Robots don’t challenge surgeons such as me – they challenge dogmatic practice

https://www.theguardian.com/commentisfree/2017/mar/09/robots-surgeons-patient-care-science-museum

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On Friday 10 March, I will perform an operation in public for the first time. In a live demonstration, I will aim to show how robots can assist surgeons to cut more safely, with greater precision, and achieve better results for patients.

I should say at the outset that no patient’s life will be put at risk during this event. I will be operating on a surgical mannequin – a specially adapted version of the shop mannequin designed to respond like a human body – and the event will take place at the Science Museum in London.

I will be using the same surgical robot that I used in 2001 when I performed the first such operation on a patient in the UK. It has three arms controlled from a console a few feet away, where I sit, allowing me to cut and stitch with great precision. Almost 16 years on, this will be a nostalgic moment for me. From cutting-edge technology to museum piece in less than two decades.

I am taking part in this demonstration, together with Professor Roger Kneebone, head of the Centre for Engagement at Imperial College, because I know that technological innovation of the kind represented by the robot has transformed surgery. But it will only continue to do so in the future if we have the vision and the courage to support it.

Critics will say that past technological advances have not delivered on their early promise. Certainly there have been challenges. Last year a research paper published in the Lancet comparing robotic with non-robotic surgery for prostate cancer found both achieved similar outcomes after three months.

The Times reported the story under the headline “Robots no better than human surgeons”. The Daily Mail, however, went with “Robots are better than humans at cancer ops”, on the grounds that the patients who had the robot surgery suffered less pain immediately after the operation. Is the glass half-full? Or half-empty?

I am firmly in the former camp. As I wrote in the Lancet at the time, the fact that the robot-assisted surgery achieved an equivalent outcome should be seen as a positive result. It shows that the innovation has preserved the intended purpose of the surgery. Advances in technology such as this provide the platform on which additional innovations can be developed, to further improve the quality and safety of surgery.

The device, called the iknife, can detect almost instantly whether tissue is cancerous or not

Consider where we have come from: in little more than 100 years since the two-part silver scalpel, with handle and replaceable blade, was invented by Morgan Parker in 1915, it has increasingly been replaced by the electrosurgical knife – a probe carrying an electric current that burns through tissue, sealing the tiny capillaries as it cuts, reducing blood loss, improving the surgeon’s field of view and the speed of the surgery.

Now a third advance is imminent, with the invention of an electronic “nose” attached to the electrosurgical knife. This absorbs the smoke given off as the blade burns through tissue and analyses it in a mass spectrometer. The device, called the intelligent knife or iknife, can detect almost instantly what kind of tissue the surgeon is cutting through – whether, for instance, it is cancerous or not. Instead of sending tissue samples to the laboratory and waiting days or weeks for them to be tested, the surgeon will in future be able to tell whether all the cancer has been removed before the operation is complete.

Membership Event: Robot Surgery Live

Advances such as this are ushering in a new era of precision surgery, in which established clinical and pathological signs are linked with state-of-the-art molecular profiling, enabling us for the first time to tailor specific interventions to the individual biology of the patient.

I was delighted with the interest and enthusiasm shown by the Science Museum in displaying the first surgical robot ever used in Britain as part of their robotics exhibition. It will remain with the museum as a donation from the department of surgery at Imperial College London.

But if we are to continue moving forward, we need disruptive innovators who are ready to challenge dogmatic practice and an environment in which they are free to experiment. What today looks revolutionary is tomorrow’s museum exhibit.