The next frontier in healthcare 

But why should healthcare embrace robotics? It comes down to three reasons: better access, improved outcomes, and standardization. The success of the Intuitive Surgical Da Vinci robot in recent years in areas like prostate surgery, cystectomy, and increasingly colorectal surgery, illustrates that surgeons are very aware of the benefits of robotic approaches. This is true not only for conventional and laparoscopic surgery, but also for endovascular interventions. During the COVID-19 pandemic, cardiologists from Sao Paulo, Brazil, conducted a pilot study using robotic percutaneous interventions (PCI) in myocardial infarction patients with COVID-19 to reduce virus exposure for the interventional team.[2]

Apart from potentially reducing virus exposure, robotic platforms lead to a steep increase in interventional precision, especially when connected to intraprocedural imaging. By using a minimally invasive robotic system for endovascular interventions, a doctor can deploy a stent much more precisely. This benefits patients, because precise stent deployment has been known for years to improve long-term cardiac outcomes. Precision can also be increased in gastrointestinal cancer surgery, where robotic systems can help surgeons spot small blood vessels, nerves, or lymphatic tissue that needs to be protected. Finally, robotic assistance can add to staff safety, for example by allowing interventionalists to stay shielded while performing a catheter intervention.

But doesn’t the use of robotics come at a cost? Do we not prefer our doctors to be human beings? What if robots cause complications, as happened in the early years of robotic surgery with robots that assisted in hip replacement surgery? How, in other words, should medical and specifically interventional robotics be judged from an ethical point of view? How should robots in any field be judged from an ethical point of view? 

Many of the ethical discussions around robotics in healthcare come down to two aspects: risk-benefit assessment and the degree of “autonomy” of a robot. Regarding autonomy: the robot complements the work of the physician, taking over some tasks and allowing the physician to focus more on clinical decision-making. The robot won’t “replace” the physician. It is autonomous in that it performs small, precise moves that are better done by a machine, but it always remains an extension of the doctor’s capabilities. The physicians remain in the driver’s seat. They oversee what robotics does at any given time. 

When it comes to risk-benefit assessment, it is worth keeping in mind that a robotic system doesn’t simply enter the medical arena. It has to be approved, and it has to thoroughly demonstrate its benefits. This, of course, is not as straightforward as it sounds. Exactly how much responsibility a machine should have is a discussion that will yield different answers in different types of medical disciplines and different kinds of care scenarios. However, there is a fundamental truth: As soon as patient outcomes are better with robotics than without it, it might in fact be unethical not to use it.