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Doctors To Control Robot Surgeon With Their Eyes

kdawson posted about 6 years ago | from the no-saccades-please-we're-operating dept.

Robotics 99

trogador writes "Researchers from Imperial College London are improving the Da Vinci surgical robot by installing an eye-tracker, which allows surgeons to control the robot's knife simply by looking at the patient's tissues on a screen. Tracking the eyes can generate a 3D map, which in turn can make moving organs — like a beating heart — appear to stand still for easier operation. Other features include 'see-through' tissues on the surgeon's screen (so tumors can be seen underneath tissues) and 'no-cut' zones, places where the robot won't allow the surgeon to cut by mistake. Says ICL Professor Guang Zhong Yang, 'We want to empower the robot and make it more autonomous.'"

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99 comments

Ah yes ... (2, Funny)

ScrewMaster (602015) | about 6 years ago | (#22830908)

but is it a Robot Chicken? If so, it's important to remember that when you're playing chicken the first one to blink loses.

Re:Ah yes ... (0)

Anonymous Coward | about 6 years ago | (#22830922)

when you're playing chicken the first one to blink loses.
You're thinking of a different game. Perhaps you're thinking of chess where you can never let your opponent see your pieces.

Re:Ah yes ... (1)

stevedmc (1065590) | about 6 years ago | (#22835900)

I think the patient has more to lose than the doctor. Perhaps the patient could get a no-blink money back guarantee.

Isn't the eye a little sensitive? (-1, Redundant)

Anonymous Coward | about 6 years ago | (#22830918)

I know they've been doing similar sounding "remote surgery" for years and years. [yahoo.com] But isn't the eye a little sensitive? Imagine if a hot nurse walked by. Ooops.
 
L.H-H

But the real question: (4, Funny)

theaceoffire (1053556) | about 6 years ago | (#22830930)

^_^ I foresee an issue with female clients.
"AHHHH! NO, My eyes are UP HERE!"

Re:But the real question: (0)

Anonymous Coward | about 6 years ago | (#22830990)

Exactly my first thought. Good thing I'm not a doctor (and the robot has red/no-cut zones)!

Re:But the real question: (1)

ortho1 (1069020) | about 6 years ago | (#22837670)

I agree with you to the fullest! The human body and especially its function is virtually impossible to be mimiced! I do not understand the point behind creation of such robot. Will it save time, reveal structures that have never been revealed, or be more successful than that of human control? Who really knows why!

I hope they know what they're doing... (1)

spydabyte (1032538) | about 6 years ago | (#22830938)

The human body is not a machine, and we cannot even come close to mimicking one, let alone thousands to millions.

I hope they have some biologists or MDs working on this robot, to take into account all those thousands of things the body does wrong that are impossible to predict. Nevermind machine failure or glitches.

On a more ethical standpoint, being interested in Medicine and Machines myself, I feel this is going in the opposite direction of what I hope for medicine. Distancing doctors from patients, and life from reality may prove a nasty combo.

Re:I hope they know what they're doing... (2, Insightful)

Aglassis (10161) | about 6 years ago | (#22831050)

The human body is not a machine, and we cannot even come close to mimicking one, let alone thousands to millions.
Why isn't the human body a machine? I'll grant that we can't mimic it but that doesn't mean that the systems of the body aren't mechanical in nature. Would you argue against using titanium rods to help with fractures, the use of plastic joints to replace failed joints, or other technologies that attempt to repair some mechanical failure in the body (including the use of micro-robots to perform surgery)?

On a more ethical standpoint, being interested in Medicine and Machines myself, I feel this is going in the opposite direction of what I hope for medicine. Distancing doctors from patients, and life from reality may prove a nasty combo.
Ethical? I'm not sure that word means what you think it means. You are advocating an almost superstitious view of how medicine should work. I'd be curious which ethical theory you are using to suggest that our modern advances in medicine are going in the wrong direction.

Re:I hope they know what they're doing... (1)

spydabyte (1032538) | about 6 years ago | (#22832244)

Why isn't the human body a machine? I'll grant that we can't mimic it but that doesn't mean that the systems of the body aren't mechanical in nature. Would you argue against using titanium rods to help with fractures, the use of plastic joints to replace failed joints, or other technologies that attempt to repair some mechanical failure in the body (including the use of micro-robots to perform surgery)?
I guess I wasn't clear with my earlier statement. I simply meant that there is no way that I would trust a machine like this to work in a general hospital. The human body is too complex for a machine to encompass and predict all possible outcomes. I understand the need and advancement of machines in the practice of medicine, but the concept of a still image being presented to a doctor, while he may need to see the moving image to watch for signs of some other problem, is a scary one to me.
If the software is written to predict the movement of a beating heart, so that the knife moves with it, so the doctor just sees a normal one, what happens when the heart beats abnormally to what it predicts? I'm assuming an improper incision. Hopefully that clears up my earlier comment.

Ethical? I'm not sure that word means what you think it means. You are advocating an almost superstitious view of how medicine should work. I'd be curious which ethical theory you are using to suggest that our modern advances in medicine are going in the wrong direction.
I'm currently studying some history of medicine through literature, like Williams, Lewis, Atwood, Mann, etc.., and can only see the distance between doctors and patients expanding. It's always been a pretty wide gap, and not wanting to really get into any great literature debate (I'm no expert on either matter), I was only pointing out that the gap between doctors and patients, I believe, will only expand due to technology. To me it would be like playing a video game. I guess this isn't a question of ethics, but it's a question of doctor/patient relations.

Re:I hope they know what they're doing... (1)

couchslug (175151) | about 6 years ago | (#22836632)

"The human body is too complex for a machine to encompass and predict all possible outcomes."

It's too complex for a physician to predict all possible outcomes. Given the minimal time allowed each patient and the extreme pressure to see many patients while coping with all his/her other duties, technology as a medical "force multiplier" will become ever more necessary to empower the doctor as a "care supervisor".

Re:I hope they know what they're doing... (2, Insightful)

vertinox (846076) | about 6 years ago | (#22831188)

The human body is not a machine, and we cannot even come close to mimicking one, let alone thousands to millions.

Wasn't that the whole point with using a machine?

A human can only hold a knife so still and accurate where a machine could cut on an accuracy scales below a millimeter.

I mean do we build planes with wings that flap like a bird? It would make sense to build a machine that does surgery without the flaws the inherit instability of the human hand.

Re:I hope they know what they're doing... (1)

spydabyte (1032538) | about 6 years ago | (#22832376)

Oh I completely see and agree with your point. I guess I didn't word mine correctly.
But what about the flaws of the human mind? If a human writes the software that doesn't work, then the machine, or plane or whatever, doesn't work in all the cases. We, as humans, tend to jump to application far too quickly without understanding it first. In this sense, a machine is no longer a perfection, not even close. Far too many people die in car crashes than a perfect machine would allow.

I know I hit on a few topics here, but let me focus on the most relating ethical debate, which I am afraid of: use before perfection.

See Dr. Ehrlich's Magic Bullet (1940) - http://imdb.com/title/tt0032413/ [imdb.com]. The entire ethical debate is of the same nature. Is it ok to spare hundreds when it would save millions more?

So even if this doesn't interest you, what about the legal side of things. When (or IF, if you're optimistic) this occurs, who is legally held responsible for the death or injury of an individual? The supplier of the machine material? The machine designer, the manufacturer, the doctor, the patient? All of the above?

Re:I hope they know what they're doing... (1)

The End Of Days (1243248) | about 6 years ago | (#22832532)

Who said perfect? Is the system this is designed to supplement/replace perfect? Not by a long shot.

I don't normally get so blunt with people's opinions, but I think you're way off base here.

Re:I hope they know what they're doing... (1)

ScrewMaster (602015) | about 6 years ago | (#22831216)

I feel this is going in the opposite direction of what I hope for medicine. Distancing doctors from patients, and life from reality may prove a nasty combo.

Well, it's a good thing most of us aren't hoping for the same things you are. Most sophisticated medical technology "distances" a doctor from his patient to some degree ... like, for example, a stethoscope. Should a doctor be required to press his ears against a patient's chest to listen the heart and lungs?

The issue here is that the human body has substantial limitations, and there is nothing unethical about augmenting a physician's natural abilities. Quite the opposite, in fact.

Re:I hope they know what they're doing... (1)

rucs_hack (784150) | about 6 years ago | (#22831288)

Well, it's a good thing most of us aren't hoping for the same things you are. Most sophisticated medical technology "distances" a doctor from his patient to some degree ... like, for example, a stethoscope. Should a doctor be required to press his ears against a patient's chest to listen the heart and lungs?

Interesting that you should mention the stethoscope. I'm a few years out of my work as a nurse, but when I was working in that field there was considerable resistance to the use of electronically assisted stethoscopes. There was some feeling that something was lost in their use, even though a recording could be made for later analysis.

The current non electronic designs are just adaptions of the same basic design that's been in use for most of the last 100 years. My personal one was very expensive, having been provided by a rep who mistakenly believed I was a doctor, instead of a student nurse on the hunt for free sandwiches. Anyway, mine felt great, but if I am to be honest, it worked no better then the ones my colleagues bought from a local toy store. Their ones were cheap, but came in lots of pretty colors.

Re:I hope they know what they're doing... (1)

spydabyte (1032538) | about 6 years ago | (#22832428)

Interesting topic about information being lost in translation. It's not quite the same, in my opinion, as something say like a drawing of a microbe. Where that drawing is a representation of the microbe, but not really the microbe itself. Besides all those side topics, what do you think about the stethoscope or machine? Is there something lost in translation?

Again, I'm agreeing that augmentation is a good thing, but the idea of removing the movement for better care doesn't make sense to me. It's taking the doctor one step away from what is really happening.

Re:I hope they know what they're doing... (2, Insightful)

NIckGorton (974753) | about 6 years ago | (#22831400)

On a more ethical standpoint, being interested in Medicine and Machines myself, I feel this is going in the opposite direction of what I hope for medicine. Distancing doctors from patients, and life from reality may prove a nasty combo.
First, you need some distance. If you are in respiratory failure, I have precious little time to get you intubated and ventilated. That is not the time you want active listening and human touch. You want technical skill and someone who does not dick around. You may even want someone who has toys like this hella sexy video laryngoscope: http://medgadget.com/archives/2006/10/mcgrath_series.html [medgadget.com]

Want.

Of course with that I am less in touch with you physically and less likely to end up spattered in the half digested pasta, beans, or nachos that everyone who needs emergency intubation invariably eats right before they crap out. Honestly though I think we are both happier that way.

Secondly though, the motivation for me that makes me want to save your life is the same one that makes me select the best tool for doing so. If that is a McGrath video laryngoscope (mmmmmmmmm....) or a good old fashioned Mac 4 blade then that's what I use. It would be malfeasance from my perspective if I chose the least effective means because I was a dilettante about technology.

Re:I hope they know what they're doing... (1)

spydabyte (1032538) | about 6 years ago | (#22832476)

You hit right on my meaning of ethical debate. Besides the question whether or not the technology works, is it really that much better if the doctor is so far away from his patient?

What about the incredibly common debate in House MD (I'm not being scientific, just generalized thinking here), which is background information. What if you don't know everything about your patient? What if I'm allergic to something in the process of that intubation and that quick thinking decision kills me?

More on topic, what if not all the information for the machine to operate on my heart isn't known? This would lead to possibly fatal problems with the machine predicting heart/excess movement.

I think neapolitan said it better than I ever could have, since I don't have the technical training of a doctor, a few comments below.

Re:I hope they know what they're doing... (1)

ScrewMaster (602015) | about 6 years ago | (#22832508)

and that quick thinking decision kills me?

The you're dead, just like you'll be if that doctor doesn't have what it takes to help you. Put it this way: if you have a competent ER physician on hand with the right equipment, you have a chance. Personally, I want that doctor to have the best medical technology available, because I want to live.

Re:I hope they know what they're doing... (1)

couchslug (175151) | about 6 years ago | (#22836596)

"Distancing doctors from patients, and life from reality may prove a nasty combo."

I'd rather have a stable "machine tool" used to cut me for surgery than a less-precise human hand. Let the surgeons brain have a better interface with my repair process than just his imprecise fingers.

This has nothing to do with "distancing" and everything to do with precision and control. If you want to use the tools they used on Mel Gibson in "Braveheart", have at it, but the point of advancing medical tech is to improve effectiveness.

jerky movement (1, Insightful)

wizardforce (1005805) | about 6 years ago | (#22830940)

!!! eye movement is jerky! why oh why would you use eye movement of all things to control a surgical instrament!? good thing that the robot will limit what areas the surgeon can cut

Re:jerky movement (4, Informative)

ScrewMaster (602015) | about 6 years ago | (#22831108)

Those movements are called "sacchades" and they are important to preventing retinal fatigue. They're actually fairly predictable and it shouldn't be hard to average them out.

Re:jerky movement (2, Funny)

Oktober Sunset (838224) | about 6 years ago | (#22831536)

What if one of the surgeon's assistants is seriously hot and is in his peripheral vision? What gunna happen when the surgeons eyes keep darting to the nurses huge jugs?

Re:jerky movement (1)

iabervon (1971) | about 6 years ago | (#22831660)

You're thinking of microsaccades rather than saccades (which are larger scale jumps from one point of focus to a different point of focus). Microsaccades are probably actually actively helpful in precise eye tracking, because they end at the target of fixation, and therefore pick out the relevant spot within the area that the focus drifts within.

Re:jerky movement (1)

ScrewMaster (602015) | about 6 years ago | (#22832480)

As I understand it, the primary function of saccades is to prevent retinal fatigue. Experiments have been performed where a grain-of-wheat lamp was literally glued to the eyeball. That way, the light source would move with the eye, and the corresponding image would be focused on the same area of the retina, regardless of eye motion. Within a few seconds, the image would fade and the light would become invisible as the retinal pigments were exhausted.

This effect is even more noticeable with people who suffer constant exposure to low-light conditions (miners, for example) which induces grossly exaggerated saccades. I did software development for a research lab back in the early eighties: we monitored eye motion using a pair of infrared glasses. It was interesting stuff: we tested people with all kind of neurological and physical problems, the idea being that variations in these repetitive eye motions could have diagnostic value. I left the project once the software was done: I don't know what might have come of it.

Re:jerky movement (0)

Anonymous Coward | about 6 years ago | (#22831138)

don't sneeze!

Re:jerky movement (1)

Mr. Freeman (933986) | about 6 years ago | (#22832976)

"Controlled with eye movement" Doesn't automatically mean that the robot is going to actually do anything to the place where the surgeon is looking. As the summary mentions, the eye-triggered commands could be as simple as switching a camera view, something that obviously isn't going to cut open the patient.

I don't know why everyone on here seems to think that they're the first person to figure out that a robot shouldn't slice open a patient because the doctor blinked.

I for one welcome my robot surgeon! (4, Interesting)

QuantumFTL (197300) | about 6 years ago | (#22830942)

Back when I was working at the NASA Jet Propulsion Lab, I was stuck in a basement laboratory. One interesting thing was that there were old robots *everywhere*, including a big old surgical robot right beside my desk. It was really interesting, as it had two 6-Degrees of Freedom "scapel" controls, and a microscope-like magnifying viewer.

I asked some folks about it, and they said that one of the main benefits was that they used Fourier transforms and other filtering to significantly reduce the "jitter" of the doctor's hands, without aversely affecting intentional motions. I thought that was really interesting, and might save a lot of complications. A former boss of mine has a surgeon for a father, and he said it was quite common fifty years ago for them to have an alcoholic beverage before a surgery to steady their nerves, and seems to think this was effective. I suppose the robotic version wouldn't have all the downsides.

I also think an interesting possibility for this technology is plastic surgery - one of the biggest current problems with plastic surgery isn't expense (a lot of things people want aren't that expensive), it's the risk of complication, which can be quite significant. My brother did not get his face repaired after breaking a cheekbone due to this risk.

This would especially be good for individuals who have recently lost a lot of weight - there's a lot of self consciousness about excess skin, and being able to safely remove it with much reduced risk of complications would go a long way towards helping these people feel better about themselves (which is one way to help keep the weight off).

So yes, I for one welcome my robot surgeon. Some day it might save my life!

Imperial College London .. (0, Troll)

ScrewMaster (602015) | about 6 years ago | (#22830966)

Says ICL Professor Guang Zhong Yang

Now that's a good, traditional British name. Wonder what his family crest looks like.

Re:Imperial College London .. (0, Flamebait)

Poorcku (831174) | about 6 years ago | (#22831020)

All Americans suck because they eat at McDonalds. :) I await the insightful moderation. thanx.

Re:Imperial College London .. (1)

rucs_hack (784150) | about 6 years ago | (#22831208)

Now that's a good, traditional British name. Wonder what his family crest looks like.

You've never heard the phrase 'a good Englishman is 99% foreign'?

My Family are English, and have lived in the UK for centuries, yet my Surname is Nordic. Extremely so in fact, It hasn't been englicised at all, in all this time, which I find quite odd. I've had no end of problems over the years with it being spelled wrong.

Re:Imperial College London .. (1)

vigmeister (1112659) | about 6 years ago | (#22831886)

I've had no end of problems over the years with it being *spelled* wrong.
The way you spelt that word suggests that you is Americaine?

Cheers!

Re:Imperial College London .. (1)

rucs_hack (784150) | about 6 years ago | (#22832258)

The way you spelt that word suggests that you is Americaine?

Nope, but since the overwhelming majority of my exposure to the written word has been early american SF (can't help it, I worship at the alter of Gernsback) , I do find that my spelling is some sort of mutant hybrid between those of our two countries.

Add to that a fascination for pre eighteenth century European dictionaries, and you end up with a vocabulary which is positively weird. I gave up trying to conform to the language norms of my country a long time ago.

Has to be said (1)

Anonymous Coward | about 6 years ago | (#22830984)

I, for one, welcome our robot-controlling doctor overlords.

Don't Blink! (0)

Anonymous Coward | about 6 years ago | (#22830992)

Don't blink!

Precision? (3, Informative)

ScrewMaster (602015) | about 6 years ago | (#22830994)

"It shows you the tumour in relation to its anatomical structure," Darzi said. That means the surgeon can be more precise and avoid cutting out large amounts of healthy tissue.

Lack of precision isn't the only reason surgeons remove large amounts of apparently "healthy" tissue along with a tumor ... it's to make sure they get all of it.

Re:Precision? (2, Insightful)

repvik (96666) | about 6 years ago | (#22831218)

They cut out a fair bit because they simply can't see the tumor... Cutting a safety margin comes on top of that again.

Re:Precision? (1)

NIckGorton (974753) | about 6 years ago | (#22831416)

You would like a good margin around the entire tumor. If you were able to precisely get 1cm margins all around that would be far preferable to getting 1.7 cm margins in one place and 0.1 cm margins in another. As it stands even if the ideal is 1cm, you often shoot for more on average because you would rather have one place that is 3cm than one place that is 0.1 cm.

So precision would definitely give you less tissue loss, if nothing else than by allowing a smaller target for margins.

Great research, but still only research! (5, Interesting)

neapolitan (1100101) | about 6 years ago | (#22831042)

I am a doctor that does surgical procedures (mainly pacemaker device implantations).

These kind of devices are very much experimental, and pop up in the news every couple of months (a slashdot search can reveal similar ideas), but quite far away from any sort of typical use. Right now heart bypass surgery is decidedly low-tech, with a surgeon viewing the beating heart with loupe glasses and very skillfully lasso-ing the coronary arteries. It is a great fantasy in the hearts of all doctors to have a machine that offsets any heart movement -- it would make things much easier if reliable. The article doesn't mention that the movement would also have to be coupled with respiratory movement, and have some sort of fail-safe in the case of patient or external movement.

However, standard surgery is still not done using these tools. There are way too many items required to make this feasible in the near future ( 10 years IMHO, although I hope I'm wrong!)

  - Testing: This is literally a life-and-death situation, and any robot "error" in a real person is likely to set the technology back 5 years after it hits the press and hospital review boards. Very, very damaging PR.
  - Education: Surgeons would have to essentially be re-trained to use such a system.
  - Feedback: It is really, really difficult to give an operator feedback on how something "feels." Part of during surgery (no kidding) a surgeon will often run his finger along cardiac arteries -- you can almost "feel" the calcified plaque in a diseased vessel. It would be really hard to approximate anything like this with a virtual robot.
  - Cost: Labor is relatively cheap compared to the capital expenditure to R&D something like this... of course, this will change as time goes by.

Exciting news, but incremental technology.

Re:Great research, but still only research! (1)

ceoyoyo (59147) | about 6 years ago | (#22831214)

Da Vinci is FDA approved and used clinically in a number of hospitals. Robotic surgery for EVERYTHING is a long way off, and I doubt eye controlled surgery will ever be useful, but robotic surgery for some procedures is here now.

Re:Great research, but still only research! (1)

neapolitan (1100101) | about 6 years ago | (#22831334)

I guess it depends what you mean by "used clinically." These generally are technology expos as part of a clinical trial -- FDA approval allows you to use it on a person, but you can bet that the patient signed a very long form indicating he is part of a research study / nonstandard procedure. Reading a few articles about this indicates the most high volume centers have done ~100 of these "robotic procedures," and mine (a major Harvard teaching hospital) has done... zero.

I'm all for it too -- but again, I just don't see this becoming routine for 10 years. My particular procedures have little use for it (we do everything through a quarter-sized incision anyway).

Finally, most of these systems (the GI doctors in my hospital have a remote device operating through an endoscope -- I will try to find out the brand) is more of a remote control through an endoscope AFAIK rather than a "robot." Without arguing semantics, this is a servo controlling a device attached to the end of a rod, and while evolutionary, I would not call it a robotic surgery. I'm not disrespecting it in the least, but if I had to guess, this is the way things will go. There will be evolution with incremental use of mechanical tools in the OR (of now there is minimal!) and someday, relatively far off, computer guided / mechanical surgery.

Re:Great research, but still only research! (1)

ceoyoyo (59147) | about 6 years ago | (#22831396)

In the first paragraph you say that nobody in your centre has done any robotic surgery, then in the last paragraph you mention that the GI doctors have. A "remote device", unless I've completely misunderstood you, is a robot, and may well actually BE a Da Vinci robot. It is not an autonomous robot, but it is a robot.

I agree, autonomous surgery, where the procedure is under the control of a computer is a long way off. Non-autonomous robotic surgery is not.

I notice that Massachusetts has nine Da Vinci robots, including ones at U Mass Memorial, Boston Children's, Boston Medical Centre and Brigham.

Da Vinci system and robots... (1)

neapolitan (1100101) | about 6 years ago | (#22831512)

Your attitude is why I don't post here much.

Dude, stop being the contrarian, it does not make you sound "smart," only childish and argumentative. People will treat you better in life if you ask questions for clarification instead of trying to trap somebody into silly fallacies to "prove your point," as the first sentence in your response. Occasionally we have trainees with your style, and gradually they socialize. :)

Again, I'm not sure the name of the GI device -- I saw a tech demo of it in one of our virtual-patient labs that we have for training fellows and medical students. However, from what I saw, I would not call it "robotic surgery" any more than using any sort of other mechanical device, or using standard endoscopy to be "robotic" (some do have motorized retrieval devices, etc.) If this is all the Da Vinci system is, then, sorry, you are right by your definition.

I know intimately well what goes on in my department, and somewhat well what goes on in other departments. If you know more, share your knowledge -- I'd love to learn about some of the intricacies of the system if you have seen it in action. However, don't act like a little kid. Do you own Da Vinci stock?

>I notice that Massachusetts has nine Da Vinci robots, including ones at U Mass Memorial, Boston Children's, Boston
>Medical Centre and Brigham.

You didn't list two of Harvard's biggest hospitals. Also, of course, UMass and BMC are not part of Harvard.

Over and out. :)

Re:Da Vinci system and robots... (1)

ceoyoyo (59147) | about 6 years ago | (#22832484)

I wasn't trying to trap you, but by your response maybe I did?

Since we're trading silly insults, I've heard some surgeons don't really like any hint they might be wrong, about anything, even if its just a silly mistake or outside their field of expertise.

For your information (or rather for someone else reading this who is actually interested), Da Vinci appears to be fully FDA certified, NOT as a research device, for some procedures since 2000 or 2001. I believe they have been certified for some endoscopic cardiac procedures as well. Yes, here's an FDA press release about approval of the device for coronary artery bypass surgery: http://www.fda.gov/bbs/topics/answers/2004/ANS01298.html [fda.gov]. (from 2004)

501(k) applications and decisions are here [fda.gov].

From the company's site, listing procedures for which the robot is certified: http://www.intuitivesurgical.com/products/fdaclearance/index.aspx [intuitivesurgical.com].

Re:Da Vinci system and robots... (1)

Eastbeast314 (1240812) | about 6 years ago | (#22832850)

I was just thinking that your posts were the reason I come to Slashdot. Well-informed experts always have interesting, relevant things to say about the articles and are a pleasure to learn from. That's all to say, don't be talked out of posting just by the one person who didn't understand your post.

Re:Da Vinci system and robots... (1)

Artuir (1226648) | about 6 years ago | (#22833938)

Yes and as a few others said, people like you are why we enjoy coming to slashdot. Thank you for giving all of us insight on what it is you do - it's not every day I get to converse with a surgeon. Thanks for doing the job you do and being so adamant about learning how to do it better - I know quite a few in this audience (me likely included) will likely be requiring similar services someday in the future, sadly. We all ought to be very grateful.

Re:Da Vinci system and robots... (1)

neapolitan (1100101) | about 6 years ago | (#22836254)

Well, thanks guys. I am happy to provide the perspective of an MD in a sub-specialty. I actually paged a few of my friends that do CT surgery to ask them if they used the da Vinci system because I was curious. All of them had heard of it, and a few had been in cases with it, and again, unfortunately, all of them said it was a sideshow currently. At another major teaching hospital, the most experienced surgeon had about 100 cases with the device: far, far fewer than standard (they do 2-3 operations *per day*.) When used, they had the patient sign special forms beforehand.

On the summary [intuitivesurgical.com] it notes that the da Vinci system has been around since the 90's.

We all agreed it was important stuff though, and should continue with research / development / implementation in some areas.

Somebody said that surgeons hate to admit they are wrong -- yeah, that is generally a stereotype, along with "Americans are all fat," "girls can't do math," and "slashdotters are all virgins in their mother's basement." Sometimes true, but a bit offensive in its generalization. Yes, there are colleagues of mine that are simply arrogant and don't want to talk to patients or can't admit they are wrong, and there are balanced individuals whom I would send any family member to be a patient without hesitation.

Slashdot is fun, and we have EE's, MD's, and prominent programmers (John Carmack, Torvalds, etc.) on here, but also a wealth of teenagers, or their mental/emotional equivalent, that say the dumbest things because their Mom isn't around to tell them to shut up, and think that doing two internet searches is going to provide them with more perspective than a professional and make them seem smart. Not that I can't be wrong, of course, and I love to learn about new technology, but I hope I know what goes on every day at work. :)

Re:Great research, but still only research! (0)

Anonymous Coward | about 6 years ago | (#22831300)

While the whole guiding it with your eyes and offsetting motion may be years away, robotic surgery has been around for many years. The da Vinci robot they modified is actually an enormous success. It is made by Intuitive Surgical [yahoo.com], and is their main product. They have a market cap of $11.5 billion and sales have been growing at an absurd rate. And from their own web site [intuitivesurgical.com], you can see it is used in a variety of surgeries.

The U.S. Food and Drug Administration (FDA) has cleared the da Vinci® Surgical System for adult and pediatric use in urologic surgical procedures, general laparoscopic surgical procedures, gynecologic laparoscopic surgical procedures, general non-cardiovascular thoracoscopic surgical procedures and thoracoscopically assisted cardiotomy procedures. The da Vinci System may also be employed with adjunctive mediastinotomy to perform coronary anastomosis during cardiac revascularization.

Representative Uses: The da Vinci System has been successfully used in the following procedures, among others:

  • Radical prostatectomy, pyeloplasty, cystectomy, nephrectomy, ureteral reimplantation
  • Hysterectomy, myomectomy and sacrocolpopexy
  • Cholecystectomy, Nissen fundoplication, Heller myotomy, gastric bypass, donor nephrectomy, adrenalectomy, splenectomy and bowel resection
  • Internal mammary artery mobilization and cardiac tissue ablation
  • Mitral valve repair, endoscopic atrial septal defect closure
  • Mammary to left anterior descending coronary artery anastomosis for cardiac revascularization with adjunctive mediastinotomy

Google Surgery (1)

Pseudonymus Bosch (3479) | about 6 years ago | (#22831472)

Testing: This is literally a life-and-death situation, and any robot "error" in a real person is likely to set the technology back 5 years after it hits the press and hospital review boards. Very, very damaging PR.

Google Heart Surgery solved this with a "Beta" sticker.

Re:Great research, but still only research! (1)

NMerriam (15122) | about 6 years ago | (#22832982)

These kind of devices are very much experimental, and pop up in the news every couple of months...but quite far away from any sort of typical use.

They are used somewhat routinely in many hospitals across the US, Canada and Europe. It's been several years since they were research-only. The only reason they aren't used more frequently is simply the cost and size, even the places that use them regularly only have one OR set up with the equipment, while they may be running two dozen ORs on a daily basis.

You're right that they require some training, which is why they've been embraced more quickly by experienced laparoscopic surgeons, since they are used to working on patients with that built-in degree of separation. We've been able to train experienced surgeons to use several different systems in an afternoon, they're not only incredibly capable, they're nearly doctor-proof (because let's face it, even a doctor can outdo the greatest fool when it comes time to screw something up :P ).

Most of your listed issues have long been dealt with. In terms of testing, the robots are far more consistent and predictable than any doctor. They have built-in safety systems on a number of different levels that vary from convenient to life-saving. I don't know of any issues that have arisen in the decades such research has been going on -- the FDA (and other governments around the world) has been satisfied, and what stats I've seen so far indicate lower incidences of complications and mistakes with robotic assistance than without (which should come as no surprise given that it's pretty much their entire purpose).

In terms of education, you're right that it requires training, but nothing as extensive as you seem to be imagining. Sure, many of the tricks and techniques of a specific procedure may change, but the overall surgical experience is pretty familiar. The big difference is that, in many ways, you can slow down the whole process, take your time and examine things in a way you couldn't before. And in terms of new surgical education, you couldn't ask for a better teaching tool than being able to switch the controls between a mentor and trainee with the flip of a switch.

Feedback will be the biggest change, definitely. There are pretty impressive haptics built into the current systems, which will only get better, along with visual overlays of real-time scans of the surgical area. This is kind of a half-dozen of one, six of another issue. You'll always think looking with your own eyeballs and running your finger along something is the best way, but in thirty years your residents will be snickering behind your back because that little change in density you're straining to find is about as subtle as Mount Everest on fire to the operator of the robot. Eventually the tactile surgical skills of the 20th century will be as useful to medical care as knowing how to shoe a horse is to modern transportation.

Cost is the biggest single issue right now, but the systems are getting cheaper while surgical teams are getting more expensive. It won't be long before malpractice insurance companies start offering discounts for procedures to be done with robotic assistance, and that will probably be what opens the floodgates.

Re:Great research, but still only research! (1)

jrau (880696) | about 6 years ago | (#22836202)

I recently had an OB/GYN professor (I'm a medical student) give us a lecture on using the Da Vinci for post-menopausal hysterectomies. Apparently he makes only 5 small incisions superior and lateral to the umbilicus (hence the post-menopausal, it can't be covered with a bikini). He said he uses it quite frequently, and that when hiring new physicians heavily considers whether they have been trained in robotic procedures during their residency/fellowship.

He also said that they expected to have force feedback versions pretty soon.

... anyway, interesting stuff. The radiologists are already practicing interstate and intercontinental, sounds like the surgeons might not be far off.

Oh. My. God. (3, Funny)

ChaoticLimbs (597275) | about 6 years ago | (#22831100)

I am so glad I am not a woman with really nice tits.

Re:breasts (2, Interesting)

TheMeuge (645043) | about 6 years ago | (#22831418)

Here's a curious anecdote, that I feel is appropriate to the joke.

I was looking for some clinical experience between the first and second years of med school, so I shadowed a surgeon, who specialized in breast tumors, and wound up spending lots of time in a "breast clinic" (screening and followup) for about a month and a half. While I probably saw some great breasts, I never felt aroused. Given that I am a very sexually-active heterosexual man, I was amazed at how my mindset was able to adjust itself, and how I was able to strip away my sexuality while I was with my patients. Not that I intended to abuse my position, but I expected that I would have to contend with a distraction, and braced my willpower for the battle. Yet in the end, it turned out that I had no problems being professional... and the only distraction I had to deal with, was a voice in my head, screaming in panic: "shouldn't a resident be doing this?"

Re:breasts (0)

Anonymous Coward | about 6 years ago | (#22832152)

I am not a doctor, but I've been in the same situation during my education as an artist. When the time came that I would have to deal with nude models for figure drawing classes, I was genuinely concerned that I would find it... difficult to stand up at times. Sure enough, my instructors more often than not hired some very attractive people to model for us, but despite seeing (and actually studying in minute detail) some *very* nice breasts, buttocks, and everything else, I never felt any arousal at all.

Re:breasts (0)

Anonymous Coward | about 6 years ago | (#22832766)

I am a very sexually-active heterosexual man
Dude, you're replying to an article on slashdot.

Being a sexually-active heterosexual man and writing on slashdot are two mutually exclusive events. You don't have to pretend to be hip around us.

And then a nurse with an unbutton shirt walks in (1)

samuel4242 (630369) | about 6 years ago | (#22831136)

I wouldn't want to be under the knife at that moment when a gaze is diverted.

Re:And then a nurse with an unbutton shirt walks i (1)

ScrewMaster (602015) | about 6 years ago | (#22831168)

Presumably the software running the show will have safeguards against such transient behavior.

Eye control? (2, Informative)

ceoyoyo (59147) | about 6 years ago | (#22831176)

Why? I did some work on development of a surgical robot. Surgeons use their tactile senses a lot, and its important to have 3D haptic feedback. Why in the world would you want to control a robot with your eyes? You can't even tell it how hard or deep to cut.

Re:Eye control? (1)

NIckGorton (974753) | about 6 years ago | (#22831452)

Why in the world would you want to control a robot with your eyes? You can't even tell it how hard or deep to cut.
Because most surgeons only have two hands. This represents a new means of input and control. Think of it as using both your hands and feet for driving. You can certainly drive with only your hands and a setup with the brake and gas on the steering wheel. However, having the break and gas operated by the feet gives the driver greater ability to use his hands for steering or drinking his coffee while shaving and eating a muffin.

Re:Eye control? (1)

ceoyoyo (59147) | about 6 years ago | (#22831502)

This is the example you use to demonstrate that eye controlled surgery is a GOOD idea??

To use a slightly different example, you could give a guy in a tank a bunch of video cameras, eye controlled aiming (already exists) and a voice command fire control, plus the regular driving controls. You don't, you build tanks to use a crew of typically three. How come? Because when job performance counts it's best to use multiple people, not overload one. Particularly not with flakey, taxing things like eye control.

Re:Eye control? (1)

Twisted64 (837490) | about 6 years ago | (#22832626)

You can't even tell it how hard or deep to cut.
Come on - that's when you start staring.
Hard stare = cut hard.
Deep and meaningful stare = cut deep, or kiss the surgeon.
1000-yard stare = sever an artery and go to sleep with the sweet sweet sounds of 'Nam ringing in your ears.

Although, really, it's a robot. How softly can it move a scalpel?

Re:Eye control? (1)

ceoyoyo (59147) | about 6 years ago | (#22833828)

A group in my lab is building one (with full haptic feedback) that can scale down the surgeon's movements to micrometre accuracy. So it can move a scalpel pretty softly indeed. Superhumanly softly.

Re:Eye control? (1)

TehZorroness (1104427) | about 6 years ago | (#22836218)

Since you have two eyes which are somewhat distanced, you can perceive your surroundings in 3D. I assume the eye trackers used would take both eyes into account and determine what you are looking at.

Re:Eye control? (1)

ceoyoyo (59147) | about 6 years ago | (#22836792)

And they'd record that you're focused on the surface of your 2D monitor....

Da Vinci is mostly used for endoscopic surgery where you can't directly see the surgical field, robot or no. Even if you use some kind of 3D, do you really want your surgery to depend on where your surgeon looks?

Okay, I want to cut here, here and here, but NOT there... oh crap.

Re:Eye control? (0)

Anonymous Coward | about 6 years ago | (#22837336)

You do know that Da Vinci is a 3D system, right? The surgeon sits at a console with his eyes looking at a stereoscopic display, so even though they are not in the surgical field, they can definitely see it as if they were.

dom

Re:Eye control? (0)

Anonymous Coward | about 6 years ago | (#22850256)

I'm sure a haptic feedback device attached directly to the eye would provide more than enough sensitivity.

Re:Eye control? (1)

ceoyoyo (59147) | about 6 years ago | (#22851196)

Might work. Surgeons would then be in good company. I have more than once written a paper that contained the phrase "we performed a study in which blinded radiologists...."

autonomous? (1)

rice_burners_suck (243660) | about 6 years ago | (#22831236)

This robot sounds pretty advanced, knowing where to cut and making 3D moving organs appear to stand still. The word "autonomous" raises an interesting question: Why not program it to perform a number of surgeries, store them all in a database, and simply select from a list the one appropriate for each patient? This way, only more complex surgeries would need to be performed by a human surgeon, which means that any hospital with one of these robots would be able to perform a great variety of "simpler" surgical routines.

The obligatory, "if they are controlling it..." (1)

unassimilatible (225662) | about 6 years ago | (#22831646)

"...it ain't a robot"? Aren't robots autonomous? If not, my car is a robot.

Re:The obligatory, "if they are controlling it..." (0)

Anonymous Coward | about 6 years ago | (#22831676)

Oh yeah? My car is an indian who turns into a wolf and he will come for you with his razor.

Oops (0)

Anonymous Coward | about 6 years ago | (#22831726)

Oops... I blinked.

Damn... (0)

Anonymous Coward | about 6 years ago | (#22831796)

A stray eyelash could kill somebody.

And no, I didn't RTFA.

Video Game Surgery? (1)

Shikaku (1129753) | about 6 years ago | (#22831818)

Tracking the eyes can generate a 3D map, which in turn can make moving organs -- like a beating heart -- appear to stand still for easier operation.
What is this, Trauma Center with doctors being given the Healing Touch? Is this what they meant when new science will make surgery like playing a video game?

Re:Video Game Surgery? (1)

Kabuthunk (972557) | about 6 years ago | (#22833984)

The last thing I'd need is the robot carving a 'star' shape into my aorta in an attempt to slow down time :P

Whoops! (1)

MalHavoc (590724) | about 6 years ago | (#22831944)

Well, this probably means that they'll be banning provocative Nurse wear in the OR. Wouldn't want the surgeon's eyes to wander and stare at boobies while trying to give some poor schmuck a vasectomy.

"Heeeeey, how you doin'?? Whooops! Sorry dude! My bad."

'no-cut' zones (1)

iminplaya (723125) | about 6 years ago | (#22831964)

The white zone is for immediate prepping and recovery of patients only. There is no cutting in a red zone.
The white zone is for immediate prepping and recovery of patients only. There is no cutting in a red zone.
The red zone is for immediate prepping and recovery of patients only. There is no cutting in a white zone.
No, the white zone is for prepping. Now, there is no cutting in a RED zone.
The red zone has always been for prepping.
Don't you tell me which zone is for prepping, and which zone is for recovery.
Look Betty, don't start up with your white zone shit again. There's just no cutting in a white zone.
Oh really, Vernon? Why pretend, we both know perfectly well what this is about. You want me to have an abortion.
It's really the only sensible thing to do, if its done safely. Therapeutically there's no danger involved.

Haptic Feedback (1)

j_sp_r (656354) | about 6 years ago | (#22832196)

I did some research on robots (the only one left is Da Vinci, having all the patents and bought out all competitors) in surgery as part of my Mechanical Engineering study, and the biggest drawbacks where:

- Lack of Haptic Feedback
- No real proven procedural benefits
- Expensive device (1.5 million euro's)
- 150000 euro's each year for the service contract
- Instruments 2000-5000 euro a piece, with a chip that only enables them to be used 10 times
- Optics cost 700 euro to sterilize, takes a while and the hospital I was in only had 2 of them.

All in all it came down to the device being stashed in the hallway because it was huge and there was no place (a few OR's burned down in that hospital) and only 1 procedure a week.

It was used for aorta replacements (till one went completely wrong when they dropped a needle, and hit a clamp) and for prostate removal (which takes as much time with the robot as by hand with no clear benefits for the patients, at higher costs)

Oh and the 3D display was 50Hz (is improved now, but that was an older model) so I only toyed with it for a few minutes, you don't feel shit and you can pull a thread apart with no effort, which is quite hard till impossible with bare hands and very difficult with normal laparoscopic tools.

probulator (1)

fahrbot-bot (874524) | about 6 years ago | (#22832824)

We want to empower the robot and make it more autonomous.
  • [Leela]: Well at least here you'll be treated with dignity. Now strip naked and get on the probulator.
  • [Fry]: Ooo!

Good timing... (1)

3waygeek (58990) | about 6 years ago | (#22835756)

On Friday, I had a balloon angioplasty & stent put in -- the procedure was done at St. Joseph's [slashdot.org] in Atlanta, which is one of the main training centers for the daVinci system. If my case had required bypass surgery, it might well have been done by the daVinci.

Was this for a bet.. (1)

Scooter (8281) | about 6 years ago | (#22835820)

2 beered up surgeons in theatre:-

"Check it out - I even closed!"
"OK smart arse - so you can do an appendectomy with your eyes huh? - let's see you do one using your tongue then!"

FOLLOW THE MONEY! (1)

heartsurgeon (453305) | about 6 years ago | (#22836850)

As you might surmise, I am a heart surgeon, and I have used the DaVinci system. (FYI the precursor is housed in the MIT tech museum on campus).

An unfortunate trend in medicine (particularly when it comes to the heart), is that marketing an idea/gizmo (and owning stock in the company) is extremely lucrative, as the delivery of heart care is highly competitive, and lots of money can be made if you are the "first" in your area to have a "new" technology. Hence, there is high interest in offering the latest procedure to people, in the hopes of drumming up business.

This, however, runs straight into the dictum in medicine to "don't be the first, and don't be the last" to adopt a new procedure/treatment/medicine.

The reason for the dictum is that real people's lives are at stake, and medical history (including the present) is replete with medications and procedures and treatments that were supposed to be "great" and turned out to actual harm people, after being evaluated in wide public usage. For a example from This week, just look at the recent HIV vaccine trial, that actually made people WORSE rather than better.

Oh by the way, in surgery, its the SURGEON, not the tools that matter. As for the DaVinci...in cases I've seen, it takes a straight forward operation ("traditional" mitral valve repair for example) that could be completed in 2-3 hours with less than 1% risk of death or serious complication, and turns it into a day long affair with worse results...in addition, you need a $1,000,000 machine (which needs a hefty service contract to maintain), more personnel, a bigger operating room,...you get my drift....I am unaware of ANY published study that proves the superiority of the DaVinci system in heart surgery, over traditional surgeries, when evaluating mortality (death rate), and morbidity (complication rate).

NOW, if you happen to be a paid consultant for the DaVinci company, or you have stock options in the company....it's great!!
If your the poor joe that gets his heart operated on by someone who has secondary gain involved in his decision making process...God Bless....

Follow the money!!!

Does that mean the system is bad? Not at all, its a tool...in the right hands, for the right purpose, it may be ideal.

What would I want done, if I needed heart surgery....go to a surgeon, and ask him/her what their results are (death rate, complication rate), and choose the best results....would i ask if they used a robot or did the surgery "off-pump" or what kind of artificial valve they preferred, etc, no..because that doesn't matter if your death or maimed....

I wont help you (1)

Tsoat (1221796) | about 6 years ago | (#22837594)

'We want to empower the robot and make it more autonomous.' When the robot uprising happens I will not help humanity precisely because of statements like these

Re:I wont help you (1)

ScrewMaster (602015) | about 6 years ago | (#22839306)

'We want to empower the robot and make it more autonomous.' When the robot uprising happens I will not help humanity precisely because of statements like these

I wouldn't worry too much until you start hearing statements like "We want to empower the super-smart AI and make it more autonomous."

I'm Sorry, Dave (1)

writerjosh (862522) | about 6 years ago | (#22848488)

HAL: "I'm sorry Dave, but I can't let you do that"

DAVE: "But HAL, it's a tumor, it's got to come out!"

HAL: "My records show this patient hasn't paid their insurance premium this month. I'm very sorry Dave, I can't let you operate."
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