Is an autonomous robot better than a human surgeon?

That was the headline on the website BGR [“a leading online destination for news and commentary focused on the mobile and consumer electronics markets”].

Engineers working with the Smart Tissue Autonomous Robot (STAR) claim it can cut skin and tissue with more precision than a surgeon.

A paper they presented last month at the International Conference on Intelligent Robots and Systems featured a video supposedly proving the point.

STAR works “by visually tracking both its intended cutting path and its cutting tool and constantly adjusting its plan to accommodate movement.” The intended cutting path must be marked by a human beforehand. So, it is not really autonomous; rather it is semi-autonomous.

The video can be seen in its entirety here or you can watch two excerpts below. The first is the robot using cautery to make a straight 5 cm skin incision which is compared to an unidentified surgeon cutting a similar incision. Watch approximately 15 seconds of this clip.



As you can see, the surgeon strays from the intended path about halfway through the process. But note that the surgeon is not holding the cautery the way most surgeons would use it. The proper way to hold the instrument is as if it were a pencil. No human could possibly cut a straight line holding the instrument as far away from the tip as the video depicts.

A second video shows the STAR excising a geometrically shaped pretend tumor.

Note: Although the video is being shown at 4X speed, it is still painfully slow. It is not clear what would happen if the robot encountered a blood vessel that bled despite the use of cautery, which by the way is not the instrument of choice for excising many tumors.

What we have here is a nice example of a “straw man” which is comparing a new technique against a phony one to make the new one look better.

Another website, IEEE Spectrum, went with this headline:

The headline should have read:

[Type straw man or artificial intelligence in the search field to your right on my blog site for more posts about these two topics.]

More on artificial intelligence in medicine and surgery

Part 1

A survey published in the journal arXiv predicted with a 50% probability that high-level machine intelligence would equal human performance as a surgeon in approximately 35 years. See graph below. 

Click on the figure to enlarge it

We have already seen a machine beat the world’s best Go player. Although Go is a complicated game, it lends itself to mathematical analysis unlike what one might experience when doing a pancreatic resection.

A potential flaw in this study is that the surveyed individuals were all artificial intelligence researchers who predicted that machines would not be their equal for over 85 more years with the 75% likelihood of this occurring being over 200 years from now.

I suspect if surgeons were asked the same questions, we would say it would take over 85 years for machines to be able to operate as well as we can and 35 years until artificial intelligence researchers would be replaced by their creations.

[Thanks to @EricTopol for tweeting a link to the arXiv paper.]

Part 2

Similar to the question “who is responsible if a driverless car causes an accident?” is “when artificial intelligence botches your medical diagnosis, who’s to blame?” An article on Quartz discussed the topic.

[Digression: The article matter-of-factly states “Medical error is currently the third leading cause of death in the US… ” This is untrue. See this post of mine and this one from the rapid response pages of the BMJ.]

If artificial intelligence was simply being used as a tool by human physician, the doctor would be on the hook. However indications are that artificial intelligence may be more accurate than humans in diagnosing diseases and soon may be able to function independently.

If a machine makes a diagnostic error, are the designers of the software responsible? Is it the company that made the device? What about the entity owns the system? No one knows.

The Quartz piece did not address this. Who is responsible if a nonhuman surgeon makes a mistake during an operation?

I’m sorry I won’t be around 35 years to hear how this is settled.