The paper argues with the prospective of the usage of remote and robotic surgery. It reviews recent cultural and technological state of the technology. Furthermore, it analyzes the benefits and the disadvantages of the remote and robotic surgery. The paper argues that despite the definite benefits of the reviewed technology for the patients and the surgeons, this technology has certain disadvantages. Furthermore, the disadvantages have ethical, technological, and legal peculiarities. Thus, people fear of the awkward machines performing precise actions because of the possible injuries. Furthermore, hardware and software glitches and malfunctions may emerge. Likewise, there is no appropriate legal strategy protecting the rights of the telesurgeons, patients, and the manufacturers.
Additionally, the investigation gives a comprehensive analysis of the presented evidence that supports both arguments. Furthermore, it provides a comprehensive strategy providing the solutions for the mentioned features.
The closing part of the paper provides the possible legal, ethical, and technological solutions. The study presumes that the rapid technological development is too fast for modern society. Thus, the subject requires further investigations to avoid various negative repercussions in the future.
Introduction
Various technological improvements of the past decades have influenced many spheres of human activity. People use different electronic devices for distant communication, data processing, scientific investigations, and so on. Moreover, the changes led by the technology have entered the sphere of medicine. The reason for this is that surgeons and physicians are in a constant search of the new solutions improving the treatment conditions. Together with surgery video systems and machines for magnetic resonance imaging, many physicians practice remote and robotic surgery. Consequently, the mentioned technological methods and solutions in medicine anticipate negative impacts or potential controversies. Furthermore, possible disagreements include political and legal issues as well as moral ethical implications. Therefore, the paper argues with possible legal and ethical disagreements in the sphere of remote and robotic surgery. Moreover, one assumes that the discussed technology has been introduced for society too early. Thus, the subject requires additional analysis with the provision of the appropriate ethical and legal resolutions.
The Essence of Remote and Robotic Surgery
The term ‘robot’” originates from the Czech word ‘robota’ that means forced labor. The Czech playwright Karel Capek used this term in the meaning known now in 1921 in his play Rossom’s Universal Robots. According to the original meaning of the word, robots are autonomous machines capable of performing the programmed set of functions. The reason for the discussion of this topic is that there is evidence that the number of robotic surgery machines is growing. Thus, Pinkerton argues that “in in 2000, there were only 1,000 robotic surgeries world-wide. That number surged to 360,000 in 2011 and 450,000 last year.” Current robotic surgery falls into three main categories: controlled systems, automatic and semi-automatic systems.The emergence of robotics opened the perspectives for the application of robots in various spheres. Thus, the factories use the robotic machinery devices on automatic industrial and assembling lines. Furthermore, the perspectives of the highly precise and rapid performance turned the medical staff towards the usage of robots in surgery. For instance, they required extremely high precision of operations during the brain surgery. The scholars claim that the era of robots in surgery began in 1994 with the usage of AESOP robot as a voice controlled camera holder. However, the first recorder surgery performed with the assistance of a robotic device occurred on 11 April 1985. In this respect, Gomes claims that the surgeons used an industrial robot to assist a computerized tomography guided brain biopsy. The reason for this was “to use a sturdy mechanical structure … to reach a surgical target deep in the brain in a linear trajectory avoiding vital structures of the brain”. Thus, one of the benefits of this technology in surgery is precise targeting required particularly for neurosurgery. Moreover, robotic devices may assist in performing repetitive tasks or the tasks that require endurance. The last case is of vital importance because a surgeon with tired hands can lose the precision of movement, which might lead to negative consequences. Thus, the perspectives of the robot assisted operations “is often heralded as the new revolution… technology that is taking the surgical profession by storm”.
Next, talking about the evolution of robots in surgery, one should note that the first robots were comparatively simple machines. The new technology required serious tests to assure its efficiency and safety. That is why the usage of robots as camera and tool holders was a perfect idea for pilot testing. However, contemporary automatic machines have such capabilities as 2-D vision, 3-D visualization, motion scaling, intuitive movements, visual immersion, and tremor filtration. Consequently, the results of the usage of robotics in surgery included the reduction of the invasiveness of the processes of treatment. Moreover, there has been a paradigm shift in medical procedures that “surgeons no longer directly touch or see the structures they operate”. Video imaging, new technological tools, and endoscope technology led to the fact that many surgeries have transferred from open surgeries to endoscopic ones. That is why specialists tend to connect robotic surgery with the minimal invasive one.
One of the most widely-used robotic surgery technologies is a slave robot. It consists of two active robotic arms with the instrument manipulators and a presurgical adjustment system supporting the patient and the instrument manipulators.
The slave robot has a variety of cameras that enable the surgeon operator to manipulate with the toolkit successfully. Thus, the surgeon contacts with the patient-side slave telerobots with the help of joysticks or master manipulators. The essence of a slave robot surgery is that the robotic arms recreate the movements of the surgeon operator. Thus, the slave robot is a passive machine that captures the surgeon’s hand motions through manipulators and sends them to the patient-side robots. The medical practitioners call such machinery a telepresence surgical system, which means “actually being present”. Nowadays, one of the most widely used slave robots is the da Vinci surgical system (Figure 1). One of the peculiarities of this system is that its instruments (Figure 2) follow the orientation and linear motions of the hands of the surgeon. Furthermore, numerous practices with the da Vinci System, including simulated trainings, lead to the fact that modern remote surgery outperforms the classical one. For instance, one of the news of the 2015 was that telesurgeons from the Philippines had removed a watermelon-sized, 2.7-kilo solid uterine mass from a morbidity obese, diabetic patient using only band-aid incisions. In addition to it, they claim that the application of the traditional surgery would have been more complicated with negative repercussions. Compared to band-aid incisions, the disadvantages of the traditional surgery would have included wound dehiscence, greater pain, higher infection rate, longer immobilization, and longer downtime.
Remote and Robotic Surgery