Surgical Robots: Who’s In Charge?

Biomedical Engineering Association Chairman Patrick Finlay takes us through the development of surgical robots, and reveals whether there’s really an off switch.


Robotics in the Palm of Your Hand


‘When we first started and the surgeon said, “robot, please,” there’d be a sort of sounding of trumpets, doors would fly open and the technician would bring in the machine. The surgeon would be displaced to make room for the robot. Now, when surgeons say, “robot, please,” a palm-sized device is handed to them. That’s as it should be: the robot is a tool for surgeons to do a job.’

Patrick Finlay is the Chairman of the Biomedical Engineering Association, a division of the Institution of Mechanical Engineers. He runs a company that develops medical robots particularly for surgery. Here, he outlines some of the complex questions of control in the midst of surgical operations.


Eliminating Human Error in Surgery


‘If there’s a tumour close to the optic nerve, a surgeon would say it’s inoperable, because if I inadvertently touch the optic nerve then the patient will be blind. With a robot, being more accurate in principal, you can dare to go closer to the optic nerve. Robots can look at a scan of the patient’s brain and compare it with every previous patient who’s had similar surgery from the database, and then plan the operation. Once you’ve allowed a robot to do that, then you’ve got to give it some control for that specific procedure in the operation.

‘The robot arguably now knows more than the surgeon. So, who’s in charge? Should the surgeon be allowed to override the robot? How should the robot react if the surgeon gives a command that the robot thinks is unsafe?


Surgical Robots: Keeping the Off Switch


‘Say the robot is starting to insert an instrument deep inside a brain and it encounters unexpected resistance from an obstruction, which typically could be a small blood vessel that didn’t show up on the scan. What should it then do? Stop? Continue?

‘Our view is that it’s safest to stop, even if there’s a failure of the system, because then you’ve got time and the surgeon can consider what to do next. Basically, a stopped robot is a safe robot and the surgeon can then give specific instructions for restart.

‘All our robots have something equivalent to a flight recorder, a black box. We record all the instructions that the surgeon gives the robot and its response, just to ensure we’ve got this right in terms of who’s in charge.’


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