Robot-assisted surgery
fields can be set to any direction within the patient’s torso without needing to move the electromagnets. Using the resulting magnetic forces, the physician can steer the tip of the ablation catheter with high dexterity and unprecedented reach within any of the four heart chambers. This control over the steering of the catheter is key to successful ablation. He went on to highlight the potential for
micro or nano robots (much like the robots seen in the animated film ‘Big Hero 6’). These tiny robots work together in a ‘swarm’. “On their own, they’re not particularly
impressive, but when they start working as a swarm, you start to see the potential for this sort of technology,” he commented. Demonstrating with a video, he explained these magnetic micro robots are just millimetres in size. They bend and move in response to applied magnetic fields and these magnetic fields are controlled by a gaming controller. The micro robots can be driven carefully and precisely. They turn by changing the direction of the magnetic field, and can even grasp and jump. Pill cams have been used for some time,
however, with a micro robot there could be the potential to stabilise the system long enough to take a sample and start using these to perform biopsies. “The developers of these miniaturised
robots are looking at bronchoscopy and lung biopsies initially. But they are still a long way off,” Jonathan explained.
He further discussed the potential, in the
future, for autonomous robotic surgery, highlighting the Lindbergh operation – a telesurgical operation carried out by a team of French surgeons located in New York on a patient in Strasbourg, France. “So, what are the critical elements of
telesurgery? You’ve got to think about the local team’s skills set. It’s all very well saying you’re going to get the top surgeon from X country to operate in Y country, but what are the local surgical skills in Y country? Can they put ports in? For example, are you going to use this in Canada or Australia to log on from your metropolitan centre to operate in a rural setting? In which case, what happens when things go wrong? What’s the plan? What are their underlying skills? “And, if you’re going to start doing this on a
more regular basis, how about skill degradation? What’s going to happen to the surgeons who are no longer doing the complex part of the operation, who suddenly – once in a blue moon – are thrown in an emergency situation? These are all questions that are yet to be answered, but the key to actually getting the technology to work is
Training and simulation There are other hurdles to overcome in the present day, as Jonathan pointed out: “I think the current issue is how do we train the current existing consultants on the robotic platforms, but don’t ignore the trainees who are in their training pathway?” Simulation, as a training tool, will be key and Jonathan highlighted some of the virtual reality simulation tools available. Telementoring has significant potential to assist with education – providing expertise from anywhere, creating affordable access, and helping to improve patient outcomes. For example, a team at the Karolinska Institute in Sweden found that telemedicine improved the cannulation rate at a district hospital from 85% to 99% after teleguided support was introduced.3
Autonomous robots So, will robots replace the surgeon altogether in the future? In 2022, a robot performed laparoscopic surgery on the soft tissue of a pig without the guiding hand of a human – it was described by the researchers as a significant
step towards fully automated surgery on humans. The Smart Tissue Autonomous Robot, or STAR, was designed by a team at Johns Hopkins University.2 “In summary, I think robotics is the future,” Jonathan commented. “There may be additional safety wins for our patients going forward. So, is laparoscopy dead? I would suggest not yet…I would also make the observation that, in aviation, the weakest link on the flight deck is the pilot… “We’ve known this for years and yet we’ve had computers on the flight deck that can take the plane off and land it at the other end...But how many of you would get onto that plane with no human on the controls? I think the reality is none of us. So, unless there’s a substantial change in culture, I don’t see this happening,” he concluded. Ultimately, the one-day symposium provided
Alex Allen, Clinical Lead for Robotic Surgery
about latency of communication,” he pointed out. Data and latency will be key, in the future, Jonathan explained, adding that we will increasingly hear about edge computing in the next 5-10 years. Cloud computing is a remote service, while edge computing is local – allowing faster visual data processing speeds. However, there are trade-offs from a cybersecurity point of view. “Cloud processing is extremely secure, but as you bring things more local, the security becomes less – and, of course, in healthcare, we work with sensitive data, so you can see the potential barriers,” Jonathan commented.
a comprehensive platform for attendees to delve into the latest advancements in robot- assisted surgery, evidence-based practices, and the future trajectory of this rapidly evolving field. With a focus on innovation and practical application, symposium attendees were able to gain valuable insights into the future of robot-assisted procedures and their impact on surgical outcomes.
References 1. Ferrari D, Violante T, Novelli M, Starlinger PP, Smoot RL, Reisenauer JS, Larson DW. The death of laparoscopy. Surg Endosc. 2024 May;38(5):2677-2688. doi: 10.1007/s00464-024- 10774-2. Epub 2024 Mar 22. PMID: 38519609.
2.
https://hub.jhu.edu/2022/01/26/star-robot- performs-intestinal-surgery/
3. Påhlsson HI, Groth K, Permert J, Swahn F, Löhr M, Enochsson L, Lundell L, Arnelo U. Telemedicine: an important aid to perform high-quality endoscopic retrograde cholangiopancreatography in low- volume centers. Endoscopy. 2013;45(5):357-61. doi: 10.1055/s-0032-1326269. Epub 2013 Mar 6. PMID: 23468194.
The AfPP Robotic symposium discussed a wide range of other topics – too many to cover in this edition. However, other sessions included: ‘Innovations in robotic colorectal surgery, advancements and practice’, by Mo Iqbal and Mr Irshad Shaikh; ‘Anaesthetic considerations with robotic surgery’, by Siew-Ling Harrison and Thomas Maynard; ‘From set-up to recovery’, by CMR surgical; and ‘The role of the wider team in robotic surgery’, by Reece Williams and Elizabeth Wightman. For details of future events, visit:
https://www.afpp.org.uk/
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