Day 4 and we’re 10 operations in. A few challenges along the way but that’s sort of the nature of the game. Although it’s been easy enough to mention the stuff about all the fancy gear and big machines, it’s actually probably more important that we brought people.
There’s more than just those you might have guessed as well. In addition to anaesthetists, physicians, nurses and physios, there is someone just to look after all the technical equipment, someone to manage pathology, a pharmacist and someone providing all that excellent info over at www.ohi.org.au.
They’re all vital and none of them could be replaced by machines. I wouldn’t even trade in the surgeon for a robot.
But Robots Are Cool
Well, robots are sort of cool. Or sometimes freaky. This self-folding origami one is kind of freaky.
In medicine though they’re getting popular and that includes in surgery. For an aid trip they are a bit big and cumbersome and expensive (like millions of dollars too expensive). We’re also not talking about fully autonomous humanoid things with temperament chips that happen to cut. The robots involved in surgery are mostly of the variety where a human still operates them.
The advantage that gets mentioned is that superior control for the surgeon can mean less tissue trauma to impose on the patient and that means less pain and better recovery for the patient. Sounds good, right?
I’ve mentioned before that I’m not convinced robots have found their niche yet. Part of the reason is that for every clinical situation where evidence appears to be mounting that they are of benefit, as in prostate surgery there are other areas where people have been overzealous. Situations like some forms of gynaecological surgery (see also here), or where there is evidence that lots of complications from robot-assisted surgery go underreported.
There are people already using these machines for cardiac surgery and examples of researchers trying to figure out if there might be benefits. What I am fairly confident of is that we are a long way off robots being able to do much without the input of the human brain (not that many are suggesting that really).
The Upsides of the Human Brain
You’ll have to gather that I am effectively whispering this online, as it’s not traditional to spend too much time telling the surgeons they are impressive at what they do. And having humans involved in stuff comes with issues with the way humans think and act in challenging situations. On this trip I’ve even heard a couple of stories of people behaving colourfully in healthcare situations that left me with this look…The things I find super impressive about the human brain are demonstrated in the way the surgeons repair the heart.
For some of the repairs there might be holes in the heart to fix, or valves to repair or replace (we’re not doing so much in the way of replacements here). When the surgeon is doing that though they’ve already put the patient onto the bypass machine, drained it of blood and given a dose of a solution to stop the heart from beating at all.
So surgeons work in an empty, blood-free heart to produce a repair that has to work in a heart that is pumping away and full of blood. In the meantime they also fundamentally alter the way the heart has been working.
That’s partly a testament to the impressive ability of the heart to adapt to the new state of affairs (in most cases pretty easily). The surgeon though has to judge how to do their repair to deal with an entirely different set of conditions once they get that heart going again. It’s a bit about experience and a bit about the ability to see the structure in front of them and visualise it under a different future reality and a lot about judgment.
So we’ll all be saddled with old jokes, occasional interpersonal challenges and some fairly ordinary musical choices for a while before robots can do all that.
And most of the time we’ll be quietly impressed.
But definitely not mention it.