Wel­come to the cut­ting-edge world of AI-led ro­bot sur­geons

The Daily Telegraph - Business - - Business - By Hasan Chowd­hury

In 2016, a study pub­lished in Sci­ence Trans­la­tional Medicine, a

peer-re­viewed jour­nal, con­tained a rad­i­cal pro­posal for surgery that in­volved su­tures, a ro­bot and pig bow­els.

The re­searchers be­hind the study de­tailed how the ro­bot, a semi­au­tonomous ma­chine named Star, was able to stitch to­gether parts of the pig’s in­testines with lit­tle su­per­vi­sion.

“The op­er­at­ing room may some­day be run by ro­bots, with sur­geons over­see­ing their moves,” the pa­per’s ab­stract noted, hint­ing the way for­ward for surgery in the fu­ture could de­pend on “re­mov­ing the sur­geon’s hands”.

The crit­i­cal el­e­ment of these ro­bots for the re­searchers was that it had a de­gree of au­ton­omy – able to serve as a valu­able team mem­ber by us­ing ma­chine learn­ing and ar­ti­fi­cial in­tel­li­gence to learn how to per­form su­tur­ing tasks based on in­for­ma­tion it pro­cessed through an al­go­rithm.

Four years on, and ro­botic surgery has come into greater fo­cus as the pan­demic has in­tro­duced wide-scale dis­rup­tions. A study led by re­searchers at the Univer­sity of Birm­ing­ham in May found 28.4m surg­eries could be can­celled or post­poned in 2020 glob­ally as Covid-19 hit staff avail­abil­ity and re­sources.

There is lit­tle doubt that, in the­ory, a ro­bot is bet­ter suited to the most del­i­cate sur­gi­cal pro­ce­dures. A ro­bot can enter body parts that hu­man fin­gers can­not touch, and more del­i­cately cut and snip with­out the risk of hand tremors.

Ear­lier this year, CMR Sur­gi­cal, a Cam­bridge ro­bot­ics start-up, de­buted its Ver­sius ro­bot on the NHS. This ro­bot can per­form in­tri­cate key­hole surg­eries. This ro­bot mim­ics a hu­man’s hand and wrist move­ments, but is still con­trolled re­motely by a sur­geon from a com­puter or us­ing a con­trol stick.

Today, a fully in­tel­li­gent, ro­botic sur­geon re­mains a piece of blue-sky think­ing. But it is clear ro­bot­ics and au­to­ma­tion are be­ing used for tasks that once re­quired the steady hand of a sur­geon with years of train­ing. Prokar Das­gupta, a con­sul­tant uro­log­i­cal sur­geon at Guy’s and St Thomas’ NHS Foun­da­tion Trust in Lon­don, thinks AI ro­bots will have a greater place in the op­er­at­ing the­atre, though sees them first be­ing eased into a role in repet­i­tive tasks like stitch­ing.

“Stitch­ing one part to an­other has the po­ten­tial to be au­to­mated,” he says. “Ac­tu­ally the ro­bot in those sit­u­a­tions might per­form bet­ter than a hu­man. It’s more repet­i­tive, more pre­cise and doesn’t get tired, un­like a hu­man.”

But could AI ro­bots un­der­take more com­plex pro­ce­dures on their own? Das­gupta does not think this could hap­pen just yet, but he is un­will­ing to rule out the pos­si­bil­ity of ro­bots work­ing in tan­dem with sur­geons in a more in­volved way de­pend­ing on cer­tain advances.

For one, cur­rent ma­chine learn­ing al­go­rithms, which usu­ally learn and develop by ob­serv­ing pat­terns in data – in this case, the se­quence of de­ci­sion mak­ing in key stages of surgery – will need to make mon­u­men­tal advances to achieve more com­plex tasks.

To il­lus­trate, Das­gupta ex­plains the dif­fer­ence between two tasks un­der­taken in prostate can­cer surgery, in which de­ci­sion mak­ing is “in­di­vid­ual to ev­ery pa­tient”.

In ad­di­tion to stitch­ing done around the blad­der, a rel­a­tively sim­ple task, a sur­geon will also re­move the prostate gland while work­ing to pro­tect bun­dles of nerves that run all the way up to the brain. One slip has the po­ten­tial to be fa­tal. In terms of com­plex­ity, the tasks are worlds apart.

“Cur­rent ma­chine learn­ing and AI sys­tems have a long way to go be­fore they can be trained to make that hu­man judg­ment of where to cut and where not to cut,” he says. “Can they be taught to do that? Yes, but that’s not ready for prime time yet.” To date, ro­bots used in the NHS have been con­trolled by sur­geons sit­ting at a com­puter con­sole who use tog­gles and but­tons to con­trol the move­ments of a ro­bot, usu­ally equipped with arms, in a pre­cise way to per­form la­paroscopy, or what’s known as min­i­mal in­va­sive surgery.

The use of these par­tic­u­lar ro­bots is about pre­ci­sion, al­low­ing move­ments to be made within a de­gree of mil­lime­tres rather than cen­time­tres, while re­duc­ing issues that even the best of sur­geons risk fac­ing such as hand tremors.

Sur­gi­cal ro­bots have been in clin­i­cal op­er­a­tion in the UK since 2001, with a ro­bot known as Da Vinci be­ing used by doc­tors in more than 70 hos­pi­tals. The ro­bot is now so pre­cise it can su­ture a wound cut into the skin of a grape.

But crit­i­cally, the ro­bots lack ma­chine learn­ing. They are in­stead so­phis­ti­cated tools used by sur­geons.

A num­ber of other firms are try­ing to mus­cle in on the mar­ket. Google and Johnson & Johnson are work­ing to­gether on a joint ven­ture, Verb, to develop a “next gen­er­a­tion” sur­gi­cal ro­bot. While Dig­i­tal Surgery, a Bri­tish start-up, had been ex­plor­ing the use of AI in sur­gi­cal train­ing apps.

Mark Slack, a con­sul­tant gy­nae­col­o­gist and chief med­i­cal of­fi­cer at CMR Sur­gi­cal, sees it as highly un­likely that an AI ro­bot could emerge that leads pro­ce­dures.

“It would have to in­ter­pret thou­sands of minute anatom­i­cal dif­fer­ences, the only way you can do that is data in­puts. Some­body would have to sit and put in videos of thou­sands and thou­sands of la­paro­scopies,” he says. “I can’t even see it in a thou­sand years.”

Even if au­ton­o­mous ro­bots were to emerge that could op­er­ate alone or along­side a doc­tor on an equal foot­ing, there are eth­i­cal ques­tions to be had as to whether or not they should be al­lowed to con­duct surg­eries, or if pa­tients will even want them to.

“To tell a pa­tient that I will press a but­ton and ev­ery­thing will be done by a ro­bot, while I have cof­fee, may not be ac­cept­able to many,” Das­gupta says. Sur­geons have a “gut feel­ing” that guides them in high-pres­sure sit­u­a­tions. But that will not stop peo­ple ex­plor­ing ap­pli­ca­tions for AI ro­bots.

In 2018, the Commission on the Fu­ture of Surgery de­liv­ered by the Royal Col­lege of Sur­geons, showed tech­nol­ogy would not be shunned if it meant bet­ter ser­vice for pa­tients, high­light­ing AI as one of four key ar­eas

‘To tell a pa­tient that I will press a but­ton and ev­ery­thing will be done by a ro­bot, while I have cof­fee, may not be ac­cept­able to many’

that could trans­form the field in the next two decades.

“In this fu­ture pre­con­cep­tions must be left out­side the op­er­at­ing the­atre; what mat­ters is who has the right skills to treat a pa­tient, not whose ‘right’ it is to pro­vide that treat­ment,” Prof Stephen Powis, med­i­cal di­rec­tor of NHS Eng­land, said in the re­port.

Ac­cord­ing to Richard Kerr, a neu­ro­sur­geon and chair­man of the Commission on the Fu­ture of Surgery, treat­ments in the fu­ture are go­ing to be “team-based in their de­liv­ery”, in which dif­fer­ent in­di­vid­u­als play a role in the suc­cess of an op­er­a­tion. How ar­ti­fi­cial in­tel­li­gence fac­tors into this team ap­proach to surgery, though, is un­cer­tain.

“What I don’t see, at least right now, is that leap where you in­tro­duce the ro­bot as one of the com­pe­ten­cies in your team to de­liver in isolation as­pects of care,” he says.

De­spite all the advances in tech­nol­ogy, Kerr notes, the cru­cial thing is the re­la­tion­ship between a sur­geon and a pa­tient. “That re­la­tion­ship is ab­so­lutely fun­da­men­tal,” he says. While ro­bots may be in­creas­ingly com­mon tools in a sur­geon’s box, they won’t be hand­ing them the knife just yet.

Newspapers in English

Newspapers from UK

© PressReader. All rights reserved.