Computer-Assisted Robotic Surgery Paper

The evolution of healthcare has brought novel technological innovations meant to improve processes and patient outcomes. Robotic surgery (RS) and computer-assisted surgery (CAS) represent one such dimension, and their use in the OR has been to enhance surgical techniques and therefore outcomes through detail and precision (Rao, 2018). Since the process requires significant expertise borne off intensive training, it is still employed in limited facilities, and as such its effect is yet to be fully realized. The focus of this paper is to examine the extent to which technical challenges hinder the extensive adoption of CAS in healthcare practice.

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Ethical Concerns around CAS

Subpoint 1

One of the paramount issues surrounding CAS is that of possible litigation in the face of undesirable surgical outcomes. While the level of detail and precision in CAS is significantly high, complications still abound. It is in the process of seeking redress for such occurrences where the attending surgeon, facility of practice, and possibly the manufacturer of the robot may be sued, hence complicating the entire process (Sheetz & Dimmick, 2019 Computer-Assisted Robotic Surgery Paper). Ostensibly, to a significant extent, blame may be shoved to the equipment or its manufacturer and it may be difficult to prove the attending surgeon is to bear the brunt.

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Additionally, the aspect of patient safety, cost, adequate information, and confidentiality are still prickly issues. In the cases of RS where a surgeon’s input is minimal, how the patient safety is assured is difficult to tell (Stewart et al., 2019). Expressing the details of the process and possible outcomes to patients also prove difficult because the technology is new. Importantly, due to the invariably costly nature of the treatment, and its unavailability in most setups, it still is difficult to reconcile cost issues with patients in actual need of the treatment, such as those requiring complex brain surgeries (Rao, 2018). Often, this leads to increased healthcare disparity between the rich and the poor.

Subpoint 2

The timing of launching such innovative endeavors in healthcare has also been a problematic issue. While it is generally appreciated that healthcare products should be rolled out with the knowledge of their safety and success indices, the need for these services may at times usurp the existent guidelines (Stewart et al., 2019).

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This is particularly common for technological equipment and hence striking the balance has been left to the prerogative of the implementing facilities. Since respective facilities retain the onus of approving devices for adoption, their credentialing standards, and evaluation parameters, it leads to widespread variability hence difficulty in assessing the benefits or shortcomings of the said devices.

Benefits of CAS

Subpoint 1

The most important role of CAS has been to improve intraoperative vision. Sayari et al. (2019) state this is accomplished using 3D-imaging, accurate tissue targeting, and real-time sensing, leading to a superior enhancement of vision-motor coordination.

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Precision has been enhanced by enabling the robot to perform predetermined movements repetitively and with superior accuracy (Sayari et al., 2019). Both characteristics have enabled the performance of complex surgeries in closed limited spaces hence enhancing operability success and diminishing hand-fatigue.

Subpoint 2

CAS has also resulted in reduced hospital stays as well as reduced postoperative complications. The reduced post-operative complications include pain, wound infections, cosmesis, and dehiscence (Childers & Maggard-Gibbons, 2018).

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While general figures pointing to better postoperative outcomes in CAS is varied, the rates are better than those of open surgeries. The success rates are particularly seen in the four areas with the highest uptake of CAS so far, gynecology, surgical oncology, orthopedics, and urology. However, it remains to be seen whether the outcomes will change when the services are finally rolled out too many people.

Laws, Standards, and Regulations of CAS

Subpoint 1

Due to the novelty of CAS, cross-cutting standards and regulatory aspects are still lacking. As alluded to earlier, these interventions have largely been left to the parent institution and manufacturers who oversee the training and the implementation process (Childers & Maggard-Gibbons, 2018). Since the FDA does not oversee the training or education of legally marketed medical devices, it is left to the users to ensure they maintain credentialing and keep abreast of the various models of the CAS in use (Stewart et al., 2019).

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The dearth of public information regarding available CAS technology exposes the consumers to the inherent risk associated with delayed or failed knowledge updates by the practitioners. Due to this problem, manufacturers provide specific training guidance for users, and recently, simulation methods are being incorporated to enhance the hands-on experience of the surgeons and hence reduce the occurrences of complications (Childers & Maggard-Gibbons, 2018). Similarly, formulating laws to guide the use of CAS has just been as difficult due to the problem of accountability and culpability, hence the FDA continues to revise its modalities of approving medical devices for use in the market.

Conclusion and Future Research Needed

Arguably, the use of CAS has enhanced surgical technics with improved patient outcomes. However, technical challenges, particularly regarding patient safety and confidentiality, alongside acquisition costs, have persistently hampered the extensive adoption of CAS. In neurosurgery, for instance, the adoption has been slower owing to the inherent complexities of the procedures involved, but resection of paravertebral tumors, presacral tumors, and biopsies have been reported with varying success. While different studies have cited equipment costs and lagging times in surgery as the main hindrances to the uptake of CAS, further research need to investigate how these factors interact in both developed and developing countries, as well as the overall consumer perception on CAS.

Computer-Assisted Robotic Surgery Paper References

Childers, C. P., & Maggard-Gibbons, M. (2018). Estimation of the acquisition and operating costs for robotic surgery. JAMA, 320(8), 835-836. doi:10.1001/jama.2018.9219

Rao, P. P. (2018). Robotic surgery: new robots and finally some real competition!. World journal of urology, 36(4), 537-541. https://link.springer.com/article/10.1007/s00345-018-2213-y

Sayari, A. J., Pardo, C., Basques, B. A., & Colman, M. W. (2019). Review of robotic-assisted surgery: what the future looks like through a spine oncology lens. Annals of translational medicine, 7(10). https://dx.doi.org/10.21037%2Fatm.2019.04.69

Sheetz, K. H., & Dimick, J. B. (2019). Is it time for safeguards in the adoption of robotic surgery?. Jama, 321(20), 1971-1972. doi:10.1001/jama.2019.3736

Stewart, C. L., Ituarte, P. H., Melstrom, K. A., Warner, S. G., Melstrom, L. G., Lai, L. L., Fong, Y. & Woo, Y. (2019). Robotic surgery trends in general surgical oncology from the National Inpatient Sample. Surgical Endoscopy, 33(8), 2591-2601. https://link.springer.com/article/10.1007/s00464-018-6554-9

Instructions

Outline Format

I. Thesis Statement

II. Discuss the ethical concerns surrounding your topic. In addition, feel free to address any cases in the media.

A. Subpoint

1. Details of Subpoint