Black Pean - Darwin information #7

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The future of robot surgery, the future of heart surgery

In this final post, Dr Watanabe will discuss the future of robot-assisted surgery and of heart surgery.

What will the future of robot-assisted surgery be like?

In future, I think robotic surgery assistants will become a completely normal, regular surgical tool.

However, we are now in a “surgical transition period” where robot-assisted surgery has only just begun, and there are clear reasons for emphasising the importance of training and discipline, saying “if an unskilled surgeon uses this, it’s nothing more than a tool for killing people”.

For now, robots are machines controlled by humans. People do things like looking at a 3D image and using an endoscope to work by moving their hands.

For example, each patient has differences in their tissues or on the surface, and people identify those by eye and make a judgement, making adjustments using the machine to work. Strictly speaking, this isn’t robotic surgery. Current robotic surgery is more like “remote endoscopic surgery”. That of course means that the surgeon’s skill is the most important thing. This is the current state of robot-assisted surgery.

However, normal people might have a different image of what a “robot” is.

I think a lot of people imaging a machine that can make accurate decisions and work flawlessly. I believe that is the future of robot surgery.

From now on, it will steadily keep changing and incorporating big data and computing power. By doing so, it will be able to instantaneously “identify” individual differences, start to be “aware” of tissues and blood vessels and decide what to do next. It will even be able to read individual patient data.

At the moment it can’t read data in that way, and it doesn’t archive data on how I operate based on my own vision and judgement. In future, I think it will be able to correctly read and archive or store individual data like that.

For example, if A’s body is like this but B’s body is like that, all of the differences will be codified and become data to consult when making decisions or giving treatment on that basis. I think that will lead to a progression from semi-automatic to completely automatic operation.

Will human skill become unnecessary?

Of course, that won’t happen right away. Firstly, it is not yet completely automatic, so plenty of expert techniques need to be accumulated.

For example, when connecting two blood vessels, all the data on where to hold them and how to place the thread, suture and treat them will be archived and used for deep learning. I’m sure that in future this will allow machines to automatically use appropriate methods faster than I am able to.

However, at this point in time 3D medical image data cannot be processed in that way, although I hear cars can already use 3D data like that. By attaching lots of cameras, the bumps and slopes of the road can be accurately confirmed, deciding how to move in order to turn right, applying the appropriate speed and torque. Since we’re already in an age where  cars can do this, I’m sure the time is coming when we will be able to deal with individual differences in human bodies.

What will heart surgery be like in future?

I’m thinking about what the future will be like in 50 years. I even think that surgery might not exist by then. You often see this in CG on television, but we can insert cameras into blood vessels and reach the organs around them, right? We can really do that, and if we could really reach the affected part and treat it by that method, there would be no more need for incisions.

Of course, improvements in and inventions of medical devices and collecting future data to support them will be essential for that, but I think it’s clear we’re heading in that direction. It really feels that way to me. For example, to start with the only surgical treatment available for arrythmias like ventricular tachycardia or atrial fibrillation was the Maze treatment, but that has already been replaced by catheter treatment. Surgical treatment has dramatically reduced and is not only around 1%. For bypass surgery, if we could overcome the cost issues I think about 80% of cases would use catheters.

Catheters have developed to be able to pass through any blood vessel, no matter how narrow, and the time is coming when aortic valve replacement will be carried out not by surgery, but using a device like the SNIPE that appeared in this drama. We could also consider different approaches including genetic treatment. I don’t think this will take 50 years, because people’s awareness is changing dramatically.

So in 50 years, things will be completely different. Children who are born now may aim to become heart surgeons, but heart surgery may have become something completely different. Medicine really is a living field.

Could dramatic surgery scenes like the ones in this drama disappear too?

For medical dramas set in advanced nations, that could be the case. The state of medicine in a country depends on its wealth. Even though medicine is steadily developing in rich countries, the truth is it’s difficult for poor countries to access cutting-edge devices and tools, so they will still perform surgery with large incisions, after all. That big difference already exists now, doesn’t it?

Also, in this age we don’t just think about things after the patient becomes ill, but we are also focusing heavily on prevention. While some people work hard to increase knowledge and prevent disease, the risk of getting ill due to lack of knowledge also increases. I think that difference will become clearer in this era, so maybe the idea of “medical dramas = surgery scenes” will also change.