Dr Jörg Traub, Managing Director of MedTech Pharma e.V., (l) talked to Dr Dirk...
Dr Jörg Traub, Managing Director of MedTech Pharma e.V., (l) talked to Dr Dirk Wilhelm (r) and Daniel Ostler (c) who presented a vision of the OR of the future and discussed the challenges and opportunities of digitalisation.
Source: Screenshot from MedTech Talks

Robotics: man and machine in the OR

Robots and digital technologies continue to conquer healthcare – indeed, in the OR they have pretty much become part of clinical routine. Nevertheless, there is an ongoing debate as to whether the extensive usage of robots in the short-term is realistic and sensible. Moreover, the benefits such systems offer for patient care are disputed.
Professor Dr Dirk Wilhelm, Head of the Working Group MITI (Minimally Invasive Therapy and Intervention) at Klinikum rechts der Isar, Technical University Munich, und Daniel Ostler, Head of Research of the Working Group MITI, addressed these issues in the last session of MedTech Talks, an initiative of M3i GmbH and Forum MedTech Pharma e.V.

Digitalisation and robotics are very important to us,” Professor Wilhelm, managing senior consultant in the department of abdominal surgery at Klinikum rechts der Isar, said right at the beginning of the session and explained that they can help reduce traumatic patient experiences, facilitate healthcare training and offer new treatment approaches that go far beyond what’s currently possible: “The advantage of robotic systems is the fact that they accurately follow instructions. […] These machines do not make errors.”

Managing the data flood

A precondition for the application of new technologies is the availability of data as Dr Ostler pointed out: “Data is the crucial factor in this development – apart from algorithms, obviously.”

Over the past few years, data-driven approaches yielded the highest number of innovations in healthcare, according to Dr Ostler. Imaging and dermatology are areas with sufficient and well-structured amounts of data. Surgery, unfortunately, is lagging behind, as Ostler pointed out and added that he problem is no longer obtaining the data but accessibility, interpretation and comparability.

A surgical robotic system for example records several thousands of data points – per second. But manufacturers do not release all data which forces researchers to negotiate access. While there are initiatives to standardise communication among devices in the OR such as Or.Net in Germany or the Medical Device Plug-and-Play Interoperability Program in the USA, it takes time for standardized networks to be established, Ostler reported. Professor Wilhelm adds that the sheer volume of data has become difficult for clinicians to process: “We have innumerable publications and knowledge is increasing exponentially. But processing this knowledge and keeping abreast of research developments is well-nigh impossible.” In this situation technology might lend a helping hand Ostler said: “As far as clinical routine is concerned, AI methods will be able to support us better as they can handle these huge amounts of data.”

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Who will be liable?

When new medical devices are introduced the issue of liability is quickly solved – either the manufacturer or the user. But who will be liable when a digital system takes a wrong decision? The system? The developer? The programmer?

A tough question, Professor Wilhelm conceded. In his opinion, we cannot hold clinicians liable for a decision which was taken by a machine. The same is true for the manufacturer.

Wilhelm pointed out that any surgical intervention as such can be considered bodily injury: “My profession, my training, my professional oath as well as information of and consent by my patients allow me to perform surgery, to consciously injure a patient. But do we want to give a machine this kind of authority, this option?”

No doubt, he said, there are great technologies and fascinating developments, “but in the end we have to take into consideration that medicine – our profession – has an ethical and a legal basis. This has to be reflected in the technology – which might be difficult.”

The systems that are commercially available today circumvent this issue as robotic systems only have a supporting and telemanipulating function. It is the physician at the console who controls the technology. “To be precise, these systems are nothing but remote controls and don’t even deserve the name ‘robot’. They are different from systems that perform actions autonomously,” Ostler explained.

In Professor Wilhelm’s opinion machines or autonomous systems are rather unlikely to be working directly on the patient in the near future. The physicians, he is sure, will remain the final deciders who will be morally and legally responsible for their decisions and the consequences.

But what is going to happen if intelligent systems are developed that outperform the human physician? “Then the physician is morally and legally required to use them for the patient’s benefit,” said Professor Wilhelm who expects this very interesting debate to continue for a long while.

Human or machine?

While Professor Wilhelm understands that people start worrying about their jobs in view of the technological potential of robotic systems he strongly doubts that AI or robot will replace physicians any time soon: “Healthcare is more than knowledge, more than precision, it is about empathy, about human interaction.”

The surgeon expects a move away from specialisation in healthcare – or rather that the specialization is going to be the domain of the machine while the human physician will be omniscient: “We won’t be replaced. There will be changes, there will be fewer physicians. Healthcare will be different – but hopefully better.”

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