“Robots, Surgery and Society” Robots have long been used in our daily lives, from helping with chores to fighting wars. In hospitals today, they walk on doctor rounds visiting patients and perform surgeries. Maja will provide an overview of current innovations in surgery and robotics, and explore how the future of robotics will have awesome implications for surgery and society. She will ask how far can we go before a surgeon’s ally becomes his achilles heal? And what is the trade off between robotic innovation and doing no harm? Maja is a liver transplant surgeon, currently training in Toronto. She has performed numerous operations both with and without the assistance of laparoscopic instruments, robotic devices, and highly technical imaging tools and holds a Masters in Public Health and training in Clinical Ethics.

1. We will let HAL do your
surgery…
Theimplicationsofroboticinnovationin
medicine
Maja Segedi MD

2. Financial Interests
None to declare

3. History of Surgical Innovation

7. Aseptic technique
Joseph Lister – biggest advocate of sterility
“Washing hands is as important before as
after surgery”

8. New frontiers in surgery became
possible

10. Minimally Invasive Surgery

13. Da Vinci’s Mechanical Knight

15. Endo Wrist Instruments

16. Stereo Viewer

19. Imaging Robot
Toronto General Hospital OR 20

20. Toronto General Hospital
Prostate, kidney, bladder
– Sept 2008
– 487 cases
– Prostatectomy, Partial
and Radical Cystectomy,
Partial and Radical
Nephrectomy
Gynecologic Oncology
– Nov 2008
– 322 cases
– Hysterectomy, Pelvic
Exenteration*
Colon and rectal cancer
– June 2011
– 22 cases
– Low Anterior Resection,
Abdominoperineal
Resection
Chest tumors
– Oct 2011
– 38 cases
– Lobectomy*,Tracheo-
bronchial plication,
Thymectomy

21. Why not do all surgery with
robots?

22. Cost
da Vinci surgical system
$2,500,00.00 USD
draping the robot/case
$300.00 USD
cost of one robotic instrument
$300-500 USD

24. Ethical Issues
Do no harm

25. • Computing technology is becoming cheaper
and better
• Machines are becoming cleverer and more
independent at completing human tasks
– Warfare robots for surveillance, diffusing bombs
– Cars that self-drive
• 2012 Car can tell if a pedestrian in front and brake
– Robots for elder care and robotic surgery

27. http://www.arjenborn.nl

28. Bomb diffusing military robot

29. Kuratas
Reuters, Nov 2012

31. Asimov’s Laws of Robotics
1. protect humans
2. obey orders
3. preserve themselves

32. Integrating ethics may be more cautious
and less agile than a 'do first, think
later' (or worse 'do first, apologize
later') approach, but it helps us win the
moral high ground - perhaps the most
strategic of battlefields.
Patrick Lin of the California Polytechnic State University in a
briefing to CIA officials (Dec 2012)

33. EPSRC Principles of Robotics
Robots are multi-use tools. Robots should not be designed solely or primarily
to kill or harm humans, except in the interests of national security.
Humans, not robots, are responsible agents. Robots should be designed &
operated as far as is practicable to comply with existing laws & fundamental
rights & freedoms, including privacy.
Robots are products. They should be designed using processes which assure
their safety and security.
Robots are manufactured artefacts. They should not be designed in a
deceptive way to exploit vulnerable users; instead their machine nature
should be transparent.
The person with legal responsibility for a robot should be attributed.
http://www.epsrc.ac.uk/research/ourportfolio/themes/engineering/activities/Pages/
principlesofrobotics.aspx

34. Steps to doing robotics right
1. More clarity (laws on what allowed to do)
2. Clarity in the machines
– Black boxes to record all
• Eg. driverless car has this (Nevada law)
3. Machines need to embody the right ethical rules
– Cultural disputes
– Ethical principles
– Trolleyology – experimental philosophy (what
percent of population prefers which principle)

35. Technology has driven mankind's
progress, but each new advance has
posed troubling new questions.
Autonomous machines are no
different. The sooner the questions
of moral agency they raise are
answered, the easier it will be for
mankind to enjoy the benefits that
they will undoubtedly bring.

36. Thank you

37. Questions?

38. Sources
Ü Ted TV Catherine Mohr 2009 “Catherine Mohr:
Surgery's past, present and robotic future”
Ü Intuitivesurgical.com
Ü Economist.com, Feb 2012 “Morals and the
machine”
Ü Lin, P., Abney, K., Bekey, G.A. (Eds.). (2012).
Robot Ethics: The Ethical and Social Implications
of Robotics (Intelligent Robotics and
Autonomous Agents series). Cambridge, MA:
MIT Press.

39. Acknowledgements
Ü Dr. John Irish, University Health Network
Ü Anne Richards, Surgical Nurse Manager, UHN
Ü Kate Mlachak

40. Ü Reach it all
Ü See disease
Ü Leave patient whole and intact and functional
Ü When you get to your date with the surgeon
Ü Facing the diagnosis of cancer or heart disease