In 2024, the landscape of surgery looks set to continue its remarkable transformation, primarily attributed to the advancements in robotics.
Increasingly, surgeons are working seamlessly with robotic systems to revolutionise how procedures are conducted and how patient care is delivered.
Robotics is integrated into surgery through specialised robotic systems, allowing for enhanced precision and control during procedures.
Surgeons can operate these robotic systems using a console, manipulating robotic arms equipped with surgical instruments. The robotic arms can execute movements with high accuracy, minimising the invasiveness of surgeries and reducing patient recovery times.
This advanced technology is particularly beneficial in complex and delicate procedures, offering surgeons a three-dimensional view and precise movements for increased surgical success. Complex procedures like neurosurgery or intricate cardiac interventions have become more routine and accessible, thanks to these robotic allies.
However, this transition is not without challenges. Ethical considerations loom large, particularly regarding the level of autonomy granted to these robots. The debate continues where the responsibility lies in case of errors or malfunctions: with the surgeon overseeing the procedure or the AI system itself. Ethical guidelines and regulations continually evolve to address these concerns and ensure patient safety remains paramount.
Legal frameworks also face significant adaptation. Determining liability in system failure or errors during robotic surgeries raises intricate legal dilemmas. Striking the right balance between technological progress and safeguarding patient rights requires careful calibration of legal frameworks.
Despite these challenges, the benefits are substantial. Robotics in surgery saves time and enhances patient care and outcomes. With increased precision, there’s a reduction in post-operative complications, shorter hospital stays and quicker recovery times. Patients experience less pain and scarring, fostering a higher quality of life post-surgery.
The proliferation of remote robotic surgery has bridged geographical gaps in healthcare access. Skilled surgeons can now perform procedures on patients in remote or underserved areas via telerobotics, ensuring that physical proximity doesn’t limit expertise.
Looking ahead into 2024 and beyond, the trajectory of robotics in surgery holds promise for even more innovations. Advancements in haptic feedback, augmented reality and machine learning algorithms will further refine the capabilities of robotic systems, pushing the boundaries of what is achievable in the operating room.
So, how will these pioneering initiatives shape the future landscape?
As these innovations continue to evolve, the collaboration between human expertise and robotic precision will redefine the future of surgery, transforming the medical landscape profoundly.
Recognising the rapid pace of evolution in this field, Surgery International invited some key industry leaders to share their insights into the anticipated trajectory of surgical robotics in the upcoming 12 months.
Their expertise and vantage point in this domain offer an exciting look at the expectations and projections for the future of surgical robotics.
Below, these experts consider the latest trends, technological advancements and potential breakthroughs – as well as the challenges and the benefits to global health.
Dr Jerry Chen is the CEO of Brain Navi, a medtech company focused on developing surgical robotic solutions. He is a practising surgeon specialising in urology. He also has a PhD in Biomedical Engineering. He co-founded iXensor, a point-of-care diagnostics company, which went public in 2019.
What are the latest technological advancements in robotic surgery?
The long and frustrating registration process remains a central issue, making current automated systems unattractive to many surgeons. We solved this problem by embedding machine vision with AI to create an autonomous patient registration process within seconds. With this technology already integrated, similar innovations will follow in this field to make systems more user-friendly.
What are the challenges preventing the mass adoption of surgical robots?
The surgical robots’ precision and stability are difficult to match by human hands alone. Given the other benefits to surgeons, hospitals and patients, expecting more surgical robot adoption is a no-brainer. However, one main hurdle is education. These systems sometimes require changes in clinical workflows – and breaking the habits by training and practising involves time.
How will robotics change and evolve in the future?
Machine learning and AI will dominate the world, and surgery will be no different. Recognition, planning, navigation and guidance seem to be the following functions to be disrupted by AI eventually in the near future, which would streamline the operating room workflow and bring extra comfort, accuracy and safety into surgeons’ lives.
Paul Gibbons is managing director of the UK-based Corin Group, which delivers orthopaedic technologies and solutions.
Will orthopaedic robotics value be tested in 2024?
Over time, trends come and go within orthopaedic technology; some are driven by the ability to solve a clinical need, some are technology looking for a home, and others can be seen to improve clinical outcomes for a fair price.
In contrast, some create little change and sink beneath the waves of obscurity – especially in public health-driven markets where there is extra focus on the outcomes and efficiencies driven by the investment of the taxman’s pound. We see more emphasis on the value generated by new technologies – this is thinking about value defined by Porter as outcome per dollar of cost expended.
Within the UK, the GIRFT (get it right first time) analysis has been applied to many medtech areas, resulting in changes in implant choice based on costs and outcomes. Still, it has yet to stray as far as looking at the other assistive technologies alongside joint replacement.
There are ongoing trials to look at robot effectiveness in joint replacement. Just by tracking presentations and papers in the orthopaedic forums, there is an increasing voice questioning the overall costs of present robotics versus the change in outcomes – this can only increase until peer-reviewed, non-prejudiced papers can show clearly where orthopaedic robotics is worthwhile in improving the value to the system.
The systems deployed are still mired in older generational approaches where the reproducible ability to hit a predetermined target is considered vital, resulting in a standard achievable skill level across a wide range of users but possibly little effect other than reducing the outliers and some complications on a broader scale.
The evolution comes where more data is gathered through patient assessment and imaging in 3D, allowing a more patient-specific target to be generated and achieved – the present robot generations can be seen as data harvesters to enable this step to change to happen. This step change should allow a genuine shift in the value delivered by orthopaedic robot systems, but whether it is truly enough to increase the value is yet to be seen.
Potentially, we will see the move to open platform systems allowing actual dynamic, 3D patient assessment and then accurate positioning using company-specific applications when needed. Robotics is evolving in orthopaedics at a rapid rate, but as with all innovations, it needs to create actual value to find its longer-lasting position in the future.
Tom Shrader is the founder and president of R2 Surgical, a global supplier of surgical robots, instruments, parts, and accessories to the secondary market.
How can we address the challenges of high costs associated with surgical robotics and the environmental impact of medical waste?
Two critical issues plague the industry – high surgical robotics costs and the environmental impact of medical waste. We must take a unique approach to address both challenges head-on.
First, let’s talk about affordability. The soaring prices of surgical robotics systems have been a significant barrier for healthcare institutions worldwide. Not every hospital or clinic has the budget to invest in state-of-the-art equipment, so sourcing pre-owned equipment worldwide and offering legacy systems like the da Vinci Si, X, and Xi at more affordable prices is essential.
This makes these cutting-edge systems accessible to a broader range of providers, ensuring patients everywhere can benefit from robotic surgery. But affordability is just one part of the equation.
The second challenge is sustainability. The healthcare industry generates significant waste, and we should all be deeply committed to reducing this impact. Offering refurbished pre-owned robotic systems (that could otherwise end up in a landfill, a storage unit or sitting unused in a hospital) can make the difference.
There must also be affordable and comprehensive support services, equipment maintenance and sterilisation expertise and staff training. We must empower healthcare providers to make the most of their robotic systems, even in financially challenging situations. We must pledge to reshape how robotic surgery is perceived and utilised by showcasing all options.
As with any emerging industry, it takes time to establish sustainability and create a thriving second-hand market that makes technology more affordable. However, affordability and leveraging it to provide customers with the tools they need to enhance their medical practice and deliver the best patient care possible can make a difference.
Dr Ed Chekan is Asensus Surgical’s Vice President for Medical Affairs and Professional Education.
How will integrating digital technology into contemporary surgical environments introduce new challenges?
Hang on, I’ve got to get this text. How often texts annoy vs. inform depends on what data is conveyed, when it arrives and where we are when we read it. Wouldn’t it be nice to triage this information more efficiently?
Today, the ability to discern the value of surgical information in real time is already unlocking a new paradigm in surgery.
Known as digital surgery, microprocessors are leveraging laparoscopic videos well past the eyes of the operating surgeon as they are simultaneously fed through machine learning and artificial intelligence (AI) algorithms.
Once analysed, the additional information is sorted and immediately redeployed in an appropriately categorised and easily used form. The question is, where will you be when you receive it?
Operating rooms have changed dramatically from the whitewashed, natural light-filled spaces of yesteryear to today’s high-tech bastions of networked computers alive with flashing buttons and robotic arms. To add more complexity, the hands of a robotic surgeon are now tethered not to scalpels and pickups but to machines, and their eyes are focused on video monitors.
Enter digital surgery. Soon, surgical hands will be able to move freely. Disconnected from tangible instruments, surgeons will have access to ever more diverse technology.
Digital surgery is poised to build a new surgical metaverse around this freedom. In this co-reality, just-in-time surgical decision support informed by real-time laparoscopic videos is an everyday occurrence.
However, these new, unobstructed surgical environments will also come with new interruptions that will present new challenges in the form of interruptions – both in the real and virtual worlds. Some will be predictable. Some will not. Whoever manages the ‘what, when and where’ of surgical data presentation holds the keys to the next level.
Ring. Excuse me, I should get this.
Darren Porras is the Market Development Manager for Healthcare at Real-Time Innovations (RTI).
What are the latest trends in surgery robotics?
Real-time connectivity (data flow) is the foundation for the fundamental technologies driving this digital transformation and the integration of robotics, visualisation, advanced sensors/instrumentation, AI/ML, and data analytics.
Regarding the digital transformation in medtech, there is a shift from siloed medical devices to connected, intelligent digital ecosystems. Integrating robotics, imaging, sensors, and data-driven technologies enables next-generation, increasingly assistive, predictive, and data-driven solutions. Leveraging data and converging technologies provides meaningful and demonstrable innovations that are less invasive, lower the total cost of care and provide more efficient clinical workflows.
What are the latest technological advancements in robotic surgery?
The integration of robotics, AI/ML, surgical video and real-time data delivers a range of features to improve procedure precision and workflow (assisted guidance, visualisation and automation). Software is increasingly a differentiator. Medtech companies seek to leverage software and data to enable integrated, flexible and upgradeable surgical platforms. The leverage of state-of-the-art technologies enables remote surgical workflows (teleoperation and telepresence).
What are the potential breakthroughs?
Remote use cases encompass telerobotic applications for stroke treatments and orthopaedics. The transformative potential of digital surgery lies in the seamless integration of data connectivity, robotics, visualisation, instrumentation, and artificial intelligence. This integration holds the promise of revolutionising treatments and enhancing clinical efficiencies.
What challenges do you foresee?
Development lifecycles are slow and expensive, and the increasing complexity and connectivity of surgical systems pose challenges for manufacturers to design scalable and flexible systems that need to integrate heterogeneous applications, devices and data. Systems must be highly reliable, flexible and secure. The need to address complex design requirements, cybersecurity, and increasing regulatory scrutiny poses significant business and technical obstacles for device manufacturers.
Are there any pioneering initiatives you foresee shaping the future landscape?
New surgical robotic form factors will be less invasive (smaller incisions/fewer ports, endoluminal) and emerging use cases will leverage surgical video for real-time guidance. There will be new remote robotic use cases for stroke treatment and orthopaedic procedures. Companies will leverage state-of-the-art technologies and partners, designing scalable and interoperable architectures to deliver transformative solutions and innovate faster.
In summary, connectivity is the core capability driving the evolution of surgical robotics toward next-generation digital surgery solutions that rely on integrating robotics, AI, visualisation, advanced instrumentation and evolving data-driven technologies.
