Detailed information collected during robot-assisted surgeries could one day have unintended side effects.
ROBOT-ASSISTED SURGERY is big business. Increasingly, surgeons are going into operating rooms equipped not just with their two hands but with robotic arms outfitted with miniature cameras, forceps, suturing tools, and other surgical instruments. Surgery can now be performed from across the room by someone seated at a computer console. Last year Intuitive Surgical, the leading manufacturer of surgical robot systems, shipped more than 900 units of its most popular model, the da Vinci, each priced at roughly $1.5 million. In 2018, the global market share for surgical robotics was $5.4 billion, and it’s predicted to leap above $24 billion by 2025.
And for good reason. Acting alone, surgeons can operate only on what their eyes can see, and basically the only way to see inside a patient is to cut them open. With surgical robots, tiny cameras and tools can be inserted through a small incision, a “keyhole,” to perform fiddly procedures with exquisite precision. The minimally invasive approach is meant to promote faster patient recovery times and reduce postoperative complications. It may also lessen the physical toll on the physician: Long hours in the operating room are less demanding when the surgeon works from a seated position.
With the mechanization and miniaturization of surgery, however, comes a side effect that has the capacity to add a completely new dimension to health care. Massive amounts of data detailing every snip, clamp, and stitch that takes place in the operating room could be made available for collection and analysis. Before robotic surgery “you had a surgeon who was operating, and nobody else knew what was going on in there,” explains Khurshid Guru, one of the earliest masters of surgical robotics. But what if everybody — medical trainees, hospital administrators, insurance companies, even the robots’ manufacturers — could follow along?
THE DA VINCI, the most popular surgical robot in use today, resembles an oversized, four-armed tarantula. In 2018, more than 1 million procedures were performed worldwide with the da Vinci, up from 136,000 in 2008. Roughly three in four of those procedures were performed in the U.S.
As with other surgical robots, video and movements from the da Vinci can be recorded. On its face, that data could become a valuable training tool, with apprentices receiving detailed feedback about their performance in the operating room. In an article published in 2017, researchers were able to analyze a robot’s movements during a suture or other discrete task to tell whether it was controlled by a “novice” or “experienced” robot surgeon. Guru, who leads the robotic surgery group at Roswell Park Comprehensive Cancer Center, has even monitored the surgeons’ brain activity, assessing the focus and stress levels of novices and experts.
But how much data is too much? The American health care system is already subject to seemingly unending measurement. The National Quality Measures Clearinghouse, a database maintained by the U.S. Department of Health and Human Services, lists more than 2,500 metrics that can be used by insurers, government agencies, and other groups to assess the performance of health care providers. An American College of Physicians committee recently studied a subset of those measures and concluded that only 37 percent of them were valid and meaningful indicators of physician performance. Robot surgery data could end up adding more noise than clarity.
Image Credit: Intuitive Surgical