February 16, 2016

Robotic surgery: Medical miracle -- and a hacker's dream come true

Denyse O'LearyRebel Blogger

At Popular Mechanics, Alexandra Ossola asks:

The tech for surgeons to operate on patients from hundreds or even thousands of miles away has been possible for over a decade. But will it ever become commonplace?

Telesurgery, as it happens, is already more common than many may realize:

In 2010, 86 percent of prostatectomies were done with robots, and they are used to operate on hearts, kidneys, gallbladders, and ovaries. In 2012, 450,000 operations were done with robots, according to the Wall Street Journal.

Recent advances even include developments in robotic brain surgery.

At first glance, it sounds impersonal, sterile. But there are some advantages. Working at a desk, guiding tiny robotic devices, is less physically taxing for surgeons. Sophisticated software can correct for accidental slips of the hand.

But the real benefits, says Ossola, are for the patient:

Thin, dexterous tools are precise over a large range of motion. For example, Tewari used the forceps to tie a series of knots with thin string to suture up his incisions, which makes it easier for surgeons to spare healthy tissue when cutting out an unwanted mass. Tewari says that at his hospital, the use of robots has cut the recovery time for prostate surgery from four days to just one or two.

And NIH's Medline, in a brief overview of the trend, lists as benefits a faster recovery, less pain and bleeding, less risk of infection, shorter hospital stays, and smaller scars.

There are now many surgical robots on the market. They began to be used as early as 1985 with names like ProBot and RoboDoc (which made clear that the public reaction was not then being considered). They first drew public awareness in 2001, when a surgeon in New York removed a patient's gall bladder in France by remote.

They can be a help for remote regions such as Canada’s far north. The patient may be too frail to travel, and the university hospital specialist cannot spare several days to reach the patient and return.

But, however we may feel about remote surgery, it is not just around the corner. All about Robotic Surgery, sponsored by manufacturer AVRA Surgical Robotics, offers this “Warning: Medical robotics is still a very new idea, and there is much more work to be done.”

Plus, there are certainly some disadvantages. If the surgeon is at any significant distance from the “surgeon” (robot), a secure, strong, and reliable internet connection is a must. At best, there is a time delay between sending and receiving a message (signal delay) that introduces risks in itself, even if the systems are sound.

The risk of hacking is, surprisingly, serious. In a recent test of hacking potential:

The researchers wrote special bits of code to delay information or to replace those given by the surgeon. No matter what they tried to attack—changing the position of the surgical tool, delaying the surgeon's command, forcing the system to reset—they succeeded. Many times, the "surgeon" didn't even notice that the system wasn't behaving as it should.

Perhaps the hacker would be a sociopath who just wants to see if he can do it. But we don't know. Healthcare hacks have become commonplace.

Fortune reported last fall:

Healthcare customers: Security experts warned in February that 2015 would be the year of the healthcare hack, and those forecasts have proven right. At the end of January, as many as 11 million Premera Blue Cross customers were affected by a hack. Anthem announced the following month that almost 80 million current and former customers’ personal information had been breached. In May, CareFirst BlueCross BlueShield, serving Maryland, Washington and Virginia, announced 1.1 million of its customers’ personal information had been compromised. UCLA Health System announced a data breach in July affecting 4.5 million people. In September, Excellus BlueCross BlueShield, based in upstate New York, said as many as 10 million people’s personal records had been exposed.

Why do hackers want healthcare data? From Infoworld, we learn:

… information contained in health care records has a much longer shelf life and is rich enough for identity theft. Social Security numbers can't easily be cancelled, and medical and prescription records are permanent. There's also a large market for health insurance fraud and abuse, which may be more lucrative than simply selling the records outright in forums.

Which amounts to saying that the best hackers may already be familiar with healthcare systems.

Practically speaking, the robots are also very expensive -- $2 million each, Ossola notes. The Third World hospitals that would benefit most would need international help to finance them.

And commenters on Ossola’s timely piece included a surgical resident who pointed out that the surgical robot probably works much better when a skilled team can just abandon the robot if a complication arises.

But that might be precisely what is lacking in some situations.

And in any event, contrary to the Medline summary above, a 2014 Wall Street Journal article reported that:

In the latest study to question the value of robotic surgery, researchers from Columbia University found that the technology costs significantly more and has a higher rate of complications than regular minimally invasive surgery for removing ovaries and ovarian cysts.

All that said, Google’s spinoff Verily has just announced the creation of a surgical robot division called Verb. We shall see where that goes.

Telesurgery by surgeons will probably become routine, for better or worse. But the additional claim explored at Popular Mechanics, surgery by autonomous robots, remind me of the self-driving car. Such a car's future is limited by the fact that it runs contrary to human aspirations: People buy cars in order to drive them themselves.

Similarly, for the foreseeable future, people are more likely to trust individual surgeons than software systems.



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