Handing the surgeon’s scalpel to a robot

In 2004, the United States’ Defense Advanced Research Projects Agency (DARPA) dangled a $1 million prize for any group that could design an autonomous car that could drive itself through 142 miles of rough terrain from Barstow, California, to Primm, Nevada. Thirteen years later, the Department of Defense announced another award — not for a robot car this time, but for autonomous, robotic doctors.

Robots have been found in the operating suite since the 1980s for things like holding a patient’s limbs in place, and later for laparoscopic surgery, in which surgeons can use remote-controlled robot arms to operate on the human body through tiny holes instead of huge cuts. But for the most part these robots have been, in essence, just very fancy versions of the scalpels and forceps surgeons have been using for centuries — incredibly sophisticated, granted, and capable of operating with incredible precision, but still tools in the surgeon’s hands.

 

Technology

Roles for robots

 

Technology

Humans beat robots, hands down

 

Health & Disease

Measuring surgical quality

Despite many challenges, that is changing. Today, five years after that award announcement, engineers are taking steps toward building independent machines that not only can cut or suture, but also plan those cuts, improvise and adapt. Researchers are improving the machines’ ability to navigate the complexities of the human body and coordinate with human doctors. But the truly autonomous robotic surgeon that the military may envision — just like truly driverless cars — may still be a long way off. And their biggest challenge may not be technological, but convincing people it’s OK to use them.

Navigating unpredictability

Like drivers, surgeons must learn to navigate their specific environments, something that sounds easy in principle but is endlessly complicated in the real world. Real-life roads have traffic, construction equipment, pedestrians — all things that don’t necessarily show up on Google Maps and which the car must learn to avoid.

Similarly, while one human body is generally like another, children’s movies are right: We’re all special on the inside. The precise size and shape of organs, the presence of scar tissue, and the placement of nerves or blood vessels often differ from person to person.

“There’s so much variation in the individual patients,” says Barbara Goff, a gynecologic oncologist and surgeon-in-chief at the University of Washington Medical Center in Seattle. “I think that that could be challenging.” She’s been using laparoscopic surgical robots — the kind that don’t move on their own but do translate the surgeon’s movements — for more than a decade.

The fact that bodies move poses a further complexity. A few robots already display some amount of autonomy, with one of the classic examples being a device with the (maybe-a-bit-on-the-nose) name ROBODOC, which can be used in hip surgery to shave down bone around the hip socket. But bone’s relatively easy to work with and, once locked into place, doesn’t move around much. “Bones don’t bend,” says Aleks Attanasio, a research specialist now at Konica Minolta who wrote about robots in surgery for the 2021 Annual Review of Control, Robotics, and Autonomous Systems. “And if they do, there’s a bigger problem.”

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