For those of you who thought that surgery by robots was something out of a futuristic science fiction novel, that day has already come for Urologic surgeons. The da Vinci robot created by the company Intuitive Surgical is an expensive but top selling robot that is a must for any health center that claims to be cutting edge. Many of you might already have heard of Intuitive Surgical as their company stock has been a top performer in the device industry for several years. I do not own stock in the company or get anything from mentioning them, but they are the pioneer for Urologic robotics.

At any rate, the da Vinci robot is an actual robot that is controlled by a surgeon who is sitting at a computerized console in the corner of the room. The actual robot is a different machine that can move above the patient and has several “arms” that contain instruments on the end. The surgeon controls the arms and moves the “wrists” at the end of the arms. Sophisticated software now allows the robot to learn the movement patterns of the surgeon. The robot can filter abrupt movements of the surgeon and smooth out the movements to minimize any trauma to the patient.

When robotic surgery first came out, it was met with resistance. Common complaints included the high cost of the machine and the sterilized add-on components, the lack of “tactile feedback” from the instruments, and the steep learning curve. Older surgeons have been hesitant to retrain and obviously are not as facile with the machine as the younger generation who trained with robotics. On the whole, Urologists who use this machine regularly for prostate cancer surgery have excellent outcomes and are able to incise, cut, sew, and handle tissues delicately with the machine. Outcomes continue to improve and there have even been reports of surgeons remotely operating the machine on patients.

Thus, for the surgical field of Urology, robotics is here to stay.

Despite the “physical exam” being the secret magic that allows doctors to be doctors, it is also the main hindrance to the one advance that would truly make the healthcare system more efficient. If you don’t know what I am talking about, I am referring to medicine in which the doctor does not actually have to be in the room. Telemedicine is where the doctor is actually not physically in the room but is seeing the patient through a video screen. Another variation of this is robotic medicine in which a robot with a live video camera cruises around the hospital floor going from room to room visiting patients. On the other end is a physician seeing the patient through his video monitor.

Why is this so important? If you think about all of the possible areas to improve efficiency in medicine, the actual practice of medicine – the seeing of patients to diagnose and treat them – is the most time consuming and thus the most costly for the healthcare system. Have you ever wondered what doctors do all day? Well, they go around and visit their patients in the hospital – they “round on their patients.” They also see patients in clinic. The remainder of time is usually spent discussing patient care issues or continuing their education through lectures or talks. Thus making this more efficient of a practice would save enormous amounts of time and money.

Imagine being able to see patients and diagnose their diseases from a different place. Expert physicians could do consultations from across the globe. Physicians could efficiently see more patients. Video files would document all examinations. The physician would not actually need to go to each and every hospital location. How great this would be!

There are many layers of resistance to this movement. Patients, in their state of need, actually want to see a doctor face to face if they have the means to do so and if there is someone available not too far way. Physicians, with their intuitive minds, have gotten the sense that if they could be replaced by computers then they would not be in high demand. If any patient could see another doctor by logging on a computer with video camera and clicking on a button then many doctors would go out of business. Perhaps most importantly, healthcare systems and their prudent risk managers worry about liability issues with telemedicine.

As information technology continues to transform the healthcare system, it will undoubtedly continue to transform the way we practice medicine. Someday probably not too far off, we will be able to do a physical exam via telemedicine. Some of us can’t wait to be accessible to the vast worldwide patient population that awaits.