Since I first ranted on this subject on the Dope some years ago, things have gone from bad to worse on the robot front.
It’s no longer just nasty little Rosie O’Donnell robotic lookalikes patrolling the hospital corridors, issuing surly injunctions to “STAND CLEAR”.
Now we’ve got robotic surgeries, which are becoming commonplace for all kinds of procedures at considerably greater expense and with potential complications. This morning at our hospital Tumor Board meeting we heard about reports that robotic prostatectomies have a higher incidence of positive margins (if you leave tumor behind, there’s obviously a greater chance it will recur or metastasize). Here’s a fun article about problems with robotic surgeries:
“There also have been a few disturbing, freak incidents: a robotic hand that wouldn’t let go of tissue grasped during surgery and a robotic arm hitting a patient in the face as she lay on the operating table.”
Comforting.
The same paper has a feature today (couldn’t find a link) about how physicians on call are using a tall skinny robot with a computer-screen head to do consults, rather than bothering to come into the hospital to see patients in person (the camera will zoom in on an affected body part, which obviously is much better than seeing and palpating it for yourself :dubious:). The best part was learning that they hope to do psych consults via robot. Yessir, the personal touch. I can’t wait to hear about successes treating delusional, paranoid patients with Dr. Medi-bot. (“DO YOU FEEL BAD? HERE, HOLD MY METALLIC CLAW. I WISH TO COMFORT YOU.”)
I don’t know about you, but I’m going to want good hard data on just why robots are so great before I let the da Vinci robot or its peers maneuver around my insides. And when Dr. Medi-bot shows up in my hospital room, I’m going to throw a food tray at it, and hope the hot soup scores a direct hit on its electronic vitals.
Last time I saw one, the daVinci is not autonomous, and leaving sub-optimal tumor margins, nicking blood vessels, etc. can be done with or without robotic assistance.
Other than the one instance where the tool didn’t let go of something, I don’t really see anything that definitively says surgical robots are the problem.
From everything I’ve read, robotically assisted surgery has better outcomes than traditional ones. The most common robotic surgery is LASIK, which has vastly better outcomes than the manually performed Radial keratotomy.
Looking at some of the literature on prostate surgery, it seems there is divided opinion on whether robotic-assisted surgery leads to more positive margins or not. For instance:
“The composite published literature suggests a higher positive surgical margin rate following robotic radical prostatectomy. We will not know definitely whether this apparent higher positive margin rates associated with robotic radical prostatectomy compromises cancer control until longer follow up is available.”
There’s an argument that robotic procedures may make margin evaluation more difficult because you lose hands-on feel for abnormal tissues. Whether that’s the case for experienced operators is something we’ll learn more about over time. Meanwhile, I wouldn’t be eager to be someone’s first, fifth or tenth case, or to be a robotic surgical patient at all if I wasn’t convinced that the supposed benefits justified the cost and potential drawbacks of the procedure(s).
And I am still not sharing my clinical history with Dr. Medi-bot and his android assistants.
The haptic feedback systems are supposed to give one the same feel. When you include advanced vision systems to artificially distinguish one type of tissue from another, adjustable ratios of movement to give the surgeon finer than normal control, etc.
Specifically with prostate surgery, I believe these factors allow the surgeon to be more careful and work harder to have the nerves - and avoid rendering the patient impotent.
See above. If given a choice between an extra two years of life with a non-working dick…
Different strokes for different folks, I guess. I’d rather tell a robot all about my {embarassing medical issue} than somebody I think might be judging me secretly…
They call that “telemedicine”, and it’s something that’s being worked on at my company. The thinking is that there’s a doctor shortage, and by taking advantage of this technology, they can alleviate this shortage somewhat, and make money in the process.
Think about it this way- if you live in some pissant town in northern Idaho, would you rather drive hundreds of miles to see a real doctor, with all the discomfort and trouble that would entail, or would you rather see the tele-doctor with a nurse or PA right there to help out?
Right. I was talking about this last night with a doctor friend who is an expert on concussions. Physical issues of his own makes travel difficult, and he’s looking at this technology to be able to consult on cases that he could not reasonably travel to.
Wait a few days for a small plane, then take it on a milk run from tiny isolated community to tiny isolated community until you transfer to a slightly larger plane which takes you for one more hop so you can spend the night in a motel and then take yet another plane the next morning to the big city, well over a thousand kilometers from your home, where after a long cab ride you get to your doctor, and after the appointment spend the night in the city at a motel and then reverse the trip home the next 'two days. Do this every month or so. Do this on your social assistance / welfare / disability income. This is what most people in remote communities in the north of our province had to deal with prior to telemedicine.
Telemedicine is one hell of an improvement over the status quo for many people who live in my province, for many communities in the north are not large enough to have a doctor, and although general practitioners (including my own family doctor) fly from community to community, the frequency is not enough and the scope of practice is not enough.
I actually visited the telemedicine pilot clinic at work when I had a sinus infection/bronchitis. I have a normal GP that I’ve gone to for years, but sheer curiosity caused me to visit the telemedicine clinic. That, and it’s free for the pilot period!
It really wasn’t as far different than a normal visit as I would have thought. Basically the nurse did all the same stuff they normally do, and then I talked with the Dr, and the nurse used the stethoscope on me, and put the scope doo-dad in my ears, nose and throat so the Dr. could look at them. The nurse took my temp, felt my glands, etc… I think there may be a little more training for a telemedicine nurse, at least as far as doing certain common hands-on diagnostic checks.
One cool thing (to me at least) is that the telemedicine setup actually displayed what the scope doo-dad was seeing, and the Dr. could actually explain to me what it was, and what it meant. For example, I had no idea I have a couple of nasal polyps; They’re benign and really common, and I’m sure my normal Dr. has seen them for years, but he never mentioned them.
Anyway, since I had a pretty good amount of post-nasal drip, a horrid cough and a slightly elevated temp, I was prescribed a 7 day course of antibiotics, which worked like gangbusters (as in, started feeling notably better 4 hrs after the first dose).
All in all, I don’t know if I’d do it regularly in place of a normal visit, but I can see how it would be handy for urgent care in certain geographically isolated or really low-volume clinics, which is pretty much the idea at work.
So is anyone else envisioning Bender from Futurama, sneaking into a hospital with a lab coat and a clipboard to steal some rubbing alcohol, winding up in an operating room where Jackmannii is about to undergo prostate surgery?
“Hey, I never knew what was inside these meatbags!”
I’m waiting for the rant to continue railing against all these new-fangled medical devices that come between a doctor and his (Yes his. What, you want to let women become doctors now?) patients. I mean, when I was young*, if a doctor wanted to listen to your heart, he’d put his ear right up against your chest. None of this cold, metallic stethoscope, there was real human-human contact! If you had something stuck inside of you, he’d grab it with his bare hands, without all the sacrifice of feeling from tweezers or forceps or what-have-you.
And they didn’t send samples off to a cold, faceless and heartless, remote laboratory, either. If a doctor wanted to diagnose diabetes, he’d taste my urine with his own mouth, just like God intended! Hmphh. I tell you I do NOT hold with too much technology in medicine.