Robotic surgery is a surgery using a robot during operation. Robotic surgery began to develop seriously in the eighties of the 20th century. However, it has a small prehistory. The application of robotic manipulators in surgery appeared on the basis of virtual reality. This method was primarily used for displaying large amounts of information that the American agency NASA missions received during their interplanetary spacecraft type of Voyager. A device for displaying information looked quite clumsy, but it worked. American scientists Scott Fisher and Joe Rosen developed the ideas of interactive information processing that should be first used in surgical robotics. It was a question, first and foremost, about the remote control of a robot-manipulator (Najad, 2008).
Something has been done in the practical application of these ideas. In the late 1980s, the development of laparoscopic surgery has set new challenges in front of doctors and developers of medical robots. Miniature incision during surgery has a positive effect on postoperative rehabilitation of the patient, but it creates problems for the surgeon, limiting the field of vision and degrees of freedom for surgical instruments. The solution was found with the help of remote control of the robotic surgical system. At the same time, the work continued in macro surgery (Samadi, n.d.).
As it often happens, innovative work on the establishment of medical robots was under the supervision of the military. The Advanced Research Projects Agency (ARPA) of the Pentagon, named as the Defense Advanced Research Projects Agency (DARPA) in 1993, launched the program for the development of biomedical technologies, which includes research on the remote robotic surgery. Financial injections from the military and the general development of computer technology played a significant role. Not only DARPA became interested in the use of robotics in medicine. In the early 1990s, engineers together with orthopedists developed robotic prostheses at the research center of IBM (Najad, 2008).
The robotic arm PUMA made by IBM is well known. They were able to develop a device for prosthetic hip joints on its basis. The result of further efforts became robotic complex RoboDoc. It ensured the accuracy of 96% while the surgeon man could only guarantee 75% precision of hand movements with the tool. Currently, RoboDoc is already a quite successful commercial project.
Over the past 20 years, this field of medicine has been revolutionized: robots have greatly reduced the risks of penetration through the natural outer barrier of the body – that is, through the skin. Moreover, the use of robots has allowed to establish two unique directions of medicine. The first direction is telesurgery: the surgeon operates the robot during operation directly without contact with the patient. The second direction is a minimally invasive surgery. The main advantages of robotic surgery are accuracy, the use of micro instruments, as well as reducing the impact of human factors in the surgery operation (WordPress, 2011).
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The operation with the help of a robot is carried out through very small holes and leaves only a few small marks that heal quickly. At the same time, the robot is under the full control of the surgeon and assistants. The risk of handling is reduced to zero, and the patient almost does not have post-operative scars. Robotic surgery is widely distributed throughout the world since the use of this technology can afford to do many operations that were previously considered impossible (Samadi, n.d.).
The possibilities of using the robotic system are as vast as those of the minimally invasive procedure, which takes the first place in terms of accuracy and miniaturization in the field of medical technology. Robotic surgery has already been used successfully in the field of neurology, urology, gynecology, cardiology, as well as committing numerous procedures in general surgery. Manufacturers are constantly improving a number of surgical instruments, thus reducing the number of necessary assistants (Najad, 2008).
Robotic surgery is growing rapidly with the invention of more sophisticated and miniaturized medical instruments. There is every reason to believe that the technical capabilities of the system will be maximally improved in the next generation of medical robots. As the absence of physical contact between the surgeon and the patient during surgery reduces the risk of infections, this feature can be used to carry out operations at a much greater distance between the surgeon console and the operating table. This advantage will allow the surgeon to perform an operation on a patient located in a separate sterile operating room that eliminates the risk of infection. The next generation of robots will probably have a remote preparation for operations, eliminating unnecessary human factor (Samadi, n.d.).
The media has made a huge impact on the popularization of robotic surgery since antiquity. Greek mythology tells of a mechanical guard created by Daedalus for King Minos. His task was to patrol the entire island every day for the detection and detention of strangers appearing there. The word “robot” was first used in the play “Rossum’s Universal Robots”, a kind of accusation of overly industrialized science, written by Karel Capek, a Czechoslovakian playwright, in 1921 (WordPress, 2011).
Capek used the Czech terms “robota”, which indicates a required, forced labor, and “robotnik”, that is a worker. In this play, Rossum and his son created humanoid creatures to use them as the servants of people. The play pushed Fritz Lang to create Metropolis, in which the robot has been described as a popular leader of the masses who worked in the city and incited people to violence (Najad, 2008).
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The writer, who made the greatest contribution to the widespread publicity of robots and who actually has the right of first use of the term “robot”, was an American of Russian origin Isaac Asimov. His nine books about robots were published in the 1940s. He predicted some of the problems that have not yet emerged, but the danger of which still exists. In the novel The Caves of Steel, which was first published in 1953, the writer formulated and developed the three laws of robots that are still very important to today’s creators and users of “smart” robots, including surgery robots (Samadi, n.d.).
The first law is that a robot has no right to harm humans or, through inaction, allow a human to be harmed. The second law is that a robot must always obey people’s orders, except cases when such orders conflict with the first law. The third law is that a robot must protect its own security if it does not contradict the first two laws. There are preconceived notions towards robots (mainly formed by mass culture) and expectations to see them exactly the same as people imagine. However, real robots differ significantly from each other and, as a rule, do not outwardly similar to human and do not possess such quality as intellect, for example the “Da Vinci” robot (Faust, 2007).
Exactly the media glorified robot called “Da Vinci”, one of the most famous achievements of recent times, which was named after the great engineer, artist, and scientist Leonardo da Vinci. The novelty allows surgeons to perform complex operations without touching the patient and with minimal damage to its tissues. A robot that can be used in cardiology, gynecology, urology, and general surgery was demonstrated in the medical center and the department of surgery at the University of Arizona. During the operation with “Da Vinci”, a surgeon is in a couple of meters away from the operating table at the computer, which shows a three-dimensional image of the operated organ. A doctor controls thin surgical instruments that penetrate into the body through small openings. Such instruments with remote control can be used for precise operations on small and hard to reach areas of the body (Najad, 2008).
Proof of the extraordinary opportunities of “Da Vinci” became the world’s first totally endoscopic bypass performed recently at Columbia Presbyterian Medical Center in New York. The unique operation was carried out by the center’s director Michael Argenziano, and the robotic cardiac surgery and head of the Department of Cardiothoracic Surgery Dr. Craig Smith. They used only three small holes – two for manipulators and one for camcorders. Bypass or coronary artery bypass surgery is the most common open heart surgery in the United States. 375,000 people undergo this procedure annually. The widespread introduction of “Da Vinci” would greatly facilitate their fate, helping patients recover faster after surgery and be discharged from hospitals earlier (Samadi, n.d.).
“Da Vinci” is just one example of the development of a new branch of medicine. Other robots are used in various operations, up to brain surgery. As these devices are rather cumbersome, doctors hope for the appearance of miniature assistants. They actually exist, but are not used in practice (Faust, 2007).
However, it is very important not to miss the cultural acceptance of robotic surgery. There are more and more issues related to the reliability and safety of robots, better known as “the Da Vinci robots” by robot making company ISRG. Recently, the FDA has reported that the number of deaths, failures, and faults per year increased by 2 times. The company had to refuse from several robots, and its market capitalization has fallen by 24%. Experts relate faults to the accuracy of robot movements, cases of collision of manipulators during surgery, problems with operating lens, and the issue of personnel training. Naturally, nobody calls to abandon robots in operations, and, certainly, their use in medicine will continue. Nevertheless, it is necessary to understand that the surgeon operating with a robot must be qualified to perform an intervention alone and spend some time on training in robotic surgery. To some extent, the use of a robot can lead to the loss of person’s own surgical skills (Najad, 2008).
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If one talks about the future of robotic surgery, just the advent of new machines will not change the society. Robots can provide an abundance of cheap and high-quality goods and services and maybe even help focus their production on individual request. Robots can be used to carry out complex operations on remote organs, for example a bladder or prostate (Faust, 2007).
Nevertheless, society will not do without social conflict. Products need consumers, and many old medical professions will be under tremendous blow in terms of the revolution in robotics and energy. One will not do without addressing the issue of stimulating demand and providing medical jobs and livelihood. For example, there is a robot called Rosie. The main Rosie task is the preparation and distribution of drugs under hundred titles. It works around the clock, without breaks and mistakes essentially. Thus, the problem will be not a provision of necessary products (drugs) for consumers, but rather how to ensure the amount of products with a sufficient number of consumers (Lafranco, Castellanos, Desai, & Meyers, 2004).
Therefore, employment policy will be one of the major problems for the world economy. What awaits medical professions which will be unnecessary because of automation? One will have to find a place in the social security system while the other has to learn. Over time, it will be difficult to find a job of a cleaner or nurse in the medical institution. If the factory worker needs the ability to control robotic lines and not compete with them in speed operations, then the profession of a surgeon will need to degrade in its knowledge (Najad, 2008).
However, there will be a need in many jobs, particularly those related to health service. Therefore, the state will have to focus on their creation primarily. The public sector and social sphere (especially health service) could become a driving force of employment at least for a time. The school will start a movement from the factory types of learning to individual or group discipleship, and, hence, the need for physicians, researchers, teachers, and educators will be enormous. Many jobs will be created in the spectrum of “man to man”. Perhaps, many people who waste their time in office routine will move to work in science, which will take precedence in the eyes of society (Lafranco et al., 2004).
Most likely, reduction of the working week will become a need. One will require a more advanced average worker to support the economy, as well as more jobs. Enterprises will probably have to hire more employees under the new laws and not to overload a small staff. In this regard, workers will have the time for development, recreation, and consumption. It will not be the first time in history when technological advances cause a reduction of the working week, though nothing ever happened without class struggle (WordPress, 2011).
On the other hand, not everyone will want to work in such a system. Probably, there will be many people who would prefer a modest social support. Society will have to fight with this by means of educating creative interests, and the victory will not come soon. The time of robots will surely become the era of cultural and scientific progress. Mainstream consumer will have the chance to climb up several steps on the ladder of social and cultural development. Medicine from a bygone era will probably seem primitive to him, limiting rather than developing (WordPress, 2011).
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There is also a trend in many countries to maximize the use of “intelligent” robots instead of adaptive and program ones. At first glance, this trend seems to be progressive: the third generation robots are of higher quality than the first and second generations, and their application marks the arrival of the latest technology in the industry. However, the point is that there is a large influx of immigrant workers in some countries today who came from poorer states and ready to work for the smallest salary. Therefore, it is unprofitable for many medical institutions to use robotic devices to automate surgeon activities: despite the best results shown by robots, immigrant workers are much cheaper than the acquisition and operation of robots replacing them (first and second generation) (Lafranco et al., 2004).
At the same time, the relatively high level of salary of highly skilled workers makes robotization profitable for those production sites, which require well-trained and skillful workers, and, for this reason, they are purchasing and installing modern “intelligent” robots. As a result, “intelligent” robots are beginning to displace highly skilled professionals and intellectuals who also have a fear of the “expansion” of robotics (WordPress, 2011).
In conclusion, robotic assistants play a vital role in modern medicine. This industry is still relatively young and is at an early stage of development, and, robots bring an indispensable aid to employees of medical institutions. The main problem is that if developed countries with stable, positive economies introduce innovations immediately after the official mass robotization, developing countries will do the same thing much later, and these novelties will not be applied in the third world countries in the near future. The reason is that all these products are very expensive to purchase. Therefore, it is necessary to raise the question of reducing the cost of this equipment within reasonable limits in the future at certain conferences and meetings of the Heads of Governments.
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