[HN Gopher] Robotic surgery turns surgical trainees into spectators
___________________________________________________________________
Robotic surgery turns surgical trainees into spectators
Author : samizdis
Score : 56 points
Date : 2022-07-05 16:07 UTC (6 hours ago)
(HTM) web link (spectrum.ieee.org)
(TXT) w3m dump (spectrum.ieee.org)
| catgary wrote:
| I'm a bit shocked that simulators aren't made readily accessible
| to surgeons. I thought that would be the biggest advantage of
| robotic surgery - a surgeon could prep with a few practice
| surgeries on the sim, while being taken through a few "sometimes
| this is what goes wrong, here is how you
| recognize/recover"-scenarios.
| adolph wrote:
| It'll be interesting to see the growth of simulation in other
| fields similar to that used in radiation oncology [0]. The
| trick about human bodies is that they aren't all the same and
| they don't say the same. Once the robot can perform
| sufficiently similarly in simulation as in real life, then a
| high risk and cost intervention like surgery will be simulated
| before performance.
|
| An additional aspect of simulation is calibration and use of
| phantoms [1]. These are materials of known characteristics
| approximating human anatomical densities. I suppose for robotic
| surgery this would be used for both the imaging and the
| surgical tech.
|
| 0. https://radiationoncology.weillcornell.org/clinical-
| services...
|
| 1. https://www.nist.gov/physics/what-are-imaging-phantoms
| iancmceachern wrote:
| The thing about simulation in radiation oncology is its more
| focused on simulation of the physics of the beam delivery,
| and not so much on simulation of the tissue or human body
| portion of the equation. This is more the latter.
| elromulous wrote:
| I don't know for sure, but I suspect cadavers are cheap enough
| and much "higher fidelity" than any sim could ever be.
| inglor_cz wrote:
| Yes and no, for example, they have no blood circulation
| anymore, thus one of the potentially fatal risks of any
| surgery - bleeding - can't be "trained" there.
| iancmceachern wrote:
| It can, they can plumb things up with pumps to simulate
| whatever.
|
| This same limitation applies to simulators though, so this
| application isn't an answer to the parent comments
| question.
| quantumduck wrote:
| It's easy to simulate the robotic manipulators - the dynamics
| are well known and they are rigid objects.
|
| On the other hand, simulating say skin/muscle/blood or anything
| that closely resembles human body is near impossible. Without
| that, a simulator is pretty much useless and it'll probably
| easier to train the surgeons on real robot + some animal like
| pig
| catgary wrote:
| I'm not even thinking of anything as grandiose as a full
| simulation of the human, it could be as simple as mimicking
| the movements from a previous surgery using an overlay of the
| simulated robot arms.
| deelowe wrote:
| Is a physical object even required? Why can't it be like a
| flight sim and just be controls and some screens?
| quantumduck wrote:
| What do you mean? In a flight simulator you have your
| controls controlling a plane (right body, dynamics are well
| known) in the sky (simple environment, dynamics are
| reasonably well known, even with different atmospheric
| conditions like wind). The output is visualized on the
| screens as a rendering of the scene.
|
| In the case of robotic surgery simulator, you are using the
| controls to control the arm, but to interact with what? If
| you just want to move the arm around and maybe interact
| with some rigid objects sure that's easy. Would that add
| any training value to the surgeon? Probably not. You can
| get value only when the simulator includes a simulation of
| something the surgeon would have to face eventually -
| organic mass of the human body. Simulating that is hard,
| and I doubt anyone would invest much into it when you can
| train surgeons on alternative physical objects like pigs.
| soperj wrote:
| it would control a software arm operating on a software
| body, just like a flight sim controls a software plane.
| sebmellen wrote:
| It is nearly impossible to accurately simulate a
| "software body".
| manmal wrote:
| Why? Couldn't one model the various tissues and bones,
| fluids, surface tensions, resistance to cutting etc?
| jpeloquin wrote:
| Yes, you can produce a model incorporating nonlinear
| elasticity, viscosity, plasticity, frictional contact,
| subfailure damage, and fracture / cutting. Repeat for
| each tissue involved. Some of those methods are well-
| developed, others are not. Damage and failure in
| particular is poorly developed, and simulating deformable
| body contacts can be tricky. Then you have to estimate
| parameters for all of that, validate that the model
| produces realistic outcomes, and get it to run in real
| time. You can ignore most of the complexity and make
| approximations, like treating everything as an isotropic
| linear elastic material, setting cutting resistance to a
| fixed value per tissue, treating the scalpel like a
| lightsaber, and accepting that contact will be
| imperfectly enforced (surfaces may interpenetrate). A
| crude simulation can still be good enough to be useful as
| a learning tool though, but it tends to work more like a
| video game than a true physics-based simulation. We'll
| still eventually get the kind of accurate simulation
| you're asking for, probably.
| deelowe wrote:
| I was specifically constraining the discussion to robotic
| surgery. Do all these variables apply in that case?
| RandomLensman wrote:
| Very very many variables... For example, burnt tissue,
| crushed tissue, injection trauma, infected tissue plus
| variable anatomy.
| musingsole wrote:
| But don't we now have thousands of hours of real-use? Surely
| in the age of Dall-e, a system to use that as input to ape if
| not fully simulate the surgical environment is within reach.
| quantumduck wrote:
| While DALL-E might seem like something out of the world,
| what it outputs at the end of the day is pretty basic: a 2D
| image.
|
| To run a high-fidelity simulator of human body that is
| useful for surgeons, you need a LOT more. And I doubt it
| can be data-driven. Data-driven simulators for things like
| autonomous cars are just coming up, and these are way
| simple as the agent (the autonomous car) doesn't directly
| change the environment when it's driving around (as in, you
| don't have to simulate the car colliding into a traffic
| pole and then breaking it, etc.)
|
| To simulate a human body, you need to be able to capture
| the material properties of different layers, some of which
| are fluids, and then also the interaction between them and
| how different organs react to a surgical operation. It's a
| very hard problem.
|
| Why do all that when you have animal corpses readily
| available? There's no need to create a problem that doesn't
| exist.
| iancmceachern wrote:
| It's a solved problem
|
| https://www.intuitive.com/en-us/products-and-services/da-
| vin...
| kingkawn wrote:
| Not impossible, there are some good new algorithms for soft
| tissue deformation that aren't CPU killers like even a few
| years ago. Most of the surgical sim software out now is
| either so basic that it isn't good for much beyond cursory
| anatomical review, or it requires some major hardware
| installed in a permanent space with limited use-cases that
| nobody ever bothers to use because at the end of a resident
| shift they just want to go home and sleep.
|
| I'm working for a small company that is trying to bridge the
| gap and make something good that can run on the consumer
| VR/AR hardware that's coming out in the next year or three.
| Lots of interesting problems to solve.
| pc86 wrote:
| What makes you think they're not readily accessible? They are.
| Part of the issue is time. If you're a surgeon, one individual
| surgery is but a small part of your day. There really isn't any
| spare time to "prep" for a surgery other than reading the
| specific of that individual case.
| foldedcornice wrote:
| The submitted article also discusses how a limiting factor is
| time rather than availability of simulators.
|
| The author wrote: "The paper I published in 2019 summarized
| my findings, which were dismaying. The small subset of
| trainees who succeeded in learning the skills of robotic
| surgery did so for one of three reasons: They specialized in
| robotics at the expense of everything else, they spent any
| spare minutes doing simulator programs and watching YouTube
| videos, or they ended up in situations where they performed
| surgeries with little supervision, struggling with procedures
| that were at the edge of their capabilities. I call all these
| practices "shadow learning," as they all bucked the norms of
| medical education to some extent. I'll explain each tactic in
| more detail.
|
| "Residents who engaged in "premature specialization" would
| begin, often in medical school and sometimes earlier, to give
| short shrift to other subjects or their personal lives so
| they could get robotics experience. Often, they sought out
| research projects or found mentors who would give them
| access. Losing out on generalist education about medicine or
| surgery may have repercussions for trainees. Most obviously,
| there are situations where surgeons must turn off the robots
| and open up the patient for a hands-on approach. [...] My
| data strongly suggest that residents who prematurely
| specialize in robotics will not be adequately prepared to
| handle such situations."
|
| The author also listed examples of accessible simulators,
| notably one that uses virtual reality: "In the past five
| years, there has been an explosion of apps and programs that
| enable digital rehearsal for surgical training (including
| both robotic techniques and others). Some, like Level EX and
| Orthobullets, offer quick games to learn anatomy or basic
| surgical moves. Others take an immersive approach, leveraging
| recent developments in virtual reality like the Oculus
| headset. One such VR system is Osso VR, which offers a
| curriculum of clinically accurate procedures that a trainee
| can practice in any location with a headset and Wi-Fi."
| iancmceachern wrote:
| It's because the interface console itself is a big part of the
| cost and complexity of the thing. The simulator requires the
| console and input manipulators to use, so they can't train on
| it while it's being used for surgury. Hospitals could buy a
| second console to use exclusively with the simulator but that's
| a multi hundred thousand dollar piece of equipment.
|
| Surgeons can take a few practice simulations in the Sim, but
| it's just that doing so ties up the robot from doing real cases
| at that time also.
| actionfromafar wrote:
| "multi hundred thousand dollar piece of equipment"
|
| So, pretty cheap, it sounds like? How much is the hourly rate
| of surgeons?
| Calavar wrote:
| When I rotated through surgical oncology as a 3rd year medical
| student, a lot of the cases were robotic.
|
| For a 5 hour surgery, the fellow got to drive the robot for about
| 90 minutes. He spent the rest of the time watching.
|
| The resident made incisions to introduce the robotic instruments
| and then closed at the end. This took about 15 minutes at the
| start of the case and and another 15 at the end. She spent the
| rest of the time standing there and watching.
|
| I wasn't even allowed to scrub in - not enough space with the
| robot docked. I had to stand in the corner of the room for 5
| hours watching the surgery on a monitor. And of course the
| circulating RN wouldn't let me stand in a place with a decent
| view.
|
| I would have had a better learning experience watching a YouTube
| video of a surgery. What a colossal waste of time for all
| trainees involved.
| pixelmonkey wrote:
| I'm a programmer and my wife is a robotic surgeon who did many,
| many operations with these da Vinci machines (and also trained
| with them in residency). Her focus is on what's known as "MIGS",
| described here: https://en.wikipedia.org/wiki/Robot-
| assisted_surgery#Gynecol...
|
| Glad to ask her any engineering- or programmer-minded questions
| that HN folks might have about what robotic surgery is like.
| (I'll collect any that are posted here, turn a list of them into
| a batch for her, and transcribe her answers.)
|
| One thing that I notice that the author of this article leaves
| out is that though trainees are often "watching" a surgery rather
| than controlling it via the second console, this is a much better
| form of "watching" than most surgical trainees are typically
| accustomed. This is because both consoles attached to the robot
| get the immersive PoV of the primary surgeon. This should be
| compared to the alternatives, "'straight-stick' laparoscopy" and
| "open surgery", wherein the view of the surgery for trainees is
| usually quite limited.
|
| FWIW, my wife trained "both ways" (robotic and 'straight-stick')
| and believes there are trade-offs -- it depends on the patient
| condition and what one is trying to accomplish.
| foldedcornice wrote:
| I'm curious to learn more about the main advantages of the da
| Vinci machines in certain contexts, over 'straight-stick'
| surgery.
|
| The article's author, who is a roboticist rather than a
| surgeon, paints a picture where robotic surgery does not have a
| clear advantage over straight-stick surgery due to a lack of
| training: "In fact, a recent survey of 50 randomized control
| trials that compared robotic surgery to conventional and
| laparoscopic surgeries found that outcomes were comparable, and
| robotic surgeries were actually a bit slower. From my
| perspective, focusing on education, it's something of a miracle
| that outcomes aren't worse, given that residents are going to
| their first jobs without the necessary experience. "
|
| To learn from an alternative perspective, what might be an
| example of a patient condition or objective where robotic
| surgery may have a meaningful advantage over conventional
| surgery?
| DoingIsLearning wrote:
| > To learn from an alternative perspective, what might be an
| example of a patient condition or objective where robotic
| surgery may have a meaningful advantage over conventional
| surgery?
|
| Stereotactic surgery in Neurosurgery.
| slt2021 wrote:
| Aren't these non-intrusive and done using gamma knives?
|
| I read somewhere that computer+radiologist perform the
| planning of beams and the gamma knive does all the work
| DoingIsLearning wrote:
| You still have biopsies, SEEGs and anything else that
| requires deep brain invasive action.
| zahma wrote:
| I spoke to a radiologist in a regional hospital in a rural
| area. I believe they were in talks among themselves at the
| hospital to buy one of the da Vinci machines. This physician's
| contention was that new surgeons operating mostly through these
| robots aren't necessarily effective to react to a bleeder
| during a procedure. He was no doubt skeptical of the surgeons
| he was seeing operating with these things. Curious what your
| wife thinks.
|
| Also... any words of wisdom for someone about to enter med
| school?
| ausbah wrote:
| how would your wife respond to the claim in the article that
| the outcomes between robotic and traditional surgeries appear
| the same?
| pc86 wrote:
| Not the GP but my fiance is also an OB and is also qualified
| on robotic surgeries. Robotic candidates are typically more
| difficult cases than more traditional surgeries, so even an
| equal prevalence of positive outcomes would indicate that
| robotic surgeries are worth the additional
| training/time/expense/etc.
|
| I think it'd be pretty hard to do a true apples-to-apples
| comparison. You'd want to find traditional surgeries that
| were complex enough that robotic surgery would be indicated,
| yet for some reason they went ahead with traditional surgery
| anyway. Almost by definition this would push you more toward
| emergent surgeries which have worse outcomes overall given
| their acute nature. You could probably find areas where
| transfer to a facility with a robot would take too long but
| you're bringing in a lot of other confounding variables
| (comparing robotic surgeries at a well funded academic
| institute with lots of residents and fellows to a small
| poorly staffed hospital in the sticks, for example).
| whycombagator wrote:
| > and believes there are trade-offs -- it depends on the
| patient condition and what one is trying to accomplish.
|
| I am interested in the trade offs & what it is not a good fit
| for.
|
| I realize that is a broad "question". But any insight is
| appreciated
| soperj wrote:
| Is there someway for the trainees to do simulations on these
| machines? You'd think if they can simulate landing the space
| shuttle, you could simulate doing a surgery.
| spicybright wrote:
| I'd actually think a surgery simulator is more difficult than
| a space one.
|
| Kind of like the difference between a kebel space program and
| an ultra realistic physics and material simulator.
|
| I'd be shocked if there wasn't at least a few "games" to
| practice dexterity and perform device diagnostics.
| fragmede wrote:
| Eg: Suture Practice Kit (physical, not digital)
| https://a.co/d/g7Ecn72
| iancmceachern wrote:
| Yes, they have simulators that bolt on :
| https://www.intuitive.com/en-us/products-and-services/da-
| vin...
|
| Other manufacturers also have them
| sarpeedo wrote:
| In cataract surgery there are three main kinds of simulation
| I'm aware of.
|
| 1. Computerized i.e. Eyesi Surgical Simulator
|
| 2. Practice surgery with real equipment on synthetic eyes
| designed to replicate human tissue
|
| 3. Practice surgery with real equipment on human cadaver /
| pig cadaver eyes
|
| Many ophthalmology residency programs use a combination of
| these for training.
|
| [0] https://eyewiki.aao.org/Cataract_surgery_training_around_
| the...
| lven wrote:
| There is long term advantage to do robotic surgery in the
| creation of a large learning dataset. All the inputs to the
| surgeon - video, audio, bio metrics - are digitized, and all the
| surgeon outputs like movements and actions and even the
| peripheral actions like dosage changes or orders to nurses, it's
| all digitized. If all the inputs and outputs can be digitized,we
| can also expect the creation of outputs to be automated. Why not?
| senortumnus wrote:
| Surgeon here who does the majority of my "major case" work
| robotically. Author of this article has a coastal-centric point
| of view. My residency was apprenticeship model and I graduated
| very confident in my capabilities to perform robotic surgery
| "skin-to-skin". The phenomenon he references about trainees no
| longer being able to start a surgery without the "attending"
| surgeon present is not related to robotics. It is due to CMS or
| liability (lawyers) or hospital policy regulations (lawyers).
| Same reason medical students are pushed away from direct patient
| care until they graduate and become residents.
|
| See the article on HN yesterday for which the comment section was
| chock full of "tear down the health bureaucracy" rhetoric. If the
| general public comes out saying "we want trainees working on us,
| if it creates better doctors and lowers health care costs" then
| the system can become much simpler and get back to the old days
| of higher autonomy for trainees in academic centers.
|
| Until then, advice for future surgeons: if you want to learn how
| to operate during residency, consider a program in the midwest
| without a lot of fellows.
| stephencanon wrote:
| I don't think it's so much "coastal" as "big-name (and big)
| programs". Wife is an attending at a one-a-year program here in
| the northeast, and the residents definitely get _way_ more
| operating experience then they do at, say, Michigan.
|
| The skills issue you identify with some big-name programs is a
| real thing for sure, though.
| [deleted]
| arcticbull wrote:
| > Many people assume that patient outcomes must be better with
| robotic surgery. It's not obvious that's true. In fact, a recent
| survey of 50 randomized control trials that compared robotic
| surgery to conventional and laparoscopic surgeries found that
| outcomes were comparable, and robotic surgeries were actually a
| bit slower.
|
| Fascinating. I definitely assumed that the robotic surgeries had
| better outcomes.
|
| I wonder how much of this kind of thing is contributing to higher
| costs in US healthcare.
| oneoff786 wrote:
| I wonder if they're more expensive though?
| lostapathy wrote:
| Or is there a bias that harder cases end up on robots, so
| they even "equal outcomes" is a big win for that cohort?
| arcticbull wrote:
| > The cost of the da Vinci robot was obtained from Intuitive
| Surgical. This analysis utilized the $1.5 million da Vinci-S
| robot. The cost of the robot was amortized over 5 years;
| thus, the robot costs $300,000 per year and the service
| contract is $112,000 per year.
|
| So it adds the cost of one extra surgeon, for the same
| outcomes, but slower?
|
| Here's a list of advantages. [1]
|
| [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016020
| elromulous wrote:
| So I suspect we're in a stage similar to where early
| muskets were vs bows. Barely better, possible even worse.
| But we're on a path that let's us unlock many advancements.
| i.e. autonomous surgery.
| oneoff786 wrote:
| Guns were pretty much immediately better. They were easy
| to use, cheap to reload, and you could shoot through
| armor.
| elromulous wrote:
| I'm not sure this is true. Reloading muskets took a long
| time, no? You had to fumble with pouring the powder,
| tamping it, putting in the round, possibly also a sabot.
| "Reloading" a bow takes a second.
| sarpeedo wrote:
| I think we should solve autonomous driving before jumping
| multiple steps to autonomous surgery. There are many low
| hanging fruit in the world of automation; automated
| surgery is not one of them.
| hypertele-Xii wrote:
| Autonomous surgery is probably _easier_ to solve than
| driving, because the patient is lying still. Though you
| 'd still need at least a nurse observing and a surgeon
| standing by. But you could have only one surgeon as
| backup for multiple robots in the same hospital.
| oneoff786 wrote:
| A surgery is a closed task. Driving is an open ended task
| interacting many actors and novel challenges. It's
| probably slow enough that it can visually confirm
| assumptions with a human operator if need be.I would bet
| on the autonomous surgeon over the autonomous driver any
| day.
| RandomLensman wrote:
| Human anatomy is actually surprisingly variable and there
| is, of course, trauma - so novel challenges.
|
| The task is also not necessarily closed at the start,
| i.e., target of surgery is established during the
| procedure and might evolve.
|
| So, I'd take the other side of that bet for surgery as a
| whole.
| iancmceachern wrote:
| It's a big marketing driver for centers.
| arcticbull wrote:
| That was the connection I was thinking it probably had
| with higher care costs. Expensive, shiny things that
| don't actually improve outcomes is a good way to bring
| people through the doors. Like my dentist's LIDAR
| scanner.
| oneoff786 wrote:
| Question: is surgery hard?
|
| I'm aware you need to be steady. I'm aware it can take a great
| deal of time and focus and endurance. But how hard is it to
| figure out a surgery, and execute it?
| skadamou wrote:
| I can't speak to how hard surgery is to perform but I will say,
| from talking to surgeons, it sounds like deciding when to
| operate (and to what extent) is more difficult than actually
| performing the surgery in a lot of circumstances.
| wincy wrote:
| I think it depends on the surgery. Farmers neuter their own
| pigs and cattle all the time which is a type of surgery.
|
| My daughter had brain surgery and we found the actual medical
| paper describing how to perform the procedure. It's basically 6
| sentences long. Cut here, make an incision, use a tool there.
| All while being sure not to accidentally sever an infant's
| spine and make them a quadriplegic. The actual instructions
| were simple enough that I could understand perfectly well how
| to do the procedure based on the document. However, I'm sure if
| I actually attempted the surgery I'd be a nervous wreck. I'd
| guess confidence is probably another part. But maybe a doctor
| will chime in.
|
| I just tried to find the paper but am not sure where we dug it
| up or I'd just post it here.
| 0des wrote:
| barber chirurgeons
| hinkley wrote:
| Any beginning woodworker quickly learns how much of the job
| is not just making a straight cut but juggling a whole ton of
| shit you didn't think about.
|
| And that's all without getting into things like how much of a
| grace period you have between the first cut and the last
| fastener, which you don't have with a living organism.
| galdosdi wrote:
| I imagine the trained surgeon knows what to do when anything
| goes wrong following those 6 simple instructions, and from
| thence flows confidence.
| usrn wrote:
| I think a lot of it is the knowledge of the rest of the body
| and the ability to adapt when something doesn't go exactly
| according to plan.
| pc86 wrote:
| My fiance does a lot of abdominal surgeries, including
| robotic. There are a handful that are "difficult" in the
| traditional sense - lots of complicated steps, indications
| and contraindications for different methods to complete the
| same task, etc - but by-and-large most of them are following
| a set of prescribed steps. For her, because the surgeries are
| abdominal, a lot of the difficulty comes in when dealing with
| patients of larger weight and/or who have had lots of
| previous procedures. A surgery that takes 45 minutes on a
| 110-pound 17 year old with no major medical history can
| easily take 4 hours or more for a 400-pound woman with
| multiple c-sections and multiple other surgeries. Scar tissue
| distorts the anatomy, it's just physically more difficult to
| move past outer layers, etc.
| iancmceachern wrote:
| There are a lot of difficult non-obvieous things to watch for
| and know. It's like an old cardiac surgeon told me, he can walk
| into a room and know from across the room if the patient has
| high blood pressure, is this, is that, just by their coloring
| etc. It's the same way watching the experienced surgeons do
| their work, they know so much about a patient just by looking
| around inside, this means that, etc. Wisdom.
|
| To answer your question, basic surgury isn't (difficult). Good
| medicine is. The more complex the issue, the better medicine
| you need.
| soontobesurgeon wrote:
| I am currently a senior surgical trainee at a major American
| academic medical center (1 year to go out of 7). Thought I can
| provide some insight on some of the primary questions I see in
| the comments:
|
| Before addressing anything further, robotic surgery is probably a
| misnomer, a better classification would be robotic assisted
| laparoscopic surgery. Once in place and spatial / positional
| orientation is obtained, the robot remains a tool directly
| controlled by the surgeon, no automation of the actual surgery is
| involved.
|
| 1: Regarding the actual commentary in the article:
|
| Surgical trainees have transiently suffered in the still (early)
| adoption of this technology as the Attending surgeons themselves
| are often recently trained in robotic assisted surgery and lack
| confidence in letting trainees take full control. In the hands of
| an experienced attending surgeon, the trainee experience is
| comparable with any other surgery. Most academic centers should
| have two consoles, one for the resident and one for the
| attending, and control is easily handed off.
|
| As is appropriate, robotic training is being increasingly
| incorporated into surgical training, with some programs being
| more advanced than others. There are a few classes (I.e
| graduation years) of trainees that have / will be left out of
| this due to the relatively recent and ongoing adoption. Overall
| though this is a transient issue that is being actively resolved.
|
| 2) Is surgery hard?
|
| While in many way surgery is similar to mechanical repair /
| construction, the human body is much less discrete and
| predictable than most mechanical objects. While some surgeries
| are straightforward and can be learned quickly (I.e with 30-100
| cases), there is an enormous variation in complexity and risk
| even with a particular surgery. For example, laparoscopic
| appendectomy is a common surgery that is considered to be "easy".
| However there is a lot of subtlety in that assessment. First
| appendicitis can range in severity, with severe cases lacking in
| identifiable anatomy and often requiring a procedure of
| fundamentally higher complexity. How would you replace a clutch
| if you can't actually see the clutch, are not sure where it is,
| and it is surrounded but a wide range of other critical
| components that would be irreparably damaged if they are touched
| in the wrong way. In addition, a lot of the learning is
| determining how hard you can safely pull or push without
| inadvertently hurting something or causing substantial bleeding,
| which is a learned skill. Finally, surgery is an extension of
| medicine, so you also have to learn how to determine a diagnosis,
| whether or not a surgery is indicated, what specific surgery is
| indicated, and how to take care of your patient post operatively
| to minimize complications.
|
| All of this usually takes many years of hands on experience.
| Reading about something (and there is a lot to read) doesn't mean
| you know how to safely and appropriately manage an issue.
|
| 3) What benefits are there to robotic assisted laparoscopy
| compared to traditional laparoscopy
|
| The robotic arms add a fully rotating "wrist" joint near the tip
| of the instrument which adds multiple degrees of freedom to the
| standard straight sticks of laparoscopy (which only has rotation
| of the instrument tip). This adds for much more flexibility in
| tight spaces, such as the pelvis, or in areas where rigidity
| limits mobility of the instruments (the chest). Related to this,
| it improves surgeon ergonomics in many cases. It's use is also
| being explored to allow for much more complex cases than have
| been possible with traditional laparoscopy due to awkward working
| angles, such as massive ventral hernia repairs. In addition it
| has a larger dual camera (for stereoscopic 3d) and comes with a
| more complex co2 insufflation system which both insufflates and
| drains air, greatly improving visualization (though this can
| theoretically be used with standard laparoscopy).
|
| In terms of outcomes, for most cases there probably won't be a
| difference, but a lot of the benefit is likely in intangible
| things like surgeon ergonomics, improved visibility, and enabling
| some cases that are simply too difficult or awkward to do safely
| with traditional laparoscopy.
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(page generated 2022-07-05 23:01 UTC)