The Robotic Renaissance in Healthcare

At the forefront of the technological revolution, unfolding in the landscape of healthcare, is the integration of robotics. Robots are beginning to transform the healthcare field both within and beyond the operating room. Robotic aids can streamline healthcare by improving surgical precision, enhancing rehabilitation through targeted exercises, and optimizing diagnostic procedures. This innovation meets precision within robotic-assisted surgeries, new procedures developed alongside our technological progress. Robots are becoming invaluable allies to surgeons, providing unprecedented levels of accuracy and control in the operating room.

During robotic surgery, a surgeon uses a specially trained robot and a high-definition, three-dimensional camera to perform the procedure. The camera magnifies the body tenfold, enhancing visualization and guiding the surgeon. Computer vision research is revolutionizing robotic surgery by enabling advanced image recognition and interpretation, allowing surgical robots to navigate with heightened precision, distinguishing vital structures rapidly, providing real-time feedback to surgeons for more informed decision-making during procedures.

However, the integration of robotics into surgery is one that can garner conflicted opinions from the general public and physicians. It undeniably stands as a tremendous asset, elevating the standards of precision and patient care. Still, as we embrace this technological leap, it is crucial to maintain a delicate balance. While robotics offer unparalleled advantages, we must resist the temptation to overly rely on automated processes. The optimal synergy lies in a symbiotic relationship, where human expertise and judgment harmonize with the precision and capabilities of robotic aids.

Robots are not only limited to the operating room; they are also making strides in rehabilitation and physical therapy. These robots can help physical therapists provide targeted exercises and a consistent training regime, ensuring improved recovery. Thus, the marriage of technology and therapy presents a new frontier in rehabilitation and patient care.

With the invention of new procedures and treatments that rely more and more on robotic assistance, physicians are facing conversations about the role of technology in healthcare. There are benefits and drawbacks to the increased reliance on robots, and it is necessary to determine where this balance lies. The future of healthcare is not a binary choice between human or machine but a dynamic synthesis, where the potential of both is harnessed to advance medical practices, ultimately ensuring a holistic and patient-centered approach to healing.

Reviewed by: Laila Khan-Farooqi

Graphic by: Heiley Tai

From Human Hands to Metal: The Potential Pros and Cons of Robotic Surgery

This past summer I had the opportunity to witness the impact of technology in healthcare from a front row seat. I spent a month shadowing anesthesiologists at a prestigious hospital in New York City, where I saw procedures in the operating room ranging from brain surgeries to c-sections to robotic heart surgeries. I was fascinated by the expansive implementation of technology in these procedures, with unique machinery used for many complex surgeries.

One area that particularly fascinates me is robotic surgery - a procedure that refers to doctors utilizing robots to guide their actions. It is a common misconception that robotic surgery is independent of human control and involves only the machinery and the patient. In reality, this type of surgery includes one or more robot arms that are remotely and accurately controlled by doctors from a nearby console (Chopra et al., 2022). A laparoscope, a small tube with a light and camera, is inserted along with the robotic arms to provide a clear view of the procedure for the surgeons. This tool can capture the patient's insides with a three dimensional view (Mayo Foundation, 2022). The robotic arms are controlled by a joystick, much like the ones used in video games, which can replicate the movements of the wrist and provide dexterity.

Technology in healthcare is a controversial topic and this is certainly true when it comes to robotic surgery. As with any surgical procedure, there are certain risks that come with it. However, research shows that there are more pros than cons for certain procedures when it comes to human versus robotic techniques. Some pros for robotic surgery include the enhanced precision, flexibility, and control during the operation which allows for a clearer and closer view of the surgical site compared to traditional techniques. Robotic surgery also makes it easier for surgeons to avoid surrounding nerves and organs (UC Davis). The surgeons are able to perform more complex techniques with smaller tools and an instrument steadier than a hand. In fact, some procedures, previously deemed impossible, have even been enabled by the implementation of robots.. Furthermore, robotic surgery is less invasive and has been found to have a decreased risk of complications like surgical site infection, less pain and blood loss, shorter hospital stay and recovery time, and smaller scars (Mayo Clinic, 2022).

On the other hand, there are specific risks associated with robotic surgery, with the most prominent being technological malfunction. There is not only the risk of human error with the surgeon operator but also the potential for mechanical failure when robots are introduced. Some common risks include electrical arcing which can lead to sparking or burns and nerve paralysis due to extreme body positioning or direct nerve compression. There is also an associated high cost of robotic surgery since the machinery is difficult to maintain, therefore often increasing the surgical price. Additionally, robotic surgery is not meant for everyone. There are certain medical situations, or comorbidities, such as a recent heart attack, that make a patient a bad candidate for robotic surgery (Pai et al., 2023).

This summer I was lucky enough to be able to observe heart surgery while sitting in one of the robotic consoles next to the head surgeon for a robotic mitral valve replacement. There were two robotic consoles, but they only needed one for the procedure, so I was allowed to sit in the other console and observe the procedure through the 3D laparoscopic lens. The experience was unforgettable. There was such a clear and accurate field of view through the robotic lens and the precision of the surgeon through the robotic arm was incredible. Another surgeon sat next to the patient and changed the robotic arms to what the head surgeon required, took out the specimens, and talked through the surgery with all those involved, including the anesthesiologist and nurses in the operating room. There was very little blood loss and when the surgeons explained the typical recovery process for this kind of procedure I was shocked. The idea that such a potentially invasive surgery, operating on one’s heart, could be reduced to a few hours and have fairly minimal scarring and recovery process is amazing. While there is certainly room for further research in the area, it is reassuring that technology has the potential to play such an important and impactful role in medicine today.

Reviewed by: Jerry Liu

Graphic by: Radhika Subramani

References

1. Chopra, H., Baig, A. A., Cavalu, S., Singh, I., & Emran, T. B. (2022). Robotics in surgery: Current trends. Annals of medicine and surgery (2012), 81, 104375. https://doi.org/10.1016/j.amsu.2022.104375

2. Mayo Foundation for Medical Education and Research. (2022, May 6). Robotic surgery. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/robotic-surgery/about/pac-20394974

3. Pai, S. N., Jeyaraman, M., Jeyaraman, N., Nallakumarasamy, A., & Yadav, S. (2023). In the Hands of a Robot, From the Operating Room to the Courtroom: The Medicolegal Considerations of Robotic Surgery. Cureus, 15(8), e43634. https://doi.org/10.7759/cureus.43634

4. Robotic surgery: Risks vs. rewards. Patient Safety Network. (n.d.). https://psnet.ahrq.gov/web-mm/robotic-surgery-risks-vs-rewards

UC Davis Health, P. A. and M. (n.d.). About robotic surgery at UC Davis Health. Robotic-Assisted Surgery | Surgical Services | UC Davis Health. https://health.ucdavis.edu/surgicalservices/roboticsurgery/#:~:text=The%20key%20differences%20of%20using,avoid%20surrounding%20nerves%20and%20organs.

Artificial Intelligence’s First Cardiologist: How Algorithms Can be Used to Improve Risk Assessment

How can AI help us tackle the persisting problems in the medical field today? Can AI diagnose more accurately than a trained physician? What is AI not capable of accomplishing? As we near the end of 2023, these questions appear to be more relevant within the world of healthcare than ever before. As demonstrated by recent applications in the field of cardiology, AI has the potential to revolutionize preventative care and treatment, but only if utilized carefully and equitably.

A new study from Cedars-Sinai, a prominent hospital in the heart of Los Angeles, has presented a groundbreaking AI coronary imaging device that is aiding cardiologists in plaque and stenosis quantification. Due to its quick response times and extreme precision, this new technology is providing promising insights into a future focused on cardiac risk prediction (1). Damini Dey, PhD., pioneer of the study and Director of the Biomedical Quantitative Image Analysis Lab at Cedars-Sinai, explains how fundamental these prevention-based practices are in reducing the number of cardiac-related deaths. She elaborates that the first sign of plaque buildup within coronary arteries is often chest pain that precedes a heart attack, which is often misattributed by the patient as anxiety or a panic attack. This makes it particularly challenging, time-consuming, and costly to identify high-risk patients with immediate cardiac complications. Consequently, plaque buildup can rapidly develop and cause arteries to narrow without proper treatment, which makes it difficult for blood to reach the heart and keep the body alive. For this reason, it is important to investigate the ways in which potential preventative measures can be implemented.

These statements are further supported by data from an international study called the SCOT-HEART trial, in which investigators confirmed the accuracy of measurements made by this AI algorithm from CTA (computed tomography angiography) images that predicted heart attack risk within five years for approximately 1,611 participants (2). The algorithm outlines the coronary arteries in 3D images, which allows it to identify the presence of blood and plaque buildup within the vessel (1). Results from the algorithm are also comparable to two existing invasive tests, intravascular ultrasound and catheter-based coronary angiography, that are used to analyze plaque deposits and artery narrowing.These deep-learning AI systems showed significant time reductions when compared to analysis by imaging specialists and physicians (1).

“This novel research could have broad applications,” claims Sumeet Chugh, M.D., Director of the Division of Artificial Intelligence in Medicine at Cedars-Sinai and the Center for Cardiac Arrest Prevention in the Smidt Heart Institute (3). Chugh further explains that “AI algorithms enable physicians to communicate more personalized information regarding potential timing of imminent heart disease events, allowing patients to engage more meaningfully in the shared decision-making process.” Even more importantly, this tool has placed a needed sense of prioritization and urgency on heart disease prevention efforts by both patients and providers.

However, in order for these data-led initiatives to make visible impacts, patients must be willing to instill complete trust in these new AI tools. Dr. Liu Nan, Associate Professor of Quantitative Medicine at Duke-NUS School of Medicine, credits the current lack of trust within the rapidly expanding medical technology to its absence within actual clinics (4). This is especially true for resource-constrained communities whose hospitals cannot afford this expensive equipment or specialized expertise.

How can we encourage trust in these new technologies for patients who face barriers in accessing it? With appropriate implementation into isolated and resource-lacking communities, we can use AI to facilitate the development of more affordable, higher quality, and accessible preventative healthcare. Amidst much uncertainty in the digitalization within the world of medicine, it is imperative that we do not lose sight or hope in our ability to provide equitable pathways to healthcare for patients who have been historically excluded from access to these preventative systems.

Reviewed by: Camille Krejdovsky

Graphic by: Ariha Mehta

Works Cited:

1. Cedars-Sinai Medical Center. (2022, March 30). Artificial Intelligence Tool May Help Predict Heart Attacks. Artificial Intelligence Tool may help predict heart attacks. https://www.cedars-sinai.org/newsroom/artificial-intelligence-tool-may-help-predict-heart-attacks

2. Lin, A., & Manral, N. (2022, April). Deep learning-enabled coronary CT angiography for plaque and stenosis ...A. The Lancet. https://www.thelancet.com/journals/landig/article/PIIS2589-7500(22)00022-X/fulltext

3. Cedars-Sinai Medical Center. (2023, August 9). Can Artificial Intelligence Predict Heart Attack Risk?. Can artificial intelligence predict heart attack risk? https://www.cedars-sinai.org/newsroom/study-artificial-intelligence-may-predict-heart-attacks/

4. Duke-NUS Medical School. (2023, April 13). Clinical trial of Duke-NUS, SGH co-developed AI system underway following HSA approval. https://www.duke-nus.edu.sg/allnews/news-highlights/aitriage