The medical professionals are the real heros here. If the da Vinci system had just come out and this was some new capability I would understand. In this case the headline should say "surgical staff saves life of inoperable patient using standard surgical quality of care and using device that has been available on the.market for 15 years".
It's one thing to say "new Invention of the automobile saves life of first ambulance passenger" and another to say, today, the same thing.
The hero talk is really cringy. Other than that, it's not going to be long until we don't need anyone controlling it and for us to find it barbaric that we used to expose ourselves to factors like "trembling hands" or other such nonsense inside our guts.
I think someone going above and beyond to literally save another's life, despite incredible odds, is the definition of a hero. What's cringe about that?
There are two sides to this coin.
It's the classic do we want to keep a human in the loop, or not. By your same point we could argue that robots are more efficient killing machines, so let's make autonomous killing robots.
Back to surgery, there are lots of reasons you want a surgeon in the loop. There are lots if things that robots can do better too (like your tremor example). The key, like many things, is in the shade of grey in between, not the extreme arguments on both sides.
I stand by calling that surgical staff heros, and also think that the future of (good) surgery lies in the combination of skilled medical professional and machine, not the replacement of skilled professionals by machines.
They aren't heroes in my opinion. A doctor would have a hero moment if they were in the middle of their regular life and someone has a piano fall on their head and they perform some MacGyver-esque surgery and save their lives.
If you clock in at your schedule time, go through your motions, clock out, what you're doing isn't heroing, you're doing your job. This isn't any sort of attack whatsoever on the profession, I have lots of respect for them, but I know plenty of surgeons and they'd all cringe at this hero talk.
From what I've gathered, this was no ordinary day in the OR. Based on my experience with complex, unusual and otherwise difficult surgical procedures, your piano MacGyver situation isn't far off from what's going on in the OR in these kinds of cases.
This was no run of the mill lap choli or gall bladder removal.
I think it's actually what happens with biological weapons. It's not actually ethics that blocks it but rather its uncontrollability to be used effectively as a weapon (and not hit your side as well).
I agree. Ethics haven't stopped weapons manufacturers from making increasingly deadly weapons, so I doubt it'd stop when the tech for killer robots is possible.
I am not sure who "our" is - but not the US, nor Europe, nor Africa, nor Asia , nor Russia (broadly speaking about bigger wars countries were in).
It is always an afterthought and depending on who wins, the horrors of war that fall outside the "that's ok" category are either completely ignored, or someone is waving a finger, or there is a trial which finishes or not with actual punishments.
Exactly. If the US breaks the Geneva Convention, will any other country be able to do anything? In war, might makes right. This has always been true throughout human history.
"In war, might makes right". Let's hope humans (predominantly old, white, men in this case) will eventually move away from banal, devoid of humanity, hackneyed maxims.
I feel/believe differently. This can't go on. ie If indeed I am right and humanity is circling the drain but somehow do manage to reach the bottom in one piece, we ( humans ) will rise better.
Maybe "hero" is over the top, but "star of the show" would be appropriate.
And I'm sure we'll get to autonomous surgery at some stage, but we can't even get autonomous driving right, and I feel like surgery is even more precise and potentially dynamic.
> it's not going to be long until we don't need anyone controlling it and for us
We’re realistically (many) decades away from this in the earliest case. AI is cool, but literally giving one a scalpel and allowing it to excise a tumor is so far beyond both what our present technology and regulatory safeguards will realistically facilitate within most of the lifetime of anyone alive.
I do admire your optimism, but I can’t help but think it’s a little misplaced. We have collectively billions of miles driven for self-driving cars and they still can’t reliably distinguish a red light in suboptimal conditions. And somehow a machine is going to slice us open and perform a surgery than even our most skilled surgeons are not reliably performing (let alone generating training data for). Not to mention the human body is an insanely complex, variable, and messy environment where even little mistakes can be life ending.
I understand that exponential growth in AI is difficult to comprehend. But fully autonomous surgery is just likely not on the bingo sheet for this century. It’s several orders of magnitude more complex and high stakes than just about every other task AI can take on.
What an amazing world we live in. There is nothing interesting about a robotic assisted surgery able to perform more delicate and sophisticated operations than the best human surgeon in the world.
Da Vinci is telecontrolled. The robot does nothing but imitate the exact motion its commanded to by the surgeon.
The headline should read " Surgeon saves patients life using surgical tool that has been widely available an on the market for decades"
The medical professionals deserve the credit. If this was 20 years ago, yeah, we should celebrate the technical achievement and advancement, but there isn't one here. It's old news.
Yes, but let's also avoid oversimplifying how complicated that robot is, how much tuning the controls took and how much special training the surgeon needed.
Not a new concept by any means, but still worthy of continued praise and admiration.
Yes, the medical advancement is quite amazing. Couple years ago a friend went on a funding tour visiting startups and he mentioned he saw a demo of 3D oral scanning device to build a 3D model of the teeth. This year I saw the device in my dentist office and did an oral scan to build the 3D mold for bite guard. He said it's cheaper than the old method.
Da Vinci is famously not better. There isn't a single study showing its better. It's also not less expensive, and doesn't reduce staffing needs in the OR.
What is it? A marketing tool. Surgery centers and hospitals can drive increases in patients and patient throughput, improving their bottom line. It's marketing and throughout.
They have a classic razor razor blade model. The surgical instrument are proprietary and locked in with eeprom chips in the disposables. They only last a handful if cases and then must be replaces. Intuitive made something like 80 billion last year and has had no real competition in their market for decades. As a result they've been able to pretty much write their own checks, choosing how much stuff costs and achieving huge margins on lots of very expensive equipment and supplies.
Source- I've worked on and lead the design teams for surgical robots for several companies in the field.
"When it comes to prostatectomies, urologists have found the outcomes for da Vinci robotic surgery to be much better than for laparoscopic surgery and use this method in more than 90% of these procedures [...] Robotic surgery also appears to provide clinical benefits for some, but not all, types of head and neck surgery."
It also reports negative value overall for gynecological surgeries.
The evidence you provided suggests it's better for some things and not others, which seems like the expected case.
Actually, it is compelling. All things being equal you give an experienced surgeon an advanced tool and get 30% reduction in hospital stay along with less damage to your kidney function
From a patient point of view it is a big difference. Hospital stay is really expensive even if you have insurance. Hospitals charge like 10000$ per day and copayment foe hospital stay is usually hundreds of dollars.
Of course, it means that hospitals can process more patients and generate more profit, but it also reduces surgery wait times, which is critical for a patient with a tumor, because the longer your wait, the more likely for the tumor to spread
No, we don't assume that its is better because it is robot. We assume it is better because it was specifically designed to give to a surgeon a better instrument. It allows more range of instruments movement and degree of freedom and eliminates issues with surgeon hands trembling.
Yes, there is no statistically significant evidence yet that it is better, but there is no statistical evidence that it is worse. I don't think it is beneficial to stop using this technology based on cost effectiveness.
I happened to had a tumor on my kidney 6 month ago, so I actually had to make a decision between regular laparoscopy and Da Vinci.
Tge surgeon who did not have access to the robot system said that robot is just marketing BS and he would do a surgery just fine. However, because the tumor was on the back side of the kidney it would require rotating kidney out of the place and would be a bit challenging. But he was confident that it could be done
THe surgeon with robot said that tumor position is not a problem for a robot whatsoever. So I went with the robot.
So, back to OP, the robot is better because it allows to perform surgery in places where it is not possible to go with non robotic instruments.
I also have plenty of anecdata from people who had similar surgeries performed on them with different techiques. It terms of post op recovery da Vinci wins unanimously. I had surgery on Tuesday and was back to work next Monday
>No, we don't assume that its is better because it is robot. We assume it is better because it was specifically designed to give to a surgeon a better instrument.
All kinds of things have been designed to "specifically give to an X profession a better instrument".
That's just a mission statement at best, marketing promo at worst. Doesn't preclude them not meeting that target.
"it's better because it has been specifically designed to be better" is circular reasoning.
It does allow for improvements in surgical technique in some ways, it introduces severe limitations in other ways.
Many of the positives you highlight are true for any modern laporoscopic surgury, not just Da Vinci. In most indications, manual laparoscopy is by far the market volume leader for lots of reasons. Reasons like big surgical systems like Da Vinci are huge and require dedicated large ORs that are expensive. Meanwhile they still need to get surgury done in the smaller, more common, more cost effective ORs. Don't get me wrong, Da Vinci is a modern marvel, as I've said in other comments here it's truly a remarkable work of engineering. Its also a monopoly that makes a ton of money, and also far from how every surgery is done or should be done. Those two things don't go together, monopoly and shouldn't be the whole market. That's all I'm saying. It's not the panacea it's made out to be often.
I have some robot experience, so I assume any robot is hot garbage until proved otherwise. In the links you've provided, the robot seems to do better than baseline in prostate surgeries, and is now the standard approach.
>Actually, it is compelling. All things being equal you give an experienced surgeon an advanced tool and get 30% reduction in hospital stay along with less damage to your kidney function
First you have to trust the surgeon not to be shilling in his report.
It's totally amazing. It's like a space shuttle. It's the culmination of decades if investment and decades of some of the smartest people in robotics working tirelessly. It's a modern marvel.
Others have been trying for years. The latest big player is J&J who faces an existential threat due to robotic surgery overtaking conventional surgery, and therefore one of J&J/Ethicons core business. They bought Verb and Auris and a few other smaller companies in the space and smashed them together. There are others in the space trying to do the same.
Ultimately Intuitive has a pretty big moat. They have a lot on the technical/IP side, but also just business wise. These hospitals and surgery centers pay millions for a robot, then need to keep it busy doing cases for several years to pay it off. There is a lot of risk and not really any clear advantages to changing to a new challenger. That new challenger would need to demonstrate some key advantage, which they have yet to do.
It's hard, its akin to trying to compete with space x or similar, starting now.
Do you hate yourself for living under a roof when so many can’t? For eating dinner when so many are starving? For drinking clean water when so much pollution exists?
Good stuff happening shouldn’t make you miserable.
>Do you hate yourself for living under a roof when so many can’t? For eating dinner when so many are starving? For drinking clean water when so much pollution exists?
I've seen authors describe their ideological opponents as being self-hating, but till now have never seen anyone own it.
There are many things in a person's emotional life that a person does not have any control over (at least not in the short term and without spending lots of time and money on, e.g., psychotherapy). I think it is commendable that you understand your own emotions well enough to perceive this self-hatred, and I do not think any less of you because of it.
If there are many people who share your emotional reaction to inequality, that would have explain a lot of things that so far have been puzzling to me.
What is your opinion of those who have things that others lack, but do not hate themselves for it? Is there something wrong with such non-self-hating lucky one in your eyes?
This robot didn’t pull money that would otherwise be used for giving people healthcare. You’re complaining about unrelated things, the problem is around bought and sold politicians allowing for regulatory capture in healthcare, not around great science and engineering building an impressive product. This what-aboutism is just pathetic.
As I understand the daVinci device is not really a robot in the sense that it works autonomously. It’s a precision waldo setup with a surgeon in control.
With enough training data it should be possible to make fully automated AI surgeon bots that outperform human operators. Who wants to sign up for the private beta?
“Surgeon removes tumor using current best practices” doesn’t sound so exciting, but is actually more amazing. These devices have made some hard surgeries much more doable.
In this case, it's about a "inoperable tumor" so I'm guessing a human hand wouldn't be able to do it at all. That's what makes this particular case more amazing.
Well only if you don't consider the surgeon who operated the davinci robot.
Not to diminish this case at all but people kinda misinterpret how surgical robots operate. They are less like CNC robots where you program in a control path before hand and the robot follows it. Rather they are like a set of "prosthetic" tools that allow you to stabilize your movements and shrink them down to extremely small motions beyond the precision human hands are capable of.
It still takes an extremely skilled human surgeon at the controls at all points of the surgery to make this possible, these are just tools that give those surgeons more fidelity and stability in their motions.
No less amazing in the slightest but make no mistake that this surgery was performed by a human, just with a far more advanced kit of scalpels and forceps.
> Well only if you don't consider the surgeon who operated the davinci robot.
No, even if you consider the surgeon. The article talks about that the robot is able to do maneuvers that a human hand cannot, drastically simplifying the surgery.
I'm well aware that the robot is controlled by a human, and I don't think anything in my comment indicates I wasn't.
I think there are also cnc type robots in surgery but doing more limited tasks - you see them in some orthopedic surgeries where they cut precision sockets to join prosthetic parts.
In a similar way that a scalpel helps execute a surgery that's inoperable without a scalpel. There's a lot of difference between a scalpel and a 'robot' but its a tool nonetheless.
TL;DR: old human hand based surgery breaks the jaw to get to the area of the throat where the cancer was. Causes lots of complications after; or is simply deemed too hard.
The robot is more dextrous and thinner and can do the surgery without breaking the jawbones.
A columnist got surgery done for case with some complications. Next some other publication wrote article to generate articles. Essentially showing where we are. Mildly interesting things get circulated.
Disclaimer: I played with a Da Vinci prototype sewing grapes but I'm definitely no surgeon. My hands shake more than someone with Parkinson's. I cannot fathom subsequent generations of refinements in steadier hands with surgical experience. Clarke's third law applies here. Although, I wonder before how long AI and mechatronics will receive credit for simple veterinary surgeries as a testbed on the path to a truly miraculous, sci-fi "surgical chamber".
Anyone know more about robot assist systems in general? Are there similar systems for performing delicate assembly operations on a production line? (Non medical)
The die binders that I used to use had physical motion reduction systems - are there more general versions of these available?
You don't probably want delicate assembly operations on production lines. You do everything possible in designing what ever you are building to not do them.
On other hand, multi-axial CNC machines and various welding robots are quite amazing.
I have been hearing about Da Vinci for years and Wikipedia says it was being for 200,000 surgeries back in 2012. [0] The manufacturer claims there are about 7000 of the units.
Is this remarkable? I would imagine that it saves thousands of lives a year.
One time in med school we had a lecture by the da Vinci surgeon guy, and of course I had to stick my hand up. “Will there ever come a time when the human hand cannot keep up with the instrument?” The whole room (200 people) laughed out loud, and the surgeon said, “No.”
I just had a thought. A thin robotic worm. Can squeeze through and around important organs/vassels. When its head reaches the tumor it gently chews and siphons the tumor. I’m imagining tiny mechanical jaws just for cool effect
The medical professionals are the real heros here. If the da Vinci system had just come out and this was some new capability I would understand. In this case the headline should say "surgical staff saves life of inoperable patient using standard surgical quality of care and using device that has been available on the.market for 15 years".
It's one thing to say "new Invention of the automobile saves life of first ambulance passenger" and another to say, today, the same thing.