Surgical Robotics: How to build a robot
Imagine a world where it's not the steady hand of a highly trained professional performing your life saving operation, but a machine. How would you feel about that? A step too far or the reassuring sound of progress in precision medicine? Well, the field of surgical robotics is very real and is either already in or is coming to a hospital near you. It's an industry fielding serious investment.
Speaker 1:Digitizing a previously analog profession opens up a whole range of unprecedented opportunity. But it's also an industry which brings new types of engineering and design problems to solve and is consistently fraught with questions. What is a surgical robot? Will they replace humans or empower them? Do we really even need them or do we just need more surgeons?
Speaker 1:Are they too expensive to be even viable? To find out, join me, Matt Millington, as we plug in to InventHealth, a podcast brought to you by technology and product development company TTP. Today we ask, are robots the surgeons of the future? Hello, and welcome to InventHealth, a podcast about the future of health and technology. Today, we're diving into the fascinating field of surgical robotics.
Speaker 1:It's an industry as high-tech and cutting edge as the name suggests. But what are we really talking about here? Are they fully autonomous droids performing complex operations ultimately destined to replace the human surgeon? Or is it more of a slave and master relationship that extends the reach of surgeons beyond their physical limitations and extends their reach of care and scope for greater impact? Given the steady hand, years of training and ice cool nerves and adaptability of a human surgeon, do we really need surgical robotics?
Speaker 1:Is it a case of technology push regardless of the real need, or will they open up an exciting new future of decentralized precision surgery? And if so, why aren't they everywhere yet? With so many investors considering it the future of surgery, why aren't we all going under the robot's knife? I wanted to get to the bottom of what might be holding back this new frontier of health tech. What does it take to build one of these robots?
Speaker 1:How much do they cost? What do patients and surgeons actually think of them? Luckily, I had on hand two people whose work in this field is truly world class. we'll hear from Paul Galluzzo. Paul is a mechanical engineer who's worked at TTP for the past eighteen years.
Speaker 1:Over that time, he's worked on everything from gardening tools to DNA sequencing to inkjet printing, and now specializes in technology enablers in med tech, including surgical robotics. And next, we hear from Dwight Meglin. Dwight has worked on complex medical systems for more than twenty five years, including eight commercial surgical robots, multiple unique medical devices, as well as numerous surgical simulators. To start things off, I wanted to break down what a surgical robot actually is to see if it was indeed the autonomous instrument wielding machine of my imagination. I thought just as a kind of bit of a warm up, I would ask both of you, and Paul, if you start, what is your favorite robot?
Speaker 2:Oh, my favorite robot. It's the one I built to play the cello when I was my PhD student. I named it after a violinist called Stefan Grapelli. Wow. And I named it the Grapelliator.
Speaker 2:Plays the cello very precisely, very accurately.
Speaker 1:That wasn't the response I was hoping for. I was expecting c three p o or something. Anyway, interesting nonetheless. Dwight, what about you? What's your what's your favorite robot?
Speaker 3:I I I have to say I've worked on so many surgical and medical robots. That's kind of everything that's in my head. But we we worked on a a GI robot, gastrointestinal robot. It basically strapped on the side of a colonoscope, and you had two fully dextrous hands. So you had seven degrees of freedom on each hand, and they were four and a half millimeters in diameter.
Speaker 3:And we did it in, like, twelve months, and it was really cool. And it was way too far ahead of its time and totally went away.
Speaker 1:Between you, can you can you tell me what what is a real life robot, particularly within the context of a surgical robot? What's a real thing?
Speaker 2:So there is a spectrum, and that spans from a little bit of autonomy, like you said, but it's dominated by fly by wire and electromechanical interface, typically where the user interface would be too complex to control if you didn't have a whole bunch of degrees of freedom passing through some kind of joysticky type control. Dwight just now in his introduction talked about a seven degree of freedom per hand notes robot. If you think about seven degrees of freedom, each of those, it's not a manual control. And then you start to you start to necessitate an electromechanical interface, which basically means you're taking all these different degrees of freedom, which means all the actuation points, all the, force vectors and the the displacements and things, and you put them through motors and into a PlayStation type controller, just for example.
Speaker 3:Yeah. I I think the thing I'd say, Matt, is that basically, it's a it okay. of we're gonna call them electromechanical devices. Okay? So they've got motors and sensors and structure and computers and other things behind them.
Speaker 3:But they basically provide some kind of enhancement or augmentation of what a human would do during a procedure. But like the orthopedic example that Paul just brought up, know, it it it's basically a fancy guide for instance, if you're for doing implants or whatever. And it's, you know, the human could do it, but it increases the reliability of the human's performance, you know, in terms of getting the guide right each time and things like that. And in some cases, they provide augmentation like a lot of the teleoperated robots. So, you know, there's robots that basically do something effectively offline like the the cutting guide example.
Speaker 3:It's all like preprogrammed and done with, you know, various kinds of alignments and things and it just gets it in place and then the human does whatever with that holding their cutting tools or drills or whatever it might be. And then there's tele operators which are live. So somebody's controlling it in real time and it's transferring what the human's doing to whatever the end effectors of the robot are doing. And those can genuinely have enhancements or augmentations. At the least, the traditional everybody thinks of like the the intuitive surgical da Vinci, which of course was the robot on market for surgery.
Speaker 3:Well, it's not it's not the robot on the market actually, but it's the one everybody heard of and the most well known. But that's a teleop robot. What the enhancement in the case of the da Vinci is that it shrinks the size of your hands, if you will.
Speaker 1:Let's talk about so what are robots most commonly used for in clinical practice? What are what are good use cases for for robots?
Speaker 3:Hauling stuff around the hospital number one use. They've been around forever. There's little tug there's little tug robots that hospitals use to drag things around hospital instead of having humans do it. You see them
Speaker 2:all I hate to be boring, but in revenue terms, laparoscopy is about 5, say about $5,000,000,000 a year right now. And hard tissue robots, which is the spine, you know, the the bone related bony thing, bony type surgery robots, is about a of that right now.
Speaker 1:Robots in health care come in all shapes and sizes, but they're nothing like c three p o. Indeed, like the term AI, the term robot endows them with a certain kudos and implied capability, which doesn't necessarily reflect the reality. Whether it's those tug robots lugging your stuff around the hospital or a laparoscopy robot like the DaVinci, which began the surgical robotics industry boom in the 20 century, robots used in health care are designed with specific and often narrow purposes. They're more like smart tools than what we think of when we hear the word robot. But that's not to detract from what they can do or more accurately, what people can do with them.
Speaker 1:When the da Vinci came out, it was when health care really started to take notice of what robotics could do. It created a groundswell of interest from engineers, health practitioners and surgeons who saw the potential for precise surgery free from the constraints of human error. One such surgeon who became interested at this time was Mark Slack.
Speaker 4:I've been aware of surgical robotics since they hit the market in 02/2001, because I was a practicing minimal access surgeon. Certainly, yeah, I saw them when they came out.
Speaker 1:Mark is one of the founders of CMR Surgical, a surgical robotics company based here in Cambridge. With their robotic surgery system Versus, CMR are pioneering work into minimal access making it their goal to ensure the benefits of their technology is accessible to anyone who really needs it. I wanted to get a perspective on surgical robotics from the other side of the coin, from a surgeon, the people who will ultimately be controlling these robots in theater. I asked Mark about how he got into surgical robotics and how he's seen the industry change and adapt over time. So they are they are relatively new then.
Speaker 1:This is not one of those high technologies that suddenly you find out has actually been written about in the eighteen hundreds.
Speaker 4:Nope, certainly hasn't been thought about in the past, but it got its FDA approval in 02/2001. So it's about twenty years old.
Speaker 1:And when did you get to use one?
Speaker 4:So I only ever, saw demo models of them in the beginning and I wasn't massively impressed. They were pretty clunky, they were big and they didn't appear to give any real advantages to me over what I could do with conventional, stress stick surgery. So I tended to ignore them a little bit.
Speaker 1:And were they something that piqued your interest mainly because of your specific focus on minimal access surgery?
Speaker 4:Yes, I mean there are two things. I'm quite interested in technology generally. But at the time, naively in the beginning, I couldn't see that they were necessarily going to compete with minimal access surgeons. And so I've actually got to take my hat off to the early pioneers who despite the naivety of the products at the time could see beyond it into the future. So yeah, huge respect to the Fred Moulds of the world who got this going and had both guts and temerity to see it through to the more sophisticated products that are now available.
Speaker 1:Sure. I would have assumed that somebody who is physically skilled in minimal access surgery does it by hand, that something that is trying to replace, well, depending on which way you look at it or augment it, wouldn't be something that you would embrace. I find it quite interesting that you saw the opportunity. Do you think that's because, as you said, you're into technology? Or was it more than that?
Speaker 4:No, I think it's more than that. You know, I lived through the at the beginning of my surgical career was the beginning of minimal access surgery. And it was a similar story then. You know, the established open surgeons my bosses would say to me, oh, I don't know why you want this minimal access stuff, you know, you put multiple holes in the abdomen and those all add up to the same length as my one big cut. And with my cut, I can take everything out, push it around, look at it.
Speaker 4:You guys all struggling for vision, etcetera, etcetera. It was the same arguments, you know what I mean? They just they felt that what they did was better and but minimal access slowly, you know, got taken up and people started to see the differences and people we started to acknowledge that, gosh, they had this pain and they had quicker return to normal activity. And actually, the cameras got better and the visual systems got better. So in fact, by the time we got into the 2000s, we're getting a way better vision with minimal access surgery, getting way better reach.
Speaker 4:And of course, there's a community of incredibly skilled laparoscopic surgeons who speak against robotics as well. And so, well, we don't need that. We absolutely perfect. We can do everything we want to do.
Speaker 1:Yeah, this is slightly off script, but just on the question of are they really robotics? Should they be called robotics? I know robotics sounds good.
Speaker 4:Yeah, know. And the patients love the concept of it. But the thought of this is a slave master arrangement. It a robotic system, but it is completely 100% controlled by the human surgeon. Yeah.
Speaker 4:So it's a slave master robot.
Speaker 1:Yeah. And what kind of use cases beyond minimal access surgery are robotics being used for in surgery?
Speaker 4:Well, there's a whole range of robotic uses in surgery. So you've got navigational robots, which they use in things like neurosurgery. Where you can hold the head in a fixed position, you take all of the scans and then your robot works out the safest route to it. And then you have the machine which actually takes away the need for the human. You get absolute precision of the instrument that's being driven to the point where it's going to work.
Speaker 4:Then you get another form of navigational robot is like some of the orthopedic robots. So rather than a human chiseling out the head of the femur to put the prosthesis in the robot will help cut that. And it cuts it to a template so that when you come to fit the prosthesis, the fit is perfect. Then of course you get the soft tissue robots, which is Auspex, which is robots which are designed to help you do minimal access surgery in the chest or the abdomen. And then, I mean, there are going to be many, many more coming in due course.
Speaker 4:And of course, it's a long, long journey. And then, you know, people hope that they will be autonomous robots. I doubt in my time it's quite a long way off.
Speaker 1:Yeah. I think from an acceptance point of view, the idea that robots add a superior level of precision is is quite a plus. But the idea of something being completely autonomous is a little scary. I can see that there would be an element of pushback from surgeons who quite rightly have trained for many years to become absolutely brilliant and incredibly precise at what they're doing. But how do you find patients perceive surgical robots?
Speaker 4:Patients are almost at the other end of the scale. They think it's fantastic. Evidence. They're absolutely convinced. There was a big study done in London where they wanted to compare an open operation removal of the bladder, which is a big operation, with the robotic version of it.
Speaker 4:And the way they had to do the study was they had to offer them the open operation and then go back to them a week later and say, if you want to take part in a study, you've got a fifty percent chance of getting the robot. Because if they had offered them a choice of the robot or the open, they wouldn't have accepted the study. Only, yeah, they would have all wanted the robot.
Speaker 1:For me, this was one of the most surprising things about surgical robotics. You might think patients would be wary robots compared with a surgeon who they can actually speak to, build a relationship with, whose hand they can shake. But no. Studies show that given a choice, patients would tend to opt for the robot. It's that idea of precision which makes them so appealing.
Speaker 1:Now we got a pretty broad idea of what surgical robotics are capable of, but I wanted to find out more about what my guests are currently working on themselves. What innovations in this new and exciting industry are they developing? As Dwight mentioned, he's been working in this space for a long time and is now the founder and CTO of Heartland Surgical, a company whose new robotic walker system enables minimally invasive surgical procedures on the surface of a beating heart. I wanted to know about the main barriers both he and Paul have come across when bringing robots to market. Is it the vast cost of the machines, the need for technological breakthroughs, or even pushbacks from surgeons?
Speaker 1:So speaking of highly specialized and and to me unexpected use cases, can you Dwight, can you tell me about, Heartland Surgical and what you've been up to there?
Speaker 3:Oh, sure. So okay. So everything we've talked about so far effectively is roboticizing what has traditionally been done by hand. Okay? I mean, we started by talking about laparoscopy.
Speaker 3:The heartlander thing that I've been involved with for far too long now is doing something completely unusual and is not done we're not roboticizing something that's done today because what we're doing isn't even done. So what we're trying to do is turn the outside of the heart, the epicardial surface which means it's underneath the pericardium which is the sac that your heart is in. So on the epicardial surface, working on making that a therapy delivery area which is not done. There are a limited number of procedures that are done on the in the pericardial space. They're not common at all.
Speaker 3:They're for very specific reasons that people do it. And we're literally trying to turn that area into a therapy delivery site using a little tiny robot. That's what the Heartlander Walker is. And it's effectively an inchworm. I mean, from a configuration point of view, can think of it that way.
Speaker 3:It has little sucker feet that move it across the surface of the heart and the body just, you know, gets longer and shorter and it can change directions. And it's relatively small. It's like eight millimeters across and about 25 millimeters long. It really ought to be smaller than that, but we've already exceeded the resolution of three d printers that we use typically. So we'd have to go to completely different manufacturing techniques if we wanted to shrink it further.
Speaker 1:I mean, we mentioned this earlier, it's cool to be able to say your product has some kind of robotic element to it. There is a lot of money flying around, there is a lot of interest, but between now and the kind of utopian future of of these fantastic surgical robotics, there are a huge amount of barriers to get past. It it seems like, you know, just starting from the very top, finding the right value proposition, finding the right application of the technology seems to be pretty difficult. Talked about
Speaker 2:Let me give you an example. Let me give you an example of a single port robot, where it actually starts to let you think, Oh, hang on. That's a really good value proposition. Let's say you could do a transvaginal hysterectomy instead of doing a laparoscopic hysterectomy. You could do a transvaginal hysterectomy.
Speaker 2:That's not really possible. If you think about all the dissection needed in the hysterectomy procedure, doing it transvaginally is not really possible laparoscopically. And if you could take a, if a single port robot enabled that to happen, that's a, that's valuable. If that's a that's an if, but if that is enabled, then that's valuable. And there are major transactions happening on exactly that basis right now, which are really exciting.
Speaker 3:Yeah. That's the I mean, so there's your value proposition as far as that goes. And that's and that one in particular that Paul just referred to, that's about a single procedure. So then you have to actually look at the economics of that. Are there enough of those procedures done?
Speaker 3:Is the profitability, I hate to say this, but it's true, the profitability of that procedure high enough to warrant it, you know, you know, etcetera etcetera. I mean, one of the things that gets left out a lot of times in the early stages of of designing a a neurosurgical device is, you know, what is the reasonable expectation on a per procedural basis of what the revenue will be? You know, in in the in The United States where I am, you know, we get stuck with the CPT codes and things like that, which is how you build the insurance companies. And that becomes the gating factor relative to how much money is available. So, like, for instance, with Heartland, or we knew for electrophysiological procedures when we started really early on, It was around $3,200 is what I remember for the money that was available for the hardware component of doing a arrhythmia ablation procedure.
Speaker 3:So we use that right out of the gates to say, you know, that's how much money would be available on a reimbursement basis.
Speaker 1:This is a very complex situation. So you've got highly trained surgeons, and learning how to use a robot adds complexity, for everybody. Maybe not the patient, but certainly adds complexity for the hospital, adds complexity, for the support staff, everything. So is there a scenario where you get a trouble with acceptance from surgeons? Do they sometimes just say, get the robot out the way with a slightly bigger incision, I can do a really high quality job?
Speaker 3:Yeah, that's that's kind of a, that's in transition. I would actually argue earlier on and there was a
Speaker 2:lot of argument about that. And in the same way, a good endoscopist, if you ask a really good endoscopist, what would you like to see in the future? And are you interested in endoscopic robotics? They'll say, oh, please, I just want a better scope holder. Just give me a scope holder really.
Speaker 2:And that's it. It's because they've gone up that painful learning curve and they know all this kind of weird motion and how to do it and they figured it all out. But I guess the thing about surgical robots is that it doesn't enable you to get better surgery than the best surgery, at least shortens a learning curve and enables bad surgeons to do surgery.
Speaker 1:So do you think the market pull is going to be strong enough to get through some of these? Well, what seemed like very difficult barriers.
Speaker 3:Yeah, mean this will say, you know, the biggest barrier right now relative to surgical robotics is actually just cost. They're just tremendously expensive. Then Expensive to buy and develop. Yeah. And then there's like the problems with actually having it in the place, having to take care of it.
Speaker 3:And we talked about that earlier. I mean, you know, the patients can want them, but the hospitals have to deal with the reality of, you know, how does it fit into the hospital itself, both from a financial and from a, you know, workflow point of view, if you will.
Speaker 1:Those barriers are pretty significant. Cost is obviously key. But how do you convince a surgeon who's been in training for many years in order to reach a highly specialized position that they need a robot to do the job better than them. It's a difficult task even if it is, like Mark's robots, a slave and master relationship. That relationship between surgeon and robot is one of the most interesting questions here.
Speaker 1:I asked Mark some more about the true benefits of surgical robotics and what some of the blockers he has found when developing a system and taking it to market. What makes him as a surgeon so keen to pursue surgical robotics? I noticed on your website something that resonated with me particularly was it says on there, we didn't set out to build a product. So I like the approach, you know, from a designer's perspective that you didn't immediately go, hey, let's make a surgical robotics company. So tell me a little bit about your solution to help you do that.
Speaker 1:Tell me about Versus.
Speaker 4:The idea with Versus, so my co founder Luke, who's the principal architect of the robot, has worked out a way of holding the instruments differently. So most other robots hold instruments more akin to that of a dagger. Whereas we hold our instruments end on in exactly the same way the human. Now physics from a physics point of view, that ability to hold the instruments end on like a human means we get greater reach and we can achieve it on a much smaller robot. So our system is a fraction of the size of pretty much all the other systems that are available or coming to the market.
Speaker 4:You know, the base of it is 38 by 38 centimeters, the the bedside unit. That's one thing. It's small, it's modular. Each arm is different, is separate from the other arms. And then the console where the surgeon works is again separate from the bed.
Speaker 4:So the surgeon sits at the console. He or she has got a three d monitor and then one of the arms holds the camera for us. And that's already a huge step. When I'm doing advanced minimal access surgery, I very often had to schedule my surgery according to the skill of the person who'd be holding the camera for me. And if they were unskilled, I sometimes couldn't do some of the more advanced stuff.
Speaker 4:I had to then get some So that was putting a burden on us finding the right assistance. And then the other arms hold instruments and then we control it all from the bedside. So the big difference with all the others is we are modular and we're small.
Speaker 1:Yeah. So I always thought that one of the biggest barriers was the fact that these things are not configurable and they are large and expensive. But you've already addressed that. How have you managed to do that? Is that through technical innovation, you know, shrinking the size of the different elements?
Speaker 4:Yeah, 100%. So that's just technical innovation. The principal part about is what we call the wrist of the arm. We call it a V wrist. And it's technically incredibly advanced for robotic systems.
Speaker 4:And that enables us to hold the instrument as we want, plus get all the reach and get all the various movements. And that enables us to have a smaller modular robot. So that was, as far as we're concerned, a huge technical progress.
Speaker 1:Yeah. So you're in the operating theatre. Do you still have the same amount of people? Do you still have the same team or are there different skill sets required?
Speaker 4:No. In fact, you know, in the fullness of time we will have reduced people in the theatre because you don't need somebody holding your camera. And, you know, at the moment, sometimes you still need a bedside assist, but certain operations you won't need them. The more complex ones you may. So same number of nursing staff, a lot of cases still have an assistant, but you have a lot lower level of skill needed for those because they're not holding the camera.
Speaker 4:And we're really working in ways of the surgeon being able to move from the console to the bedside so that may reduce the need for an additional person. Of course, we looked at this incredibly carefully at the beginning of COVID. And potentially COVID has other advantages because you could have the surgeon outside the Operating Room.
Speaker 1:Yeah. So there's another point for defending the return on the investment, actually enabling surgeons to do more surgery.
Speaker 4:You know, a 50 year old surgeon has to stop operating because of neck problems and so on, that's a huge cost to the society. And you're in the peak of a surgeon's age is to the mid fifties to sixties. So if you're getting rid of surgeons in that age group, you're actually doing society quite a harm. And you can enable them to prolong their surgical careers absolutely, the right way.
Speaker 1:So Mark's Versus system is actually not about getting rid of surgeons. It's more about enhancing their skills. The transference from doing years of procedures by hand and moving on to controlling a robotic arm is not as great as you might think. But even so, the training of surgeons to use these machines is gonna be one of the most important sectors for the industry as it continues to grow. I asked Mark about this balance between surgeons and robots, about which side, the tech or the people controlling it, held the most important position as we move forward.
Speaker 1:So when it comes to training people on how to use these things, how have we got to the sort of iPad stage other tablet devices are available where something as complicated as an iPad is actually you don't even need to learn how to use it. The the design and the UX, the UI is so intuitive. Do you find it's easier to learn or are the training programs quite significant for this for Versus?
Speaker 4:So in terms of learning it compared with learning keyhole surgery, straight stick, conventional, whatever you call it, chalk and cheese. And we are actually formally studying that. So I'm doing what we call transfer and studies where I'm actually measuring how long it takes a novice surgeon to learn it, how long it takes an experienced robotics surgeon on a different system to learn it, how long it takes a minimal access surgeon to learn it. So we can actually see what it is. But from our early work, it's so much easier.
Speaker 4:You know, they can see everything. So if I wanted to teach you to tie a knot laparoscopically, to be good at it, sixty hours. On a robot, I'd probably have you make a fairly decent knot in about thirty minutes.
Speaker 1:Wow.
Speaker 4:You know, it's a massive difference because you've got wrists. And on the robot, I mean, I taught one of the previous Secretary of States for Health to tie a knot in about thirty minutes. And then that also means that maybe in certain surgical techniques we're going to do more suturing rather than use staplers or clips and that may itself have advantages. Yeah.
Speaker 1:It always makes me think of a potential future where surgeons are able to work from the comfort of their home as if they're playing an immersive computer game.
Speaker 4:Absolutely. As long as it's not me, they operate on. Yeah, I mean, you know, there was a very famous operation done in New York called the Lindheim operation where the surgeon was in Strasbourg and the patient was in New York. And it was done as a publicity stunt largely. And they were actually cable connected, the console and the arms.
Speaker 4:It cost them about 30,000,000.
Speaker 1:A physical cable?
Speaker 4:Literally, they got all the from beginning to end and cost a fortune. And it was largely gimmicky. And up till now, the speed of light largely prevents what you can do at a distance because you get a lag. And once you go over about two fifty milliseconds lag, then it's very difficult to operate fluently. Now having said that, that too may change, and you may well get people operating at a distance.
Speaker 1:So obviously your campaign is to or your purpose is to get more of these robots in the field and it sounds like you're doing a fantastic job. Do you think we need more robots or do we just need more surgeons or do we need more of both?
Speaker 4:I think we need more of both. So, you know, if take low and middle income countries, the failure to provide good surgery costs those economies trillions of dollars in lost productivity. And, you know, we've also got to think very carefully about the low and middle income countries. They deserve good surgery as much as any world country does. In fact, if anything, they almost deserve it more because a lot of them are very dependent physically on their health.
Speaker 4:So that's something we're very interested in as well. I think there are patches in the world where the failure to provide appropriate medical care is just shocking and scandalous. And so it's not just a campaign for the rich countries of the world. We've got to drive a campaign for humans to get decent treatment. And, you know, I believe that we will be able to train more robotic surgeons than we can open ones And that the robot will provide economies efficiency that will help drive it up.
Speaker 4:We do need more surgeons. I mean, if look in The UK, I mean, for goodness sake, we've got potentially 14,000,000 people going to land up on the waiting list. Somebody's going to have to be pretty inventive and quick to overcome that little. And part of that will be reassessing patients, do they actually need the surgery? Are there alternative ways of achieving the same aim?
Speaker 4:I mean, as tech advances now, we've got a couple of really huge responsibilities. One is to make sure patients get the good tech, but make sure that the tech is good and not just tech.
Speaker 1:It seems a bit counterintuitive, doesn't it? Putting multimillion pound surgical robots into hospitals in countries who currently have large shortages of skilled practitioners and a lack of funding to support them. But despite their reservations, my guests today all think teleoperations could become a feature of health care systems across the globe in future. I went back to Dwight and Paul to see if the future really does look like one in which robots reign in hospitals and surgeons control them from the comforts of their own homes. Let's, fast forward a little bit into the future perhaps.
Speaker 1:So we've already talked about some fairly futuristic, to me, futuristic concepts. Certainly, Paul, you mentioned sort of VR teleoperation. How did you say it? VR teleopathy. How do you see that proceeding?
Speaker 1:Do you think we're ever going to get to a point where there is a surgeon or are they a surgeon or are they a surgical robot operator and people are going in, but that surgeon is wherever they want to be in the world? Like, you know, what is the future of this sector?
Speaker 2:So I'm split because they say that the future is teleoperation and I just can't see the value proposition yet. I really want to, because I like the people in those companies, but I just haven't yet been persuaded of the value propositions of teleoperator. The idea that a community hospital out in the sticks can afford a 1 and a half million dollar robot, but can't afford to hire a specialized surgeon. I dunno, maybe, I think it is probably more interesting to talk about the future of autonomy.
Speaker 3:Well, so the one before we switch over on the tele op, there are certain contextual situations where it can make sense. You know, for instance, like if you really are in a resource constrained environment, you know, in the developing world, etcetera, you can actually make good good situationally appropriate arguments about this. The problem the problem is so let me let me actually spin this a little bit and and move to where Matt was going with the machine learning then. Because as opposed to a teleoperator, like literally somebody's controlling it from name your distance, right? You can also think about phoning a friend, if you will, or phoning a helper or phoning a mentor, okay, that is what they're watching over your shoulder and kinda helping out.
Speaker 3:And there's technological issues, but there's much more than that involved here. There's all kinds of sociological issues, psychological, societal issues here of a surgeon being willing to accept the input of another in real time during a surgery, etc, etc. This is also where machine learning can potentially come in also because of providing the same kind of a thing. You know, it's not necessarily telling them what to do. It could just like a tele mentor could tell them what to do.
Speaker 3:But it could also be a appropriate way to prevent something from going wrong. You know, and it only injects itself, either the person or an automated system when it's become convinced that if the continuation of what we are observing right now is going to result in a either non optimal or particularly potentially catastrophic result. I have an
Speaker 2:alternative perspective doc. I don't have a strong, I don't have a positive opinion. Okay, I do have an opinion, but it's not very good about machine learning, but, I do have an opinion about the future of surgical robotics, which is I think a lot of effort, it goes into making electromechanical systems that are safe and that have applicability and use and value. And I think what you, should see over the next fifteen years is a new generation. And I know you're asking about like thirty years, fifty years, but still over at least ten years, I think that there will be filling in some of the gaps and making better use of those platforms such as, if you, if you operate through an electrical mechanical interface, you lose a feeling of touch.
Speaker 2:You don't know necessarily, but could integrate through a robot the capability to detect critical structures. Am I near a blood vessel? Am I about to sever a nerve? Am I gonna tunnel through an articulated surface joint? This is sensing and imaging and yeah, exactly.
Speaker 2:Situational awareness, you know, what's around me, not just what's within the field of view, but what's important to this procedure that I need to know about.
Speaker 1:That tension between cost and access or precision and complexity is what makes the surgical robotics industry so fascinating. Just recording this episode has shown me that the notion that surgical robotics is being driven by the technology rather than by the need seems far from accurate. As Mark said, any new innovation should fundamentally be about improving outcomes. If the robot enables that and their accessibility improves, they could well point to a bright future where robots enhance and extend the reach of care rather than replacing surgeons. That's all for today.
Speaker 1:Thanks so much for listening, and thanks to our guests, Paul, Dwight, and Mark for helping us navigate this incredibly interesting industry. We'll be back next week with an episode which sees us look at machines not in theater, but in your living room as we discuss health care's recent move back into the home. We'll see you then. InventHealth is a podcast from TTP. It's written and hosted by me, Matt Millington, design and strategy consultant at TTP.
Speaker 1:It was co written and produced by Harry Stott. The executive producers were Abby Williams and Sam Zaccarino from TTP and Ollie Judge from Adrift Entertainment.
