Professional Engineering

Medical procedures and interaction with medical professionals are delicate matters. Outstanding healthcare, it could be said, relies as much on the personal touch as on accurate diagnosis and timely treatment. So should we be concerned if robots are now taking over some of the tasks of even high-ranking medical staff such as surgeons? 

Increased levels of automation in front-line medicine are likely to continue, the experts say, and while there is a need for stringent checks and balances in the industry, there is much that robots and other automated systems have to offer. 

Professor Noel Sharkey, an expert on robotics and the ethics of automated systems at the University of Sheffield, says that criticisms directed at systems such as the RP-7 robot, which can take the place of the doctor at the bedside, are unfounded. 

The RP-7, developed by California’s InTouch Health, is a mobile robot with a screen through which a doctor at a remote location can converse with a patient. It essentially provides mobile videoconferencing-style services without the need for the patient to be in a room with a laptop, internet connection and webcam, or for the doctor to even be in the same country. Some have criticised the system on the grounds of depersonalisation – the bedside manner, or lack of it – but Sharkey believes it has great potential, especially for remote regions in the developing world. He says: “I understand the concern that it is very important not to deprive people of contact with their surgeon or doctor. By contact, we mean personal visual contact to relieve anxiety – that’s a big thing. 

“But in the case of the RP-7, which comes and talks to you, that’s a little bit short-sighted. If you look a little bit into the future of these systems, what they mean is you can talk to several doctors through it.” Remote areas in emerging economies that have little or no access to doctors could benefit from similar technology. Sharkey says: “I have given talks in India where I talk about service robots in general, and they laugh at the idea of cleaning robots and that sort of thing because there’s so much manpower. 

“But what they don’t laugh at is the idea of travelling robot doctors like the RP-7. It’s not really a doctor, it’s just a device that lets the doctor speak, and there is such a shortage of doctors in India: there are many, many villages that have no doctors at all.”

Surgery is also an area where automation has made significant inroads over the past decade. Prime among these systems is the da Vinci surgical system, developed by US firm Intuitive Surgical, which is currently being used at 22 hospitals in Britain. The da Vinci system was originally developed with military needs in mind and designed to assist surgeons carrying out laparoscopic, or minimally invasive, “keyhole” surgery. Chris Simmonds, senior director of marketing services at Intuitive Surgical, says: “The original prototype for Intuitive Surgical’s da Vinci system was developed in the late 1980s at the former Stanford Research Institute under contract to the US Army. 

“While initial work was funded in the interest of developing a system for performing battlefield surgery remotely, possible commercial applications were even more compelling: it was clear to those involved that this technology could accelerate the application of a minimally invasive surgical approach to a broader range of procedures.”

The US Food and Drug Administration approved the da Vinci for general laparoscopic surgery in 2000. In subsequent years it has been approved for thoracoscopic (chest) surgery, cardiac procedures with adjunctive incisions, urologic, gynaecologic, paediatric, and trans-oral otolaryngology (ear, nose and throat) procedures. It was first used in Britain at St Mary’s Hospital, Paddington, London, for cardiovascular treatments, and is still in use there today. 

The da Vinci system has opened up some operations such as the removal of the prostate to minimally invasive surgery, with an increase in the number of these operations in the US being performed using laparoscopic techniques by surgeons employing it. Benefits of minimally invasive surgery include less pain, fewer complications and quicker recovery times for patients. 

Sharkey is clear that automation can pay dividends in the complex arena of surgery. He says: “I’ve heard it said that surgeons should be able to do these jobs just as well as robots. But those I’ve talked to say that, while that might be the case with the top surgeons, it’s not always that way. 

“The top surgeons can do as well as a robot – maybe even better. But there are more junior surgeons where, potentially, they would do a better job using robotic assistance.”

Systems like the da Vinci, he says, “allow the surgeon to delineate the area inside where he or she goes”. He adds: “It stops them making big sweeps and sets a boundary. But also you can make big hand movements outside the body, and the system makes tiny little hand movements inside – so if you jerk your hand suddenly it’s not going to jerk with you. It really is very useful for a lower skill level, extremely useful.

“I suppose therefore that, speaking ethically, it should be used. Anything that’s going to make the patient’s life easier should be used. But on the proviso that the doctor’s always there: that they can meet the doctor.”