Can surgical robots replace surgeons?

China Business News (Reporter Ma Jiawen/Photo)The flexible robotic arm moves slowly, and the 10x high-definition endoscopic lens magnifies the structure of the affected area. The robotic arm performs precise surgery under the control of the surgeon. Surgical operation... The surgical robot, which looks very cool, currently has less than 1% chance of participating in surgeries in our country. But in the future, "robot doctors" are expected to have "fixed posts" in hospitals.

So, how do surgical robots work in hospitals, what are the thresholds for use, and are they expected to completely replace surgeons? With these questions in mind, a reporter from China Business Daily went to United Family Healthcare Beijing District (hereinafter referred to as Beijing United Family) to have an on-site visit on the implementation of “robot doctors”.

The doctor is operating the da Vinci surgical robot.

When the robot enters the operating room

How does a robot perform surgery? A reporter from China Business Daily saw that taking orthopedic surgical robots as an example, the surgical robot will formulate a surgical plan based on preoperative imaging data, and then the doctor will determine the plan. During the operation, the doctor controls the robot and, with the help of the computer navigation positioning and tracking system, locates the location of the lesion and performs the actual operation.

The robot's mechanical arm replaces the doctor's "hands". Take the flexible manipulator of "Da Vinci" as an example. It introduces the concept of "wrist joint", which can move up and down, front and back, left and right, rotate, open and close, and bend, and the range of movement of each joint is greater than 90 degrees, which exceeds The limits of human hand activity.

Zhu Gang and Da Vinci Robot. (Picture provided by interviewee)

It is understood that the surgical robot mainly consists of three parts: a robotic arm, an imaging system and a computer system. According to the medical environment and the actual needs between doctors and patients, the process is compiled and actions are performed to assist positioning, imaging modeling, and surgery. operations and other purposes. Different types of robots have different purposes and compositions. The most commonly used surgical robots at present are endoscopic surgical robots, orthopedic surgical robots, neurosurgery robots and vascular interventional treatment robots.

The robot’s imaging technology also makes the surgeon’s vision more precise. "Compared with traditional laparoscopic surgery, the three-dimensional high-definition imaging of da Vinci robotic surgery allows doctors to see more clearly," said Zhu Gang, deputy director of Beijing United Family Medical. "The robot's movements are more accurate and detailed. For example, patients The lesions need to be peeled off layer by layer. The robot can not only separate the tissue structure like 'peeling an onion' and remove only the 'core' with lesions, but also minimize the damage to the surrounding normal tissue structures. Compared with open surgery and ordinary abdominal surgery Compared with endoscopic surgery, patients who use robot-assisted surgery have a significantly lower chance of postoperative complications."

Robots may help doctors realize the best idea for surgery. Lu Jike, director of the Department of Orthopedics at Beijing United Family Hospital, said that taking the Mako orthopedic robot as an example, it can help doctors complete the crucial positioning steps in surgery efficiently, accurately and safely, and realize the doctor's best idea of ​​the position of the joint prosthesis. The clinical accuracy of the Mako orthopedic robot can reach 1 millimeter, which can significantly reduce the number of fluoroscopy during patient operations.

Still needs a doctor to perform the surgery

Da Vinci surgical robot is currently the most successful and widely used surgical robot in the world. Relevant data shows that as of 2022, 315 machines have been installed in mainland China, and 100,400 surgeries have been completed in the country throughout the year. On average, each da Vinci surgical robot can complete 318.7 surgeries a year. In Asia, on average, a da Vinci robotic surgery is performed every 2 minutes.

Intuitive Fosun data shows that among non-public medical institutions, Beijing United Family currently ranks first in the total number of da Vinci surgeries performed, reaching 875. Zhu Gang said that they will apply Da Vinci to more surgical procedures in the future.

After robots enter the operating room, will surgeons still have a role to play? Zhu Gang said that robots cannot yet replace surgeons, but they can only provide surgeons with "eagle eyes" and "dexterous little hands", making surgical operations more precise and stable. At present, the robot is still only controlled by the surgeon, who still needs to control the camera angle and the depth and position of the robot arm according to the intraoperative situation. It is worth looking forward to whether surgical robots can "intelligent dialogue and communication" with doctors in the future.

Take the da Vinci surgical robot as an example. Surgeons can clearly see "dead spots" through Da Vinci's high-definition field of view, control the robotic arm to contact locations that are difficult to reach with human hands, and operate and suture around organs at different angles. And it was the surgeon who controlled Leonardo da Vinci to complete the task.

Lu Jike and Mako orthopedic robot. (Picture provided by interviewee)

“By controlling the Mako robotic arm, doctors can complete some actions and steps that cannot be completed or are not completed well in traditional surgeries, reducing surgical risks, shortening the duration of surgery and hospital stay, and bringing better and more subtle benefits to patients. The effect of invasive surgery." Lu Jike said.

"If surgical robots become more intelligent in the future and there are surgical robots that can replace surgeons, we are looking forward to it." Zhu Gang said, "We can use the time saved to communicate more with patients. , giving patients more care."

Price is still the “threshold” for application

“How many laparoscopes there are now, how many surgical robots may be needed in the future.” Zhu Gang described to reporters, “Currently, the price of surgical robots is indeed relatively expensive, which is the key reason for restricting the entry of surgical robots into hospitals. Now more and more companies are producing surgical robots, including many domestic companies, and we can expect that surgical robots will become more popular."

Expensive price may be an important reason limiting the popularity of surgical robots. Data from Frost & Sullivan shows that in 2020, a total of 189 laparoscopic and joint replacement surgical robots were installed in China, with surgical penetration rates of approximately 0.5% and 0.1% respectively.

It is worth noting that in addition to the cost of purchasing machines, training doctors who can operate surgical robots is also a considerable "expense" for the hospital.

Surgeons have their own surgical operating habits after years of clinical accumulation. On this basis, using surgical robots requires special training and accumulation of experience in robotic surgery in practical applications. Zhu Gang has 8 years of experience in operating surgical robots. He believes that robotic surgery is very different from traditional open and laparoscopic surgery in terms of modes and operating habits, which is a challenge for new robotic surgeons, and these require time to learn and improve.

Pan Zhongying, president of Beijing United Family Hospital, said: "It is difficult to calculate the financial accounts because we don't know how many patients will choose robot surgery. Taking orthopedics as an example, investment in new technologies, What needs to be considered is to build an excellent orthopedic team with the assistance of advanced equipment. After the discipline is developed, more patients will be willing to choose Beijing United Family when facing orthopedic problems, and more doctors will be willing to Come to Beijing United Family to work.”

With the advancement of technology, "robot doctors" may have "fixed posts" in hospitals in the future.

Hou Yan, chairman of the China Medical Equipment Association, told reporters that in the past five years, the average compound growth rate of China's surgical robot market has exceeded 30%, which means that more and more medical institutions are introducing and applying surgical robots.

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