HOW THE FUTURE OF SURGERY IS CHANGING: ROBOTICS, TELESURGERY, SURGICAL SIMULATORS AND OTHER ADVANCED TECHNOLOGIES:

摘要

Since the advent of minimally invasive surgery, there have been new discoveries in robotics to perform telesurgery, in virtual reality and surgical simulators for surgical education and many emerging new technologies to revolutionize what the future of surgery will become. This is a review of the state of the art in these related fields, of disruptive technologies in the laboratories and the long term implications of the radical new technologies that are emerging. Introduction Although many factors, such as economics, managed care and regulation contribute to the changing landscape in surgery, nothing causes such dramatic change as the introduction of a revolutionary technology. The change is so rapid in fact, that a new term, disruptive technology, is applied to signify such abrupt and radical change in a short time. The American baseball coach, Yogi Berra very cleverly anticipated such change when he said “The Future is not what it used to be!”. The implication of course, is that we cannot judge future changes by using contemporary standards. Laparoscopic surgery was the first of such technologies, and many others are soon to follow. Robotics is just emerging onto the scene, along with virtual reality for surgical simulation – and many others are in the laboratory today. The following is a review of the current status of robotics, telesurgery and surgical simulators as well as an introduction to numerous other new technologies that may significantly impact upon the practice of surgery. The rapid rate of such technological change is creating such extraordinary social, behavioral and ethical upheaval that speculation upon their profound effects is warranted. Surgery in the Information Age. Before examining specific technologies, it is important to provide the framework for a change of such magnitude. This radical change is a reflection of Information Age technologies, such as computers, robots and virtual reality. However there are some underlying principles that must be understood, since it is this “Information Age perspective” which not only drives the change, but binds everything together. The first principle is that we can represent real objects in the real world with a computer or information equivalent (this is Nicholas Negroponte’s ‘Bits instead of atoms’ analogy) – for example, your body in the real world and a CT scan of your body in the information world. To this total body image is added all the vital signs, mechanics, physiology, etc of an individual person. The result is an information representation, a holographic medical electronic representation (or holomer) , of a person which is a surrogate for the patient or person in information ‘space’ (computer), and which permits simulation upon the image before actually providing medical diagnosis or treatment on the person (see below). The US military has a proof of concept project called the Virtual Soldier, in which a total body computer tomography (CT) scan of a soldier is used to represent the soldier (Fig 2). By carrying this scan on the electronic dog tag, if the soldier is wounded, the medic or surgeon will have an image of what the