The american journal of surgery


Nowadays, computers and robotics become more normal in daily life than ever before. Almost everybody has electronic devices at home and knows how to use them to make life easier. In fabrics, humans are being replaced by advanced robotics to reduce costs and increase the quality of products. Also in hospitals robots and computers are being used more and more. For example, robots can monitor a patient's heartbeat, or support a specialist his digital dossier management. This is also known as Electronic Care (E-Care). E-Care is the automation of all aspects of health care, from administrative aspects to surgeries. This research paper will focus on the aspects of E-Care during surgeries. The reason of the focus on E-Care during surgeries is that the administrative aspects of health care are already widely developed, where electronic surgeries are not. Robots are nowadays being used to perform precise and accurate surgeries, and this will be developed further in the future. The reason for the use of robots in health care is to reduce costs and to perform better surgeries then before. A robot does not experience any fear, stress or anger during a surgery like a surgeon. As William James, the great philosopher, stated that a robot has no mind because it is programmed by humans to serve for them, I would call E-Care Robotic Healthcare. Robotic Healthcare can be a huge benefit for health, the society and economy. Robotic Healthcare offers a secure and sustainable health provision with the same or even better quality than humans can offer. The future prospect for Robotic Healthcare is broad. According to Commission (2008), a revolution in surgeries will start around the year 2025. During this revolution, robots will be able to perform more and precise surgeries, make diagnoses, carry out patient tasks at home through domestic robots, support nurses and difficult work of professionals, or even counteract the upcoming staff shortages (Commission, 2008). Will robots take over the difficult tasks of surgeons in the future, or will they only support the surgeons? The past, present and future prospect will be discussed in this paper.


In 1941, in a story written by Isaac Asomiv called 'Liar!', the word 'Robotics' was used for the first time in history. According to the writer, the word already existed, but it was the first recorded use of it. In his story 'Liar' and his second story 'Runaround', Asomiv stated three rules for robots, that nowadays are still in use. Rule 1: ''A robot may not injure a human being or, through inaction, allow a human being to come to harm.'' Rule 2: "A robot must obey orders given to it by human beings, except where such orders would conflict with the first law." Rule 3: "A robot must protect its own existence as long as such protection does not conflict with the first or second law.''(Newman, 2009). These rules suggest that robots are slaves for human beings, and that they have no rights like humans. The first robotic use in hospitals has been researched by Grundy et al. in 1977. Grundy et al. (1977) used 'Telemedicine' to communicate between a private hospital and a university medical center. 'Telemedicine' is defined as "the use of telecommunications to allow caregivers to interact with patients and/or other caregivers operating at remote locations" (Craft, 2001). According the findings of the study by Craft (2001), 'Telemedicine' provides regular consultation in critical care, and it can be implemented for the use of several providers. The classical telephone line was replaced by a higher bandwidth audiovisual link whereas the 'Telemedicine' improved the quality of critical care units. The advantages of 'Telemedicine' were clear, although it was too costly to implement it in hospitals at that time. Further research would be needed to increase the value of robots in healthcare and decrease the costs to implement them in the working field. These further researches proved that 'Telemedicine' was successful for support of the emergency department in hospitals. Mobile videoconference workstations were used to cover several areas of interest and proved that early trauma care was improved. These mobile videoconference workstations were remotely directed by trauma surgeons in another department (Rogers, et al., 2001). Those research studies were performed at a time that internet and intranet was not widely developed as it is nowadays (the year 2010). Data connections were slow and were limited through bandwidth. Because of the rapid innovations in internet and telecommunications, the research on robotic healthcare and 'Telemedicine' continued.


Currently, internet and intranet are communication tools that are used by almost every company in the world. Internet and intranet are widely developed and have a high bandwidth level for fast data transactions between companies or departments within companies. This made the videoconferencing workstations as studied by Rogers, et al. (2001) cheaper and easier to use. These videoconferencing workstations were the next step in 'remote presence'. "Remote presence is a wireless mobile robotic telemedicine technology that consists of a desktop or laptop control station and a robot." (Chung, Grathwohl, Poropatich, Wolf, & Holcomb, 2007, p. 593). This remote presence is basically an audiovisual communication between the patient and the doctor, where the doctor can monitor the patient via the robot over an internet connection. The workstation replaces the physical presence of the doctor, but the doctor controls the workstation by himself at a remote location. In that way the doctor is still able to interact with the patients. The presence of a robot instead of a doctor has been researched in several studies. The results of this research were that the patient had an increased satisfaction because the communication of medical information was better, and there was better attending physician availability (Chung, et al., 2007). Through the worldwide availability of the internet, specialists from all over the world can communicate via workstations with patients that need special care. Next to 'Telemedicine', an interesting new term is introduced, named 'Telesurgery'. 'Telesurgery', which stands for performing surgeries from a distance, is another aspect of the robotic healthcare of today. With 'Telesurgery', surgeries can be performed on remote locations where no specialist is available. It was primary designed for the US army, to perform surgeries in areas in need when in war. However, the need for 'Telesurgery' for patients all over the world increased raplidly. This need for robotic surgery will continue in the future, and robotic health care will play an important role in the revolution of health care. Note that robotic health care, as the usage of robots in surgeries, was introduced only 30 years ago. The developments of robots is growing fast nowadays, and robots will become standard and accepted by patients and specialists in the near future. The benefits of robotic telepresense are currently the rapid assesment of patients, the reduction of hospital costs and the length of stay pf the patients, and improved efficiency and bed capacity in hospitals (Vespa, et al., 2007). These benefits will probably grow or extended in the future.


Currently, the use of Robotic Telepresence like 'Telesurgery' and 'Telemedicine' are limited through the broadband requirements. According to Chung, et al. (2007), installing a robot on a remote location for the use of providing advanced telecommunications is not realistic. However, broadband connections will be improved in the near future, introducing fiber connections first. These fiber connections are currently five times faster than normal internet connections. The maximum speed is captured at the moment, because there is no need for faster connections. When the revolution in robotic health care will start, around the year 2025 (Commission, 2008), the fiber connection will probably be used at full bandwidth. This will make it more interesting to have a robot at a remote location that provides hospitals advanced telecommunications. Thus, when the telecommunication technology evolves, the Robotic Telepresense can evolve too. It will be easier and much cheaper to implement the Robotic Telepresense in hospitals when the technology to use it already exists, and the infrastructure is not only being used for Robotic Telepresense. When implementing Robotic Telepresense in hospitals, a network will be established between hospitals all over the world. Within these networks, hospitals can easily share information, manage complex patients information, have educational conferences, and compete in quality improvement projects (Chung, et al., 2007). All of these aspects will improve the quality of the hospitals within the network. For example, the mobile videoconferencing workstations as mentioned by Chung, et al. (2007) will be widely available at different areas and departments in hospitals. Specialists will communicate with patients via a robot, where the specialist controls the robot at a remote location. These workstations will provide all the information the specialist needs, and supports the specialist in diagnostic decision making. The workstations will document all the diagnostics of the patient in a digital medical record, and compare this record with other medical records to improve the support of diagnostic decision making. Next to this 'Telemedicine', 'Telesurgery' will evolve too in the near future. Surgeries from a remote location are rare nowadays, but will become more standard in the future. The current robotic systems for surgery require substantial space and time for setup. To perform precise and fast telesurgeries in the future, robots have to be compact and easy to setup (Camarillo, Krummel, & Salisbury, 2004). When the size of robots will be reduced, microscale surgical manipulations will be possible too. When microscale surgeries are possible, it would enable performance of procedures that are nowadays impossible. Progression in the microscale of robotic will require new materials combined with a new way of manufacturing to ensure the performance and ease of assembly (Camarillo, et al., 2004). A counterpart of the future prospects of robotic healthcare is the government, because every system needs approval by the government regarding safety and implementation. Governments are skeptic in the regulation of new machines or robotics in health care. New systems have to be tested and be fully safe before implemented in the marked, but confidence comes with experience over years.

Discussion and Conclusion

Everybody who is alive right now has grown up with robots and machines in his or her environment. Every machine that is programmed is a kind of robot and it serves you in the best possible way it can. Robots and humans are closely related to each other, but are definitely two separate 'machines'. Robots and humans can and will be operating as one system in the future regarding to healthcare. They already operate together nowadays, but it is not fully integrated, and robots are only used as 'slaves'. In my opinion, robots will always be used as slaves, but they will get a bigger role in decision making or operating surgeries. They will support specialists regarding diagnostics and will be the third arm of a specialist. Maybe they will replace the first arm of the specialist in the future, but robots will never replace human completely when it comes to health care. Robots have no mind or consciousness, they are programmed by humans as William James stated (Cunningham, 2000). Without the right programming by humans, robots cannot function properly. Especially when it comes to healthcare, it is important that robots are used as slaves. When a robot makes a mistake, or does not function properly, a specialist has to have the opportunity to interrupt or disable the robotic functions for safety reasons. Will healthcare totally controlled by robotics in the future? Only time will tell.


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