Robots Replacing Doctors in Operating Rooms

Many science fiction writers have dreamed of it. But not even Phillip K. Dick would have imagined the day should come so soon ― robots are replacing doctors in operating rooms.

The world is seeing a craze for robotic surgery, where machines take care of precise sewing, clipping or other procedures. Patients undergoing operations and doctors performing them claim they are safer and less painful, and more and more people are expressing their willingness to go under the knives of these machines.

Amid the craze, there is the Da Vinci surgical system, which is said to be the best in the business.

Da Vinci Robot: Epitome of Medical Robots

Robotic surgery involves making three to five 0.5-1 centimeter incisions near the affected are instead of cutting and opening it up, and then using robot arms inserted into them to perform the surgery.

The idea for the system came first from the military. The United States government thought robots could conduct basic combat surgery in the field remotely operated by doctors.

The basic idea was for robots to repair wounds and injuries using micro-tools controlled by doctors in urban medical centers ― certainly one of the most fascinating ideas at the time.

The prototype was developed in 1992 and was first introduced to the public in 1997 in Belgium after winning U.S. Food and Drug Administration approval.

The machine consisted of two-lens endoscopes with attached articulated instruments having a full-range of three-dimensional movement. The operator, sitting at a consol, puts his or her arms through two armholes and manipulates the instruments as if they were actually performing the surgery.

The endoscopes send three-dimensional images to the operator and the power and directions of the robot hands can be controlled by several pedals. Doctors testified that once they get used to the images, and the feel and sense of the instruments, the process is easy to use and convenient.

In 2000, the Da Vinci system was used in about 10 cases in the U.S., but this jumped to more than 40,000 cases in 2007.

In Korea, Yonsei University's Severance Hospital first adopted Da Vinci in 2005 and has conducted successful operations on gall bladders and prostate glands. Since then, the hospital alone has conducted more than 500 surgical procedures using the robot. Now, there are 13 robots in the country and more institutions are planning to buy them.

Da Vinci Lessens Pain, Increases Comfort

Surgeons and their patients admire the machine as it brings about a win-win effect for both groups.

Prof. Lee Young-goo of Hallym University Medical Center, Kangnam Sacred Heart Hospital said Da Vinci is the best operating tool to date. Lee, also the chief of the Da Vinvi Robot Surgical Center at the hospital, said because the surgery requires smaller incisions in the abdomen, patients do not bleed so much leading to faster recovery times.

``If we have to perform open surgery, patients lose about 900 ccs of blood, but with the Da Vinci incisions they lose only about 150 ccs,'' he said. Therefore, the body receives less shock and the period for hospitalization is shortened, he added.

``It lessens patients' pain, which also leads to a shorter hospitalization period. It also has less possibility of contamination or infection, and leaves much smaller scarring,'' he said.

Kim Young-joo, who had a cancerous prostate removed in January, said he was very satisfied with the result. He said the shock of his disease and all the talking added stress to his heart beforehand.

``But I was really happy to get the surgery,'' he said. He showed his wound where only a small scar remained.

``I was able to move the day after the operation, which I never imagined. I even joked that it was a relief I was diagnosed with the disease late enough meet the robot,'' he said.

For the doctors, the robot is convenient, too. The arms move in a micro-scale and doctors say they are more articulate than human hands. Also, while human hands can shake in the middle of a procedure, the machine compensates giving a consistent performance.

``And because it is very small, the tip of its hands can move a lot and reach to a very small space in the body rapidly,'' Lee said.

Lee, an authority in urology, said the robot is especially good for prostate cancer. ``One of the side effects of the prostate cancer surgery is that incontinence often happens because surgical scalpels can cut veins. But with the robot surgery, it doesn't happen. Also, the chances of being accidentally made impotent are dramatically reduced,'' he said.

Da Vinci Taken up by Major Hospitals

Since its successful launch in Korea, the robot has been rapidly adopted by many hospitals in Korea. The Severance Hospital, Samsung Medical Center, Youngdong Severance Hospital, Korea University Medical Center, Asan Medical Center, Kangnam Sacred Heart Hospital, Bundang Seoul National University Medical Center, Donga University Hospital and Kyongbuk University Medical Center have all bought machines.

The Severance Center opened an educational institute for the robot for Asian countries while the Sacred Heart Hospital opened its own robot center.
``Because Korean surgeons have sensitive hands, teaching techniques are getting better and better,'' Na Gun-ho, a surgeon at the hospital, said.

Bundang SNU Hospital has recently started main arterial surgery with its robot. Surgeon Lee Tae-seung said the procedures were difficult, but with the Da Vinci system exceptionally precise surgery was possible.

Da Vinci Has Ups and Down

While Da Vinci surgery is successful, the high price is something that holds patients back. The Severance Hospital spokesman Lee Sung-man said the surgery costs between 7 million-20 million won.

The high costs is due to the eye-popping price of the robot itself ― 2.8 billion ― and the fact that its arms must be changed after every tenth procedure.
``It is why some people back out at the last moment,'' he said.

However, Lee Young-goo said the good outcome outweighs the cost and the pain a patient has to endure.

``I say it's the best surgical method yet,'' he said.

According to hospitals, the price is cheaper than in the U.S. and other countries ― ``I say about 20-30 percent,'' Lee said. He added that many foreigners have actually come to Korea for surgical procedures.

``For Koreans, there is no need to go abroad as surgeons here are catching up with the skill and are ready to perform,'' he said.

http://www.koreatimes.co.kr/www/news/nation/2009/05/242_21380.html

A Doctor’s Vision of the Future of Medicine

It's June 2018. Sally picks up a handheld device and holds it to her finger. With a tiny pinprick, it draws off a fraction of a droplet of blood, makes 2,000 different measurements and sends the data wirelessly to a distant computer for analysis. A few minutes later, Sally gets the results via e-mail, and a copy goes to her physician. All of Sally's organs are fine, and her physician advises her to do another home medical checkup in six months.

This is what the not-so-distant future of medicine will look like. Over the next two decades, medicine will change from its current reactive mode, in which doctors wait for people to get sick, to a mode that is far more preventive and rational. I like to call it P4 medicine—predictive, personalized, preventive and participatory. What's driving this change are powerful new measurement technologies and the so-called systems approach to medicine. Whereas medical researchers in the past studied disease by analyzing the effects of one gene at a time, the systems approach will give them the ability to analyze all your genes at once. The average doctor's office visit today might involve blood work and a few measurements, such as blood pressure and temperature; in the near future physicians will collect billions of bytes of information about each individual—genes, blood proteins, cells and historical data. They will use this data to assess whether your cell's biological information-handling circuits have become perturbed by disease, whether from defective genes, exposure to bad things in the environment or both.

Several emerging technologies are making this holistic, molecular approach to disease possible. Nano-size devices will measure thousands of blood elements, and DNA sequencers will decode individual human genomes rapidly, accurately and inexpensively. New computers will sort through huge amounts of data gathered annually on each individual and boil down this information to clear results about health and disease.

Medicine will begin to get more predictive and personalized (the first two aspects of P4 medicine) over the next five to 10 years. First, doctors will be able to sequence the genome of each patient, which together with other data will yield useful predictions about his or her future health; it will be able to tell you, for example, that you have a 30 percent chance of developing ovarian cancer before age 30. Second, a biannual assessment of your blood will make it possible to get an update on the current state of your health for each of your 50 or so organ systems. These steps will place the focus of medicine on individual patients and on assessing the impact that genes and their interactions with the environment have in determining health or disease.

In preventive medicine (the third P), researchers will use systems medicine to develop drugs that help prevent disease. If, say, you have a 50 percent chance of developing prostate cancer by the time you're 50, you may be able to start taking a drug when you're 30 that would reduce substantially reduce that probability. In the next 10 to 20 years the focus of health care will shift from dealing with disease to maintaining wellness.

Participatory medicine acknowledges the unparalleled opportunities that patients will have to take control of their health care. To participate effectively, though, they will have to be educated as to the basic principles of P4 medicine. New companies that can analyze human genome variation, like 23andMe and Navigenics, are already planning to provide patients with genetic information that may be useful in modifying their behavior to avoid future health problems. In the future, patients will need not just genetic data but insight into how the environment is turning genes on and off to cause disease—just as smoking often causes lung cancer and exposure to sunlight can cause skin cancer.

P4 medicine will have a big impact on many industries, including pharmaceuticals, food and insurance, as well as health care. The interesting question is whether preexisting businesses and entrenched bureaucracies will be able to respond to these winds of change, or whether a host of new companies will emerge to replace them—focused precisely on these new opportunities.

Research will also have to change. Because most important diseases such as diabetes, cancer, heart disease, obesity and Alzheimer's are so complex, the traditional approaches to studying them have had only marginal results. Powerful new systems approaches, individual measurements and computational technologies will transform our ability to deal with complexity and fashion new drugs and approaches for therapy and prevention.

Medical education will also need to be transformed. Although today's medical students will be practicing P4 medicine within the next five to 20 years, their training is still focused on a classification of disease based on observation of relatively few measurements of health parameters. Tomorrow's physicians will need to be familiar with the complexity of the human biological system as never before, and they'll have to be handy with computer-based tools. Physicians will need to deal with patients who have an enormous amount of information at their disposal. And doctors will need to deal with maintaining wellness more than with disease.

The digitization of medicine—that is, our ability to extract and store disease-relevant information from DNA and molecules in the blood of each individual—together with the revolutionary changes in diagnosis, therapy and prevention will allow those of us in the developed world to export P4 medicine to the developing world and thus transform the quality of its health care. The new P4 medicine will eventually lead to a universal democratization of health care, bringing to billions the fundamental right of health, unimaginable even a few years ago.

Hood invented the genome sequencing technology that led to the decoding of the human genome in 2001. He is a pioneer of systems biology and medicine and founder of the Institute for System Biology in Seattle, Washington.

http://www.newsweek.com/id/204227/page/2

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