Schwab: Why C-3P0 won’t be asking for a scalpel during surgery

Robotic surgery is a thing; but it has more to do with remote controls than artificial intelligence.

By Sid Schwab

Herald columnist

To benefit humanity, and from the goodness of my liberal, bleeding heart, I answer medical questions on some websites. Of late, many concern “robotic” surgery, about which it’s apparent there’s much misinformation. As it happens, the FDA just warned surgeons to stop going crazy with what they’re doing using robots. So let’s talk about it.

For general surgeons, robotic surgery is laparoscopy, but cooler. The laparoscopy revolution happened well after I finished my surgical training, so I took courses later. The first, for laparoscopic gallbladder removal, was sponsored by a laser manufacturer; in fact, the procedure was originally called “Laser Laparoscopic Cholecystectomy.” We practiced on pigs (sorry), using both lasers and standard electrocautery. Seeing no advantage to the laser, I asked the sales-guy why anyone should spend fifty grand (back then) on the device. “Because,” he replied, “If people hear you’re not using one, they’ll go elsewhere.” Ah.

In hospitals across the land, those lasers now gather dust, after recognition that, for most operations for which they were purchased and advertised, there was no added benefit. It’s unlikely surgical robots will become electrified dust-bunnies, but, for now, their value is familiarly controversial: multiple studies have found no improvement in outcomes, whereas operative costs increased by several thousand dollars. (Robots cost millions. Attachments add more.) That FDA missive was occasioned by surgeons using robots for mastectomy, raising concerns, because of a more restricted view, about leaving critical tissue behind. Having done many mastectomies, I’m concerned, too.

Evidently, lots of civilians believe robots do the operating, employing extraordinary artificial intelligence. They ask if my profession is threatened, if surgery is better done by robots than humans. So, here’s the deal:

Robotic surgery was conceived as a way for military surgeons to operate on soldiers near the battlefield, but remotely, from behind the lines. (Not so, of course, for the medics who’d be installing the instruments.) Mechanical arms would move the instruments, controlled from anywhere, wirelessly, even across the internet.

My analogy: You’re being driven somewhere. The driver is your surgeon; the car is the operating room. With traditional open surgery, the driver sits up front, her hands on the wheel, gearshift, operating all controls directly, looking out the windshield to see the road.

With laparoscopic surgery, the driver is in the back seat, controlling the wheel, etc., with long tools, and instead of looking out the window, he’s looking at an image sent from a maneuverable camera on the front of the car to a TV screen, giving a closer, changeable view. Also, it’s a minicar.

In robotic surgery, servos, grabbers, whirring motors, are attached to the controls. That marvelous mass of machinery is being operated by your driver, who’s nowhere to be seen; ensconced, rather, at a console, in the garage, at home, or, truer to the surgery analogy, in a trailer being pulled behind the car, in case of mechanical trouble. She’s got fingers in all sorts of moveable gadgets, her head in a booth at the front of which is a TV screen. The controls of the car are moved by the attachments, but only in response to your driver’s every action, including verbal commands. It’s laparoscopy by remote control and with more agile instruments. The “robot” itself, though, is stupid. Acrobatic, yes. But dumb as a gallstone.

Robot-assisted abdominal surgery ramped up with prostatectomy and hysterectomy. Surgeons like the view they get, and the un-anatomical movements that are possible using their brilliantly engineered tools. And it’s fun. Because medicine in the U.S. is a commercial, competitive enterprise, doctors — and especially hospitals — trumpet their use of robotics. As with lasers, patients are impressed, convinced it’s even more “non-invasive” and less dangerous than laparoscopy alone. Futuristic. Magical. Cutting edge, one might say.

Now, “robots” are employed in ever more complex operations. Also, simple ones: gallbladder removal, hernia repair, for example, adding complexity (setting them up is a big deal). Better results have yet to be demonstrated, compared to standard laparoscopy. Greater expense remains the only consistent finding. But robots market really well.

Occasionally, robots have been used as imagined, by surgeons remote from the operative location. Having a world-renowned expert available from afar to “do” your operation is rightly appealing. In other situations? We’ll see. No matter what, though, there’s no thinking robot involved. Tender and variable tissues still need human minds.

We’re not even at the R2-D2 stage, let alone C-3PO.

Email Sid Schwab at

Talk to us

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Opinion

Editorial cartoons for Sunday, June 23

A sketchy look at the news of the day.… Continue reading

FILE - Lion Air's Boeing 737 Max 8 sits on the tarmac at Ngurah Rai International Airport in Bali, Indonesia, April 13, 2019. Indonesia said Wednesday, Dec. 29, 2021, it is lifting its ban on Boeing’s 737 Max aircraft, three years after one crashed shortly after takeoff, killing all 189 people on board. (AP Photo Nicole Evatt, File)
Editorial: Boeing quality proving difficult to recapture

The company seeks to assure its rededication to quality, but recent news is getting in the way.

President Joe Biden hugs Javier Quiroz Castro, who benefitted from the Deferred Action for Childhood Arrivals program, during an anniversary event for DACA in the East Room at the White House on Tuesday, June 18, 2024. President Biden on Tuesday announced sweeping new protections for hundreds of thousands of immigrants who have been living in the United States illegally for years but are married to American citizens. (Haiyun Jiang/The New York Times)
Comment: Biden looks to protect immigrant spouses of citizens

An executive order providing legal status would help families and the communities in which they live.

Loss of Herald staff a loss for journalism, democracy

Friday, the League of Women Voters of Snohomish County issued the following… Continue reading

Readers will notice the loss of Herald staff in newspaper

My deepest sympathies for The Herald’s newsroom staff regarding the pending layoffs.… Continue reading

Herald layoffs mark sad day for local journalism

I did not subscribe to The Herald to support a company from… Continue reading

Thanks for doing the math to determine Herald Athletic Cup

I read with pleasure the article about high school sports and the… Continue reading

How can Herald continue with much smaller staff?

I am stunned by the news in Thursday’s Herald regarding the significant… Continue reading

Layoffs of Herald employees shameful treatment

I read the online article about the layoffs of Herald newsroom employees.… Continue reading

Herald has helped hold community together

Regarding the pending layoffs of Herald newsroom staff, this is a sad… Continue reading

Robust staffing of Herald newsroom is necessary

I’m writing today to express my disappointment in the recent layoffs of… Continue reading

Editorial cartoons for Saturday, June 22

A sketchy look at the news of the day.… Continue reading

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.