Friday, February 17, 2017

Will robots eliminate the need for surgeons?

A medical student from Germany emailed me saying he had always wanted to be a surgeon, but someone told him that by 2030 surgeons would no longer be needed because robots would be doing all the operations. He worried that after years of studying and hard work, he might lose his job to “R2-D2.”

He mentioned IBM’s Watson and a recent paper that appeared in the journal Science Translational Medicine about a robot that can handle and suture bowel.

He asks, “What do you think about the future of surgery?”

Thank you for your email and the link to the paper.

I read the paper and was amused by its title "Supervised autonomous robotic soft-tissue surgery" which is an oxymoron. The definition of autonomous is "acting independently or having the freedom to do so." This “supervised” robot is not really autonomous.

The robot is capable of performing a nearly technically perfect intestinal anastomosis but still needs a human surgeon to open the abdomen, prepare the bowel for the procedure, tidy up, and close. I'm not sure that this is any different than when surgical staplers were introduced. This robot is simply making the operation easier and possibly more precise.

Surgeons will still be needed in case the robot makes a mistake like causing bleeding while placing a suture near the mesentery. If bleeding in that area is not promptly controlled, a large hematoma can develop and possibly compromise the blood supply to the anastomosis. And will the robot be able to decide who needs an operation and when to do it?

One worrisome byproduct of surgical stapling is that many graduates of residency programs within the last 15 or 20 years have little experience in performing a hand sewn bowel anastomosis. What will they do if the hospital runs out of staplers? Soon, I guess they could consult the (somewhat) autonomous robot.

I have written about automation and the erosion of surgical skills. This problem also affects pilots. I have also addressed the concept of  robots operating alone. I don't see it happening any time soon.

I think there will always be a need for surgeons. Even the smartest robot is going to have some trouble dealing with a trauma patient who is hypotensive.

The future will take care of itself. In the 1980s, people were concerned about the demise of general surgery. Opinion pieces with titles like “Will the general surgeon become extinct?” and “Is general surgery a dying specialty?” appeared in major journals like JAMA and the World Journal of Surgery.

Then in 1990, laparoscopic cholecystectomy opened the door to a whole new area of general surgery that no one had ever dreamed of.

Good luck with your studies and your surgical career.


Korhomme said...

This is the area of 'codifiable' and 'non-codifiable' knowledge. Codifiable knowledge means that we can put routines into an algorithm which the programmed machine can follow. Non-codifiable knowledge is the stuff that can't easily be put as algorithms. Thus, we can instruct the robot to make a skin incision so many inches long for a particular operation; what we can't, or what is much more difficult, is to tell the machine just how hard to press the knife to get a clean, incised cut.

Anonymous said...

Unfortunately "robots/computers do XXX better than humans" has become a lead that bleeds.

Skeptical Scalpel said...

Kor, good point. I agree with you.I have always said programing a robot to do a cholecystectomy would be difficult due to the high incidence of anatomic variability.

Anon, Sad but true.

artiger said...

Does a (human) surgeon supervise the robot? If not, and there's a complication, can the robot be sued? Does the robot need to carry liability insurance? If so, who pays for it?

So many unanswered questions and unconsidered issues, so little time. Even though that might seem like a sarcastic comment, raise your hand out there if you think there our legal system will have made many significant changes 13 years from now.

RobertL39 said...

Surgeons need have NO fear. There are at least 2 things I can think of that they'll never teach robots to do: sit on committees and do massive data entry. Guys, your jobs are safe as can be.

frankbill said...

Artiger the robot surgeons will be defended by the robot Lawyers. As the link says Lawyers could be the next profession to be replaced by computers.

Skeptical Scalpel said...

Artiger, same issues with driverless cars.

Robert, I agree surgeons will still be needed to sit on committees.

Frank, I wonder if juries will be replaced by robots too.

drinkingfromthefirehose said...

Don't fear the future - it's already here.

"Robots" already augment surgeon performance by driving the camera (Synaptive exoscope), the davinci system, through guidance for spinal instrumentation (Mazor) and in countless other ways. The bowel anastomosis 'bot is just another example of how robots will continue to augment human performance rather than replace it. And moving a technology demonstrator to an approved device takes ~a decade and $billions.

Watson proves this challenge. Even though it can beat us at Jeopardy, we can't get Watson to provide clinically useful diagnostic medicine despite years of effort and over $50m (

Surgeons are not taxicab drivers (replaced by self-driving uber) or fighter pilots (drones). I don't know of any group seeking to replace us en bloc, for all of the reasons mentioned above, and others.

In my estimation, the future of surgery has never been brighter. Robots and other tools will become indispensable allies as we perform more intricate and complex operations on sicker (older) patients. Surgeons should guide the development of new tools and devices to create new possibilities (less morbidity, better quality interventions) in the care of our patients.

I would advise your young friend to see tremendous opportunity in this developing, disruptive technology.

Anonymous said...

RobertL39 you missed one:

be target practice. I'll leave it to you gentlemen here who and/or what groups have you in the bullseye.

Skeptical Scalpel said...

Drinking, thanks for the positive comments. I agree with you.

Anon, I'm glad you didn't list the groups. It would have been a very long comment.

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