Robots, surgery, and the NHS – what will the future medical bot look like and when will the machines take over the operating theatre?

 
Luke Graham
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Versius is a robot controlled by a surgeon to perform complex medical procedures

In the 2012 film Prometheus, there’s a memorable scene where the protagonist uses an automated medical table to remove an alien creature growing in her stomach.


At the press of a few buttons, robotic arms quickly perform a complex procedure – the operation looks more like a car assembly line than surgery.

The scene is fascinating (if also a bit disturbing) and is part of a long lineage of science-fiction fantasies about the future of healthcare.

In a hundred years’ time when we go under the knife, will we use an emotionless, industrial machine like in Prometheus, or will our surgeons still look humanoid – like the android doctor in Star Wars who treats Luke Skywalker?

This isn’t just idle speculation. We’re all aware of the problems facing our cash-strapped National Health Service and the demands for it to be more productive. As well as money troubles, the NHS has a staff crisis – experts warn that it could be short of 350,000 key personnel by 2030.


If a shortage of trained physicians is keeping waiting lists long, perhaps robo-doctors could help alleviate these problems?

That future might not be as far away as you think – robots have assisted in surgery at least since the turn of the century. To find out more about how robots are taking over the operating theatre, I spoke to Martin Frost, the chief executive of CMR Surgical, a medical robotics company based in Cambridge.

“In the UK, there are around 70 robots that have been purchased for use within our healthcare systems,” he tells me. “Worldwide, that number is about 4,500. Together, those robots do around one million procedures each year.”

Frost and his partners set up CMR in 2014, hoping to transform surgery in the UK. The company has spent the last five years developing a system called Versius, which uses multiple robotic arms that are controlled by a surgeon using two joysticks and a 3D screen.

The device isn’t commercially available yet, but Frost expects many hospitals across the UK and Europe to start using it this year.

There are several advantages to using Versius, according to Frost. It’s designed to assist in laparoscopic – or keyhole – surgery, where special instruments are used inside the body via small incisions. Patients recover faster, experience less pain, and leave hospital sooner after this type of operation compared to open surgery.

However, keyhole surgery can be physically difficult for the surgeon.

“Laparoscopic is physically and mentally demanding, to stand prone above a patient, potentially for hours, performing a difficult surgical procedure,” explains Frost.

Instead, with Versius the surgeon can sit at the console and control the arms. This isn’t just better for the physical health of the surgeon – it means that they could work much later into life, helping to relieve that worsening staffing crisis.

In addition, Frost claims that robots can reduce a surgeon’s training time.

“Robotic technology helps the surgeons become competent much faster. It could be up to two years faster. That’s a significant benefit for them and for our healthcare system.”

Of course, there are drawbacks as well. These robots are not cheap – CMR Surgical has not revealed the cost of Versius, but does want to make minimal access surgery more affordable and accessible. For comparison, a similar system called Da Vinci produced by a Californian robotics company costs $2m (£1.54m) per unit.

Older robots are also heavy, and take up space in the operating theatres.

Frost makes a point to explain that Versius has been designed with utility in mind, so that it can be used more often and in more operations. As such, the machines are light, so that they can be easily moved to where they’re needed.

But this shows how fast expensive technology can become outdated – this may explain why those 4,500 robots worldwide are only being used in procedures on average every other day.

For the time being, surgery will still be overseen by a human, even if they’re controlling a robot. The idea of AI-powered physicians regularly performing operations on their own is a long way off.

But Versius may be an important step towards that potential future.

“We’re today looking at extending and expanding the capabilities of the surgeon, not replacing them. But I think we’re in the early days of understanding the real benefits of data and AI in the operating room,” says Frost.

“We’ve put a great deal of thought into how that may evolve in the future in terms of parts of the procedure potentially being automated.”

By using these robots more and more in operations, organisations are collecting data that could have all sorts of benefits. A surgeon’s performance could be tracked and measured to make sure that they’re operating safely and at their best. Data could help to standardise surgical procedures, making operations more efficient.

Eventually, an AI may be able to use these millions of recorded operations to perform surgery on its own.

People may be concerned by the idea of a robot wielding a scalpel – would you trust your life to an algorithm? And there will certainly be questions over ethics and morality if the robo-surgeon faces an unexpected life-or-death decision, or who will be held at fault if it makes a mistake. These same thorny debates are currently hotly underway regarding self-driving cars.

But ultimately, robotics will help surgery to become safer and much more efficient. This is not only good for our individual health, but for our society, as the NHS will be able to look after more people and treat them more quickly.

The future of healthcare may end up looking more like the surgery table in Prometheus, though hopefully in a hundred years’ time none of us will need treatment to remove alien parasites from our bellies.