Surgical Robots: Current Uses and Future Expectations

A staple of science fiction, robots have stirred human creativity since ancient times; and well before the term itself was coined by the ?apek brothers in 1921. Homer’s Iliad features automatons while more recent works like The Terminator merge robots and artificial intelligence (AI) to depict doomsday scenarios. Far from the latter apocalyptic scenario, robots have made it past the sci-fi realm and into our everyday lives. We have grown used to the sight of robot vacuum cleaners in our homes as we have shelf-stacking robots in warehouses.

The resilience of robots and their imperviousness to human traits such as fatigue have also made them apt assistants in healthcare. They have made strides in the field of surgery for their precision and speed. This article will cover the surgical robot landscape and contemplate what we can expect from these mechanical assistants in the future.

What are surgical robots?

As the term implies, a surgical robot is an assistive tool for performing surgical procedures. Such manoeuvres, also called robotic surgeries or robot-assisted surgery, usually involve a human surgeon controlling mechanical arms from a control centre.?

While robots in the OT might sound futuristic, they have assisted surgeons for decades already. As far back as 1985, surgical robots would assist in performing brain biopsies. Over the years, the surgical robots market is a booming one and is expected to reach $14.8 billion by 2027.?

A popular surgical robot is the da Vinci surgical system from Intuitive Surgical. First launched in 2000, the system involves an array of agile and dexterous mechanical arms that can bend and rotate to a far greater extent than the human hand. Human surgeons are always guiding these arms at a surgeon console to carry out more precise operations.?

Since the da Vinci system was first introduced, Intuitive Surgical has developed newer models and now has fifth-generation da Vinci systems. Over the two decades, more than 8,600 da Vinci systems have been adopted across 71 countries. This evolution shows a growing adoption of the surgical robots as well as a need for such assistants in conducting surgical procedures.

The need for and current use of surgical robotic assistants?

One might question the need for surgical robots in procedures that require human dexterity and agility. In fact, those skills are enhanced by the mechanical assistants. Surgical robots have highly flexible arms that enable surgeons to perform complex and delicate procedures that would otherwise be challenging or even impossible. For example, the Flex robotic system provides ENT surgeons with sub-millimeter accuracy across non-linear winding paths through a single-site access into the body.

Indeed, robotic surgeries are key in performing minimally invasive surgery, where the surgery is done via small skin incisions. Through such an approach, patients have less complications, heal faster and have shorter hospital stays. The da Vinci system allows for heart bypass surgery through a couple of one centimetre chest incisions instead of one-foot long opening required for traditional means. Over 14 million surgical procedures have made use of the system worldwide.

Beyond incisions, surgical robots also assist in other procedures. The Versius Surgical Robotic System can perform laparoscopies ranging from thoracic to urological procedures. The MONARCH platform has been used to complete over 20,000 lung biopsies.?

Surgical robots also assist in radiosurgeries. These involve very focused radiation beams for the treatment of cancer tissues. Accuray’s CyberKnife provides robotic radiation treatment anywhere in the body with sub-millimeter accuracy. The company notes that over 350 systems have been installed globally to treat more than 40,000 patients.

AI and the automation of surgical robots

Using the assistance of robots to perform surgeries already sounds futuristic but there is a future beyond their current use. In particular, researchers foresee the combination of AI technologies with surgical robots. Deep learning models could aid surgical robots in learning from experience, akin to a trainee surgeon. They could create and suture surgical incisions; a task that AI-controlled robotic systems have undertaken with precision in previous studies.

As AI-powered surgical robots progress through levels of automation, they will become more and more independent. Below we provide a brief description of each of the 5 levels of automation and how they relate to surgical robots. For a more in-depth explanation of these levels, we have dedicated a separate article.

Automation level 1: human only

The initial level involves no AI software. This is the level at which most, if not all, surgical robots are at in practice. They are under human control and essentially act as extensions of the surgeons’ arms.

Automation level 2: shadow mode

A surgical robot with level 2 automation will be equipped with AI software in “shadow mode”. It will still be under the surgeon’s control but it will learn from the latter so that it can progress through the automation spectrum.

Automation level 3: AI assistance

With enough training, a level 3 surgical robot can provide autonomous assistance to surgeons. It can suggest adequate procedures and techniques which can then be signed off by human surgeons.

Automation level 4: partial automation

As the AI software underpinning surgical robots gain more experience and become more confident, a level 4 surgical robot could independently assist surgeons, whether it is through devising surgical techniques or conducting procedures. If it is not confident enough, it will turn to human surgeons for assistance.

Automation level 5: full automation

At the 5th automation level, a surgical robot would be able to perform surgeries on its own. It will not require human supervision or input for its own decisions.?

Steps to combine AI and robots for surgical ends are still in their infancy; but over time we can expect such a merger to materialise. Before AI-powered surgical robots make their way to the OT, their safety will need to be ensured and they will need to be supervised by expert surgeons.?

The future of robots in the realm of surgeries?

Through technological progress, we can expect more from surgical robots in the future. For example, at higher levels of automation, surgical robots would be able to make telesurgery more accessible. This would enable surgical procedures to be conducted in remote or under-resourced areas in order to improve health outcomes.

We can also expect surgical robots to become smaller. This would make them even less invasive than they currently are. Micro-robots, for example, could even perform targeted surgeries through GI insertion with no external incisions.

Above all, it’s a surgeon-AI-robot collaboration that we should expect rather than fully mechanised procedures. You can think about it as a souped-up version of the current existing assistance of robots that already help perform tens of thousands of surgeries every year. With more automation in the mix, the healthcare landscape stands to benefit from the potential of more precise and more accessible surgeries.