This excitement is spreading to other areas such as interventional pulmonology. New fly-by-wire systems aim to improve early stage evaluation of peripheral lung nodules which are difficult to reach and biopsy. These systems, combined with microwave ablation capability, pave the way to “see and treat” early stage cancer in a single procedure. That is a superb vision, and potentially also a superb strategy.Cognitive learning styles

But does it need a robot? On one hand, a recent study published in the journal of thoracic oncology, shows successful navigation in 94 percent of 1,157 lung lesion biopsy cases using medtronic’s superdimension, a “manual” navigation system without the capital costs of robotics [1]. This suggests the answer is no. But on the other hand, auris has created a robotic lung biopsy platform which allows the pulmonologist to see the biopsy needle entering the tissue: direct optical visualisation gives confidence that the biopsies are taken exactly where intended, with the aim of reducing false negatives.Cognitive learning styles

A key technological enabler by auris is the mechanical stability designed into auris’ scope, especially by means of a controllable sheath. This helps the entire endoscope (optics and working channel) to get all the way to the outer periphery of the lungs. Like intuitive’s laparoscopic endowrists, auris’ mechanical arrangement is made much easier to control by the robotic interface; i.E.Cognitive learning styles the mechanical design needs a robotic interface rather than any assumption that a robot is beneficial in its own right. Of course, this presents a capital cost barrier to hospitals. It is too early to say whether the clinical benefits justify that cost, although at least J&J’s multi-billion valuation of auris is a vote of confidence.Cognitive learning styles

Clinical needs, in turn, cascade into design objectives. For instance: identification of critical structures such as nerves; reduction of collateral damage to other organs; detection of cancer margins; reduced bleeding; situational awareness; ease of use (and ease of training, and ease of buying); speed; stability; reduced x-ray exposure, etc… and of course no more time or money than necessary.Cognitive learning styles

But that is difficult!! Even surgeons themselves often guide us towards incremental improvements instead of innovation, because they might not know what is technologically possible if it is not what they are used to. If a surgeon’s job was (say) to ablate tissue under the guidance of video endoscopy, then he/she might demand higher quality optics in the endoscope to help her position the ablation probe for a more controlled procedure. But what if a novel form of imaging would show both the anatomy and the zone of ablation, and even better, what if it could be combined with the ablation tool? That would make optical improvements the wrong design objective: the procedure is both safer and more effective if one can see the zone of ablation with a co-located ablation device. The burden is on the manufacturer, to have the insight to spot and analyse the underlying “need”, the awareness to know that better solutions are possible, and the bravery to act on it!Cognitive learning styles

Similarly, lack of boldness has pushed some companies in the direction of feature-starved low-cost robots. Yet, there is a subtle (but vast) difference between optimising the workflow of a me-too product based on medical knowledge, and pursuing a bold design that enables better clinical outcomes and totally new modes of surgery.Cognitive learning styles the latter is far more disruptive and valuable.

Some next-gen surgical robots have features which could equally be applied to manual surgical tools for the same benefit. For example, a straight-stick laparoscopic instrument can be just as impactful as a robotic laparoscopy system, when both have a sensor in the right place, surgical and imaging functions integrated in a single tool, or pre-op scans fused into intra-op images. So, is robotics a strategic objective? It may help to guarantee a certain level of precision and stability, but that might not translate into clinical benefits and it can even be an impediment if the fly-by-wire interface reduces the surgeon’s sense of touch, and increases costs or makes procedure times longer.Cognitive learning styles

Despite the well-deserved success of intuitive, robotic surgery in its own right is a terrible objective. Whilst investor excitement and the patient “billboard appeal” of robotic surgery have to be acknowledged, robotics poses a capital and training barrier to the clinician, and a complexity, support and infrastructure barrier for the manufacturer.Cognitive learning styles