Katherine Moore, and she 0:17:08.480 --> 0:17:11.800 was talking about a prototype of a surgical robot that 0:17:11.880 --> 0:17:15.000 would be a single incision surgical robot. So it just 0:17:15.320 --> 0:17:20.199 it inserts, say just a single tube into the patient 0:17:20.320 --> 0:17:23.440 through a single incision, and out of that tube comes 0:17:23.560 --> 0:17:28.040 your camera and several telescoping surgical instruments, so you don't 0:17:28.080 --> 0:17:30.760 even have to come in from multiple directions. That would 0:17:30.760 --> 0:17:34.720 be pretty incredible. Yeah, So the benefits there are pretty 0:17:34.880 --> 0:17:38.119 pretty easy to understand. The idea that you heal faster, 0:17:38.359 --> 0:17:40.479 that you have much lower risk of infection. I mean, 0:17:40.520 --> 0:17:44.560 that's that's huge important news. The precision is also really 0:17:44.640 --> 0:17:47.879 important because again, you can end up having a surgical 0:17:47.960 --> 0:17:53.000 procedure where you get the specific UH outcome that you 0:17:53.119 --> 0:17:58.040 desire with as few side effects as possible, right right. 0:17:58.119 --> 0:18:01.040 And you can also with the precision factor in things 0:18:01.359 --> 0:18:06.800 like a robotic control system for your hands. So imagine that. Well, 0:18:06.880 --> 0:18:09.320 you don't have to imagine. You probably know from experience 0:18:09.400 --> 0:18:12.560 that human hands are not perfectly steady. You know, even 0:18:12.880 --> 0:18:16.119 somebody with the surgeon's hands might have slight tremors in 0:18:16.200 --> 0:18:20.159 their movement, especially after you've been doing a surgery for 0:18:20.440 --> 0:18:25.000 some seven or eight hours. In these procedures are not 0:18:25.640 --> 0:18:29.359 necessarily quick, right, So, uh, what if you have a 0:18:29.520 --> 0:18:33.160 machine that is able to detect unintended tremmors in your 0:18:33.200 --> 0:18:36.000 movement and filter those out? Well, in fact, that's something 0:18:36.080 --> 0:18:38.399 that Da Vinci claims to do with their systems. So 0:18:38.440 --> 0:18:41.240 in other words, uh, the movements that the surgeon makes 0:18:41.560 --> 0:18:44.439 consciously are the only ones that get translated into actual 0:18:44.560 --> 0:18:48.840 surgical procedures. Anything that was an unconscious movement is filtered out, 0:18:49.320 --> 0:18:54.520 and thus you don't end up negatively impacting the patient. Right. Um, So, 0:18:54.720 --> 0:18:57.159 there have been a lot of questions about whether robot 0:18:57.160 --> 0:19:01.200 assisted surgery offers any like measurable bowl net benefit to 0:19:01.280 --> 0:19:04.600 the patient today. Right, Because, as it turns out, one 0:19:04.600 --> 0:19:06.520 of the things we'll talk more about a little bit later, 0:19:07.119 --> 0:19:11.959 these systems are really really expensive. So to justify the expense, 0:19:12.000 --> 0:19:14.240 you have to say, well, what's the actual benefit is there? 0:19:14.240 --> 0:19:17.240 A benefit. Well, we mentioned prostate cancer that that robotic 0:19:17.280 --> 0:19:19.880 surgery is kind of the norm for prostate cancer these days. 0:19:19.880 --> 0:19:22.280 I think that that's the only one that's been proven 0:19:22.520 --> 0:19:25.760 by scientific study to to have an advantage. I don't 0:19:25.840 --> 0:19:27.320 know if it's the only one, that's the only one 0:19:27.359 --> 0:19:30.679 I've seen. Okay, well, well, to to be fair, robotic 0:19:30.720 --> 0:19:33.680 surgery is still even though it started back in it's 0:19:33.680 --> 0:19:37.680 still relatively young, and it's hard to do, uh, studies 0:19:38.040 --> 0:19:41.840 to show continued success because you don't have a lot 0:19:41.880 --> 0:19:43.679 of you don't have a very large pool of patients 0:19:43.720 --> 0:19:46.879 to look at. It's a relatively small sample size, right, 0:19:46.960 --> 0:19:50.720 and very few of them have had robotic surgery long 0:19:50.840 --> 0:19:53.440 enough ago for you to say, look, you know, and 0:19:53.600 --> 0:19:56.120 at five years the success rate was blah blah blah, 0:19:56.240 --> 0:19:58.680 ten years. You know, we don't have enough of a 0:19:58.760 --> 0:20:01.399 size there. But we have had some studies, right. Uh. 0:20:01.640 --> 0:20:04.119 The one I wanted to talk about that you just mentioned, Lauren, 0:20:04.240 --> 0:20:06.520 was the one about prostate surgery. It was a U c. 0:20:06.760 --> 0:20:10.080 L A study. It was published in February in the 0:20:10.160 --> 0:20:13.879 journal European Urology, and it found that prostate cancer surgeries 0:20:13.920 --> 0:20:17.680 performed by robotically assisted surgeons as opposed to the traditional 0:20:17.760 --> 0:20:22.560 open procedures have a superior success rate, like measurably. Uh. 0:20:22.680 --> 0:20:26.760 They measured the cancer margins in excised tissue from these 0:20:26.840 --> 0:20:30.440 removed prostates, and the robotic surgery was quote associated with 0:20:30.840 --> 0:20:34.480 five percent fewer positive margins. So that was thirteen point 0:20:34.600 --> 0:20:38.560 six percent versus eighteen point three percent. And in a 0:20:38.640 --> 0:20:41.920 cancer surgery, you don't want positive margins, you want the 0:20:42.040 --> 0:20:45.560 thing removed. Positive margins means that there was cancer at 0:20:45.640 --> 0:20:47.880 the edge of the thing they took out, which suggests 0:20:47.880 --> 0:20:52.439 that there could still be cancer cells left within the patient, right. Uh. 0:20:52.560 --> 0:20:55.520 And so what's more, the patients who had the robotic 0:20:55.600 --> 0:20:59.400 surgery in these uh in this study had a one 0:20:59.640 --> 0:21:03.479 third reduction in the likelihood of needing to get another 0:21:03.640 --> 0:21:06.800 therapy for their cancer within the next two years. That's 0:21:06.880 --> 0:21:09.400 and that you know, for cancer patients, that's a that's 0:21:09.840 --> 0:21:13.240 huge news too. I mean, obviously, managing cancer is is 0:21:13.440 --> 0:21:17.639 a life altering experience, and uh so any patient who 0:21:17.680 --> 0:21:21.600 would have that kind of um benefit, I mean, it's 0:21:21.680 --> 0:21:23.639 kind of hard to I don't know that you can 0:21:23.720 --> 0:21:28.240 overstate how beneficial it is. So another potential advantage we 0:21:28.320 --> 0:21:30.840 talked about briefly, or a little bit earlier, was the 0:21:31.960 --> 0:21:35.680 ability to perform surgery. A doctor could perform surgery even 0:21:35.760 --> 0:21:39.360 if that doctor is nowhere near the patient using robotics, 0:21:39.520 --> 0:21:43.680 using a telesurgery, right, the idea of telepresence, where the 0:21:43.880 --> 0:21:46.840 doctor's presence is pretty much taken up by this this 0:21:47.000 --> 0:21:50.479 robot that's following the doctor's commands, right, And that can 0:21:50.520 --> 0:21:53.040 be terrific for many different situations. If you've got an 0:21:53.119 --> 0:21:55.440 expert in a certain kind of surgery, um, but he 0:21:55.560 --> 0:21:58.439 or she cannot be in the physical location or cannot 0:21:58.480 --> 0:22:03.160 be there quickly enough to perform surgery, then uh yeah, yeah. 0:22:03.280 --> 0:22:04.960 This is one of those things I often hear about 0:22:05.119 --> 0:22:08.240 for cases where you have people, like say in a 0:22:08.400 --> 0:22:12.520 scientific research center in a really remote location like I 0:22:12.560 --> 0:22:15.920 don't know, Antarctica, and you may or may not have 0:22:16.480 --> 0:22:19.480 someone at that center who has the training and ability 0:22:19.560 --> 0:22:22.760 to perform particular medical procedures. But if you had one 0:22:22.800 --> 0:22:25.880 of these robots and the ability to connect with someone 0:22:25.920 --> 0:22:28.800 who does have that expertise, you could still have that performed. 0:22:29.000 --> 0:22:31.040