The surgical robot

Recently a French surgeon based in Shanghai performed prostate surgery on a Moroccan patient through a Chinesemade robotic system marking it as the worldrsquos longestdistance remote robotic surgery with the patient being 12000 km away from their doctorBesides the multiracial involvement in a patientrsquos care what are the first few thoughts that strike you when you read the headline For me it was the bravado of using a robot thatrsquos ldquoMade in Chinardquo This was immediately followed by a memory of our COVID days when healthcare workers were the only professionals who were expected to be on the field if COVID or one of its brethren struck again we will finally be able to work from home A third thought was that some desi surgeon sitting in New York must already be planning to break this record by operating on someone in Singapore 15000 km away from them And a final sobering fourth thought this needs a stable 5G connection linking the surgical console of one country to the robotic arm in another but in India wherever you go the network doesnrsquot always followInterestingly India pioneered telerobotic heart surgery in 2018 when a cardiologist based in Gujarat conducted a coronary intervention from a distance of 32 km using a robotic system They stuck to a shorter distance in case something went wrong one could quickly drive down and fix the problem The word robot comes from the Czech word ldquorobatardquo which means ldquolabourrdquo whether it makes the surgeonrsquos work more or less is still hard to determine But since its advent in the late 1980s itrsquos come a long way with enhanced visualisation superior dexterity and precision during minimally invasive procedures Interestingly the first robot platform used on a human patient was in 1985 to perform neurosurgical biopsiesI was recently at Spine Roboticon a conference in Bangalore dedicated to robotic spine surgery It was ironic that we had to travel from Mumbai to another city to watch surgery being performed elsewhere that was transmitted to us in the hotel where the meeting was being held What separates us also eventually binds us together because we had to come together as a group to discuss the future of this technology Ten surgeries were performed live on all parts of the human spine the robot hand being held by the surgeonrsquos A presurgical plan was made based on the patientrsquos CT scan a day prior and then on the day of the surgery by computing various algorithms the robot positioned itself at various points on the human spine to give us the perfect trajectory to pass screws Technically this avoids any inadvertent damage that the human can potentially cause using a ldquofree handrdquo techniqueHow did we operate before the robot was routinely adopted in surgery That is akin to asking how we drove before Google Maps came around or how we communicated before the cell phone arrived In my opinion it was beautiful and charming but one can wonder as to its efficacy In my opinion the cell phone has destroyed communication Will the advent of technology eventually diminish surgical skill A robot is not a replacement for a surgeon because as my teacher used to say a fool with a tool is still a fool Proponents of the robot believe that it can only make a good surgeon betterlsquoThe decision is more important than the incisionrsquo is the dictum for any operation But will a time come when AI integrated into the robot might overpower human decisionmaking in choosing whatrsquos best for the patient when several options are available AI in the form of doctors are already conducting outpatient clinics in some parts of the world dispensing medication and treatment advice for basic ailments It wonrsquot be long before it might be a rarity for a patient to interact with a human doctor AI can now demonstrate empathy compassion and patience too The dark side of this also needs to be pondered if AI doesnrsquot have a solution to your problems it might just convince you itrsquos better to dieToday we are at a point in our lives when everyone wants a robotic operation Patients are convinced that if your doctor is using a robot they will have a better outcome The doctor is convinced that if they tell a patient ldquoHum operation robot se kerengerdquo the patient will opt for the surgery For hospitals itrsquos an essential marketing tool Robotic knee and hip replacements are now as common as knickknacks available at a local store The common man which includes the common doctor has very little idea of what a robot does but the general perception is that it could enhance the potential of the surgeon and the potential outcome for the patient which in the larger scheme of things is true It is also true that itrsquoll become part of every relevant surgeonrsquos armamentarium very soonRobots in brain surgery enhance precision to target deepseated lesions improve accuracy in removing brain tumours and protect important functional areas of the brain Robotic exoskeletons for spinal cord injury rehabilitation have gotten paraplegic patients to walk We must embrace technology but we must also be free of itmdashbecause not all patients will have equal access to it Should funds be spent on robotic systems if they do not always provide clear benefits over traditional methods If a robot malfunctions and this has happened and patients have been harmed who is to blamemdash the surgeon the hospital or the manufacturerDependence on robotic systems may reduce surgeonsrsquo manual skills over time It may however enhance the possibility that paramedical staff might end up performing most of the procedure as everything is so automated We were under the impression that no matter how advanced technology gets one will still need a driver to drive a car or a pilot to fly a plane The first one has been satisfactorily debunked The second one will soon see fruition And the third will be when a patient checks into a hospital gets their surgery done and leaves without any human interaction But if I were a medical administrator I would rather employ a robot for the admission and discharge process because for most patients thatrsquos more painful than the actual operation The Indian robot will also be trained to deal with patients asking for a bed upgrade and after that a discount Obviously theyrsquoll be GujjuWhile there is so much controversy about this technology for me the most confusing thing about the robot still remains whether to pronounce the ldquotrdquo at the endThe writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals mazdaturelmiddaycom