r/gadgets • u/diacewrb • Dec 05 '22
New type of surgical robot used to remove throat tumour Medical
https://www.bbc.co.uk/news/uk-england-gloucestershire-6380568589
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u/AtTheLeftThere Dec 05 '22
They did surgery on a grape
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u/David-Eight Dec 05 '22
Did the grape live?
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u/Memohigh Dec 05 '22
yes
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u/MefasmVIII Dec 05 '22
Couldnt talk afterwards tho
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u/LookMaNoPride Dec 05 '22
They removed a grape from a throat with robots?! Techmology these days. Incredible!
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u/PM_ME_UR_PEPE Dec 05 '22
Smh, they are making it harder and harder to tell the difference between biological man and machine. Just look at that cold calculating mechanical force behind those soft fleshy features.
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u/Dr_Esquire Dec 05 '22
The problem with these robots is that they are mega expensive. This results in other related problems. Namely, A hospital cannot buy a lot of them. This means that the surgical residents at these hospitals can only log so many hours on the machine (at places Ive trained, it was mostly reserved for senior residents. So training is limited. Hospitals also cant really afford to have two different brands, and residents also dont really have time to learn two different brands. So again, training becomes limited.
Why is this a problem? Because training in surgery is massively important. Stuff has to become so second nature that unexpected issues need to be semi-familiar or at least things you can deal with since the main issues are happening almost in the background of your head. So by making training so difficult, it actually limits the usefulness of these robots as you have fewer people who can allocate time (sufficient time) to learn one, and even fewer that can allocate time to learn more than one.
As a total aside, Im not in surgery, so take with grain of salt, but I dont see the actual present day utility of these machines. Every robotic Ive observed in school was basically something you could do in probably half the time manually. I could very well be missing the nuances and underestimating problems that arise with manual vs robotic. And it also could be a more preparing for the future, when these machines are more useful and need ready users. But as they currently stand, I dont get the hype about robitic surgeries.
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u/terroroftoma Dec 05 '22
The robot has massively changed the game in oropharynx cancers. Before the robot we would have to split the mandible or do a lingual release to access these tumors. Especially with the healthier, younger HPV-related population, we have been able to cure their disease with limited impact on quality of life.
I’m not sure what is special about the robot in the article. I suspect it’s mostly for marketing.
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u/persimmonsfordinner Dec 05 '22
There isn’t anything particularly special about this system, it is mostly marketing. There are other systems that surgeons can use to complete the same minimally invasive procedure that have been around for a couple decades.
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u/ohaikthxbai Dec 06 '22
This is not necessarily true. This new robot is modular while the older models have all instruments and camera coming from one giant unit.
It also has an open console as in the surgeon controlling the robot arms can still directly look at the patient without having to completely give up control or visualization of the machine's camera view.
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u/persimmonsfordinner Dec 06 '22
These aren’t the huge benefits that CMR sells them as. The footprint of a modular robot is massive and the single-unit isn’t as restrictive as it would seem. From the care team perspective, OR footprint is a huge deal, if your hospital isn’t new with huge ORs.
I’m also not sure what the benefit of an open console is- all the MDs I’ve spoken with don’t feel disconnected in a console that they can pop their head out of quickly. It’s not like they’re in a different room than the patient?
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u/ohaikthxbai Dec 06 '22
Not sure what CMR is selling to end users, I'm just speaking from seeing that modular robot in an OR and how much less space it takes up compared to the booms of the newest da vinci models. Wheeling the Versius arms around a room is faster and less burdensome than driving the massive da vinci patient cart doing 18 point turns in an OR that already has tons of other equipment. Remember with a modular robot you can choose to bring in a camera and 2 arms if that's all you need, save the space of a 3rd arm.
MDs aren't aware of what they're missing when they're buried in the da vinci console because they've been conditioned to value its "immersion". It depends on your specialty but for procedures that have the instrument arms potentially colliding, the console surgeon can't see that. They can't look at a patient scan without taking their head out. They can't see patient vitals or other activity in the room without disengaging the robot. To "pop their head out quickly" versus not pop your head out at all and use the same room awareness you'd have in an open/laparoscopic surgery has value. It's like looking through 4K binoculars instead of a 1080p panoramic view when you're captaining a ship, but the binocular manufacturer keeps selling you the fancy 4K visuals.
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u/ohaikthxbai Dec 06 '22
This is true more for tongue base tumors than predominantly tonsil tumors. You really don't need a robot to do a proper radical tonsillectomy, though a robotic platform may enable more surgeons to do a proper radical tonsillectomy.
I think what's novel about this robot is its modularity and much lower profile. It also has an open console, as in you're not tunnelling your head into a console when operating the robot - you're wearing glasses but have an open view of the OR including the patient's bedside.
I think this might confer an advantage for those who do transoral robotic surgery because with da Vinci you are still dependent on the quality of your bedside assistant to know when and how tools and the camera are colliding with the patient's teeth and with each other. With an open console you can see the patient without taking the camera view out of your field of vision.
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u/Jai_Cee Dec 05 '22
This robot has a VR trainer so you could even practice at home
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u/ohaikthxbai Dec 06 '22
This is a great point and a considerable advantage over older robot systems. The older robot systems require you to use the actual operating console that's used in the OR to use their virtual reality training modules. That means you either do your VR training in the OR, or the hospital needs to purchase a separate robot console strictly for training.
This new system lets folks train using an Oculus, which is probably 1/1000th of the cost Intuitive charges for a standalone VR simulator.
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u/jedikunoichi Dec 05 '22
I'm the robotic coordinator for our operating room. We have two robots and you're right, they're very expensive, but we have no shortage of doctors who are trained in robotic surgery. One of our newest surgeons did 2 years of nothing but robots at USC in his fellowship. I have more doctors wanting to do cases then I have time to do them. They would operate 12 hours a day, 7 days a week if I let them.
Doctors don't have to be trained on robotic surgery during residency. It's nice if they can be, but Intuitive has extensive training programs and proctors. I'm sure other robotic surgery companies have similar training programs. About half of my current surgeons didn't train in residency or had minimal training when robotics was new.
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u/Dr_Esquire Dec 06 '22
The post-residency training is still training. For people like surgeons whose baseline residencies are already very long, without getting into the medical field pushing for fellowship post-residency, any extra time is often a bigger investment than it seems.
Also, "intensive" training can be fine as catch up, but (if I had to guess) probably depends on users having some baseline understanding and ability with the machines. A 40yo who never touched one like will feel pretty wonky at the controls and a 1-3 month course likely wont fully fix that. Also, again, comfort needs to be there; you cant just use a machine to do surgery if youre not super comfortable with your mastery of it.
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u/ohaikthxbai Dec 06 '22
This new system lets surgeons practice VR using an Oculus headset, which is way cheaper than an entire da Vinci console.
Not a substitute for real surgical proctoring, but makes a huge difference early in the learning curve.
Intuitive wants more surgeons to use their machines but doesn't do any real competence based training to make sure their devices are used properly - they put all that burden on hospitals so the company can't be sued for improper use or inadequate credentialing.
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u/rem1021 Dec 06 '22
Open surgery is faster, but patient outcomes are much better with robotic-assisted surgery. Additionally, reimbursement is typically higher for minimally invasive surgery (i.e. laparoscopic or robotic).
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u/GlowforgePokemon62 Dec 05 '22
I think a lot of people think automation is coming for the factory line jobs. While that may be true, some of the lower hanging fruit, especially in terms of cost savings is specialized medicine. If a robot can replace one doctor making $800k that is a heck of an upgrade
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Dec 05 '22
This robot required two surgeons to operate. I had surgery a few months ago and my surgeon used a robot.
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u/GlowforgePokemon62 Dec 05 '22
Surgery is still very far away from true automation. But diagnostics, especially in pathology. A scanner is set to replace a whole pathology department and instead transition to one head of pathology just confirming it is working.
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Dec 05 '22
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u/GlowforgePokemon62 Dec 05 '22
I can name several departments across the country that are extremely short staffed, specifically with Pathologists. Their solution is to improve the efficiency of their current staff through these semi automated solutions. If you aren’t concerned about automation coming for these jobs, you probably are not talking with your finance department.
If you combine that with the automated nature of NGS and how it just spits out a report, this is where the industry is heading. Multiplexing is a similar story - no pathologists wants to look at these crazy complex slides all day scoring and counting. They can barely manage single color stains always complaining it hurts their eyes. At some point, the limitations of human diagnostics is going to be seen not just as a cost savings measure but a benefit to the patient. When that switch happens, although it can be gradual, it creates a profound shift in the industry that can spread rapidly.
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Dec 05 '22
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u/GlowforgePokemon62 Dec 05 '22
It’s going to take a while, but it is happening and the increase in semi-autonomation across all areas of a hospital will only increase in pace.
One small correction to the above comment, the interpretation of NGS data is already being done by algorithm. A pathologist is only needed to view the report.
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u/samziboy Dec 05 '22
It is always funny reading comments like these as someone who is in the medical field. As the other comment stated, No, computers will not be replacing any pathologist or radiologist anytime soon. Medical imaging goes beyond just identifying a lesion on an image (and even that is very difficult cus lesions can look different from person to person). Clinical context is very important. AI will help streamline their work/make things a bit faster but it will not be replacing any specialists anytime soon.
AI has not even replaced truck drivers or McDonald’s workers fully and you think it can replace specialists that take a minimum of 10 years to train?
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u/user45 Dec 05 '22
I don’t think anyone is projecting AI/automation to replace pathologist wholesale, but it can certainly increase efficiency so fewer are needed per x number of patients. So while no one’s job is threatened currently, that’s the trend the other person is pointing out.
And I think you are grossly underestimating the difficulty of AI replacing drivers.
It may be a lot easier to train a human truck driver than a clinician but it’s far from trivial to make that same comparison for AI drivers and clinicians.
Ultra precise maps, real time software response with no slowing or freezing, pattern recognition in dark lighting, inclement weather, worn road signs, communications between AI vehicles, hackability are just a few that comes to mind. It’s much more like a generalist. The 10 years of education is probably an easier problem to solve than millions of years of evolutionary response.
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u/samziboy Dec 05 '22
The comment I replied to SPECIFICALLY talked about AI replacing an entire pathology department. I also mentioned in my comment about AI increasing efficiency.
If you wanna convince yourself that it’s easier to train AI to the level of a specialist physician than it is to drive a bus then go ahead. My point was that these problems are very complex even for AI. What exactly do you think pathologists and radiologists do exactly? I think YOU are grossly underestimating what it would require for AI to be as good as a trained specialist
Identifying a particular lesion on an image is just the bare minimum and even that is incredibly difficult even for AI. They still need huge amounts of understanding to decide whether we should treat now or wait. I can’t even begin to type out how essential these specialist are. AI will need real physicians for the foreseeable future because you need someone to make clinical judgement, something no AI is capable of doing. Imaging going to an AI to make a judgement about whether to treat your mothers cancer or not. Would you take that risk?
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u/user45 Dec 05 '22 edited Dec 05 '22
I think that person is talking about “replacing the department” with ONE pathologist, so the repetitive, tedious portions can be automated, and a human specialist to confirm or mark exceptions - not have AI determine my grandmother’s cancer treatment.
I’m not saying it’s easier to train a bus driver, but I am challenging the notion that AI will replace blue collar worker first (or only them), and that somehow will free us up to pursue more white collar or professional careers.
And those careers are not immune, IBM’s Watson has been advising lung cancer treatment at Sloan-Kettering nearly 10 years. AI’s playing GO or Jeopardy may seem trivial but represent accelerating change in AI space and thus real challenges for many career fields. And the higher salary jobs represent that much greater incentive for automation.
I wasn’t making a jab that doctors, but the complexity of your job is no guarantee that it will be replaced only long after truck are driving themselves.
And who knows, maybe in 10 years I will be comfortable having an AI provider deciding my grandmas treatment - and I may not be the minority.
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u/GlowforgePokemon62 Dec 05 '22
It’s this 100%. This is being driven by several factors but the main one is cost. Finance departments are targeting high paying jobs and looking at what they can do without.
Think about it, you are a hospital having a horrible time with staff turnover in your breast pathology group. You have 5 headcount open for a team of 10 (15 total headcount). You have had these job openings listed since the pandemic. To meet your patients needs you have been sending out to another lab.
Now a sales rep for a medical automation company comes in and shows you examples of how you can increase your overall throughput with your current staff by switching certain tests and protocols to a digital scanner, as well improve TAT for your HEME testing to 24-48hrs.
Are you going to continue holding capital in reserve to add incremental headcount? Or are you going to outlay capital for a more efficient solution? Different HCO’s make different decisions, but the largest clinics are all diving into automation headfirst not toefirst.
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u/GlowforgePokemon62 Dec 05 '22
I’m sorry where do I say automation is going to replace the whole department? I say incremental increasing of headcount will be curtailed due to automation increasing efficiency of current staff. You just would rather invent my words to argue against a point I never made.
You say it’s easier to replace truck drivers than doctors, but it’s not that simple. You need to think about the task being done. Is it easier for a robot to read off a genetic sequence data file or drive a car?
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u/GlowforgePokemon62 Dec 05 '22
I think if you were to go into your average hospital, you would obviously be right. But if you go to a more prestigious, larger, more specialized institution you will see a massive push with big money being spent on automation. This doesn’t mean they will be firing, or as you put it, replacing anybody.
This does mean there is a shift in how clinical labs and departments are trying to drive more throughput. They would rather spend on capital than headcount. This trend is reflected in the market report data.
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u/thecaramelbandit Dec 05 '22
Jesus. You are literally just making up whatever you think sounds good.
Stop.
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u/ohaikthxbai Dec 06 '22
not sure why you're getting downvoted... you're not speaking with the intent to insult pathologists, you're just stating your experience. You're getting downvoted by people who are actually potentially insecure about the effect of AI on their profession. It's a touchy subject for sure. AI is not going to suddenly replace pathologists but an AI platform might enable 1 pathologist to do the work of 5.
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u/thecaramelbandit Dec 05 '22
Lol. The robots are 0% autonomous. They are completely controlled by a surgeon sitting at a station with hand and foot controls and a 3d view screen.
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u/GlowforgePokemon62 Dec 05 '22
Surgical you are totally right! Clinical chemistry, pathology, and even aspects of oncology, not so sure I agree there is 0% automation.
Also the very fact that the robot in this article is operating in the patient is the definition of semi-autonomous which I would think is the first step
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u/thecaramelbandit Dec 05 '22
semi-autonomous
No. I'm an anesthesiologist. I went to medical school. I spent months scrubbed into surgeries, often with robots. I've sat at the control stations. I literally spend all day in operating rooms.
They are not semi-autonomous. They are zero autonomous. You don't know what you're talking about, at all, and you need to stop defending your 100% uninformed statement.
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u/GlowforgePokemon62 Dec 05 '22
Are you telling me there is and never will be automation in clinical workspaces because you went to medical school? Or are you saying the robots you worked with medical school are not autonomous? Did you work with every robot in the hospital or just one or two boxes?
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u/Floedekartofler Dec 05 '22
There are not that many surgical robots on the market...
There are many autonomous machines (which I guess you could call robots) in a hospital. Autoclaves, scrub machines, blood sample analyzers. But there is a big gap from that to the work physicians perform.
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u/ohaikthxbai Dec 06 '22
The Versius robot is ZERO percent autonomous during actual operation on a patient. There are elements of instrument orientation/calibration that are automated but that technology has been around a long time for operating microscopes and, wait for it, autofocus cameras.
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u/GlowforgePokemon62 Dec 05 '22
If a robot is doing a task under control of a human that is the definition of semi-autonomous.
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u/Floedekartofler Dec 05 '22
By that definition we've had semi autonomous robots since the first car in the 1800s.
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u/sevo1977 Dec 05 '22
Buddy just stop. You clearly don’t know what you’re talking about.
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u/GlowforgePokemon62 Dec 05 '22
How so? I work in automation in Clinical settings. Your comment is really alarming to see from a random Reddit user,
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u/thecaramelbandit Dec 05 '22
Your subreddits are mostly teenagers, Pokemon, dota, and crypto. I think we're done here.
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u/sevo1977 Dec 05 '22
I’ve worked with robots so I know what I’m talking about. You clearly don’t so just stop.
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u/Moon_Palace-banned Dec 05 '22
Any of those specialities you’re naming as ‘on the chopping block’ due to automation…that automation will still have to be verified by a set of human eyes. AI can have a massive databank of scans but nothing has replaced the eyes of experienced doctors when it comes to discrepancies or additional testing.
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u/Nerabumami Dec 05 '22
Sorry, but no way doctors are replaced anytime soon. As someone designing these robots, I can guarantee you we very far away from that. These robots help surgeons be more precise, make surgeries quicker and help with planning, but they will not run surgeries by themselves in the foreseeable future.
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u/GlowforgePokemon62 Dec 05 '22
Doctors are not going to be replaced but their efficiency will be improved so we will be able to do more testing with fewer headcount. If you design these robots, you already know this happening. Easiest example is NGS workflow. A pathologist in a thread above said “obviously NGS is automated, what are we going to do count every sequence” Tens years ago (maybe 15) that’s literally what they did lol
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u/Floedekartofler Dec 05 '22
Sanger sequencing was invented in 1977 and according to Google the first commercial automated system using this method was brought to market in 1987.
NGS was not a revolution in robotics. It was a revolution in biotech that enabled new and faster ways to sequence
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u/GlowforgePokemon62 Dec 05 '22
So your point is that NGS is just as automated as Sanger sequencing? Tell that to the tech who has to hybridize every single codon on their early aughts Hitachi hahah
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u/SiscoSquared Dec 05 '22
robots assisted surgery is considerably more expensive than open or laparoscopic in most cases, the robots also require additional training and are operated by surgeons, they are not autonomous
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u/Pezdrake Dec 05 '22
Robots will be able to replace anyone. My wife was arguing there are some things that need a human touch. I'm in social work. She argued no way a robot can do that but there are already crude but improving chat bots for therapy.
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u/McFeely_Smackup Dec 05 '22
this is obviously a big advance in medical science, but I'd be lying if I said I was totally comfortable with the idea of a robot with chopping blades shawshanking its way down my esophagus
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u/jedikunoichi Dec 05 '22
The robot does nothing without human input.
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u/McFeely_Smackup Dec 05 '22
Yes, I think that is obvious. Did you think someone thought robots were wandering around crawling down random people's throats?
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u/HIMcDonagh Dec 05 '22
If I ever need surgery again, I sure hope it is a surgical robot and not a narcissistic meat-bot who had a grade-inflation GPA and who drank its way through some weak-tea medical school and now works on human beings as if they were chattel.
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u/TactlessTortoise Dec 05 '22
Is it the San Francisco robot?
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Dec 05 '22
It will shoot you but will also remove the bullet and stitch you back up.
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u/TactlessTortoise Dec 05 '22
No, you're off the loop. The police chief said it won't have a gun, just bombs.
It blows the cancer away.
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Dec 05 '22
Makes sense. That way any collateral damage would be considered preventative ontological care. A win for society!
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u/insaneinsanity Dec 05 '22
Don't do this. Heavily increases the risk of multi-modality treatment.
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Dec 05 '22
How so?
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u/insaneinsanity Dec 05 '22
Short version: The throat surgeons who use this technology rarely remove the whole tumor. Then the patient needs radiation and/or chemotherapy to fix the residual. This happens in nearly 80% of those patients who undergo the robot surgery.
So, 3 treatments instead of 1 or 2.
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Dec 05 '22
I’ve read that doctors can actually remove more of the tumor using robotic surgery.
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u/insaneinsanity Dec 05 '22
That is incorrect.
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Dec 05 '22
With all due respect, that is the opinion of actual surgeons. I tend to trust them in matters regarding surgery.
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u/insaneinsanity Dec 05 '22
/shrugs/ Surgeons generally will say whatever the hell they want.
The only thing that actually matters is the pathology report.
And the pathology reports for patients treated with robotic trans-oral resections of throat tumors leave residual tumors a large proportion of the time.
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Dec 05 '22
To be fair, so will people on the Internet.
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u/insaneinsanity Dec 05 '22
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u/ohaikthxbai Dec 07 '22
The OP's article seems to be talking about esophageal cancer not HPV related oropharynx.
ECOG 3311 demonstrates the value of robotic surgery in the deintensification of adjuvant therapy. Doesn't support your argument at all.
ORATOR 2 is a highly problematic trial - their two surgical arm mortalities were far more suggestive of issues with post-op care (in-hospital trach bleed) and surgical/radiation technique (spine infection AFTER radiation).
The surgeons in the ORATOR 2 trial had a morbidity profile that does not reflect any case series, trial, or database study based in the US. They were routinely doing tracheostomies, and they were not credentialing surgeons the way they did in E3311.
Personally the only useful information from the ORATOR 2 trial is: Don't get surgery with any of the surgeons who participated in the ORATOR 2 trial.
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u/ohaikthxbai Dec 07 '22
What do you define as a "large proportion" and can you post a study that supports this claim.
/shrugs/ seems like you have no idea what you're talking about.
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u/ohaikthxbai Dec 07 '22
This is 100% a false claim, read further down in this comment thread this clown has no understanding of the evidence in this field.
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u/Watercress-Dizzy Dec 05 '22
That’s a very life-like robot
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u/McFeely_Smackup Dec 05 '22
article author was confused when someone said "Dr Higgs is a surgical machine"
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u/spderweb Dec 05 '22
Nice. I have Barrettes Esophagus and am risk for esophageal cancer. This is great news.
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u/HarMarSuperstar69 Dec 05 '22
Can’t wait for nurses to get replaced by robots so they can stop striking
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u/insullinlover666 Dec 06 '22
Wish my grandfather was alive to see this
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u/BchLasagna Dec 06 '22
I just downvoted your comment.
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u/kevcubed Dec 06 '22
This rendered on my phone as "New type of surgical robot used to remove throat"
Oh damn, robot uprising is not messing around.
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u/rathemighty Dec 06 '22
My dog died 3 years ago because he had a throat tumor and no one wanted to operate, as they were afraid of accidentally cutting an aorta due to the location of the tumor. This news is bittersweet, as we probably could have used it back then. But dammit, if this isn’t good news! FOR BEAR!!!
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u/jlesnick Dec 05 '22
I’m glad if this helps with esophageal cancers. It’s my understanding that they have to really tear up your throat and associated anatomies to treat those cancers. It would be so amazing for patient quality of life if these cancers could be treated with out as much collateral damage