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"To talk about surgical robots is also to talk about surgery."
With those words, the talk begins. Surgeons cut, reshape, reform flesh.
If it was done anywhere but in the operating room, it would be illegal,
and it would be horrific.
Surgical instruments and the evolution of surgical technology go together,
hand in hand, and cannot be separated. 10,000 years of surgical history
are thus condensed into this talk, starting at 1:32 with holes in skulls.
Judging by the healing on the borders of the holes, these people with
holes punched in their heads, lived. They lived for weeks, even months
after surgery. As the bronze age hits, tools improve, and as tools improve,
surgeons become more daring.
Performance art surgery is discussed in depth, where travelling surgeons
would perform surgery in front of an audience - as there was no anaesthetic.
Anaesthetic finally came in the 18th century - the removal of sensation.
This is when surgery really exploded, when surgeons could delve deeper
than ever before. The upshot was, patients died far more quickly than
they ever had before - massive infection of deep tissues.
They learned that you should wash your hands before surgery as well
as afterwards. The death rate dropped, and you could start doing surgery
all over the body. The problem was as incisions got deeper, they got
wider, and sometimes the entire arm or torso was completely opened up,
skin peeled away, and 20 inches or more of cut to get at deep tissue
to see what they were doing.
Patients had a hard time recovering from that, so along came laparoscopy.
This process of doing surgery via minimalist incisions was only really
possible with the computer revolution, as it involved holes in the outer
tissues no wider than the size necessary to get a camera system and
a set of tools into the patient. Very little tissue to cut, means very
little to heal. This was the dawn of roboticisizing surgery.
Some of the tools had been around since the 1880s as a diagnostic technique,
but it was only first used for actual surgery in the 1980s. At 07:40
we see a short film of a laparoscopic procedure carried out on a human,
from the camera's point of view.
Within 10 years of the first of a given type of surgery being done
laparoscopicly, the trend was for the majority of such surgeries to
be done laparoscopicly. However, laparoscopic techniques are a lot harder
to learn than the previous sorts, and mistakes were made more frequently.
Surgeons gave up 3D vision, their wrists ,and intuitive motion of the
instruments in order to operate this way.
In order to overcome the problem, a wrist needs to be put back on the
operating instrument. The only way to do this of course is to turn them
into robotic arms. It was from this realisation that robotic surgical
systems like the Da Vinci were born.
The robotic wrist, pictured at 9:30 allows precise, deft placement
of tools right in the flesh, bringing the effect of the surgeon's own
wrist back. Rather than holding long tools, the surgeon's hands fit
directly into a tactile interface that controls the robotic hands inside
the body. Every tiny motion of the surgeon's hand is replicated precisely,
with the tool.
With the addition of a stereoscopic camera, the surgeon has depth of
field back, with each lens reporting to a different eye. It has achieved
such a fine degree of control that bypass vessels have been sown onto
a live, beating human heart.
Its so good of course that it almost seems that all surgery should
be done this way. A major problem however, is cost. A Da Vinci robot
costs as much as it would be to make a life size model of the surgeon
in solid 24 carat gold.
Another limitation is if you need to operate in several different places
at once, a da vinci system won't work. It takes too long to calibrate
at each location. Ther next challenge then, is to fix that.
One idea is to bring all the instruments together in one place, so
no further calibration is required. The cameras and all the instruments
into the body together, through a single tube.
We also need to take our eyes into the body in new ways, to see below
the surface of the body naturally, not just via a single camera. Biomarkers
and VR overlays are starting to be utilised.
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