Session 10: Technology Assessment & Forecasting

Brief Overview/ Introduction

Technology assessment and forecasting was the topic of this week’s session. Technology forecasting consists of predicting the future direction of the technology. In contrast, technology assessment involves evaluating the potential changes and implications that may result from an emerging technology, and finally deciding on whether or not to bring forth its existence.

During the session, we discussed the importance and techniques of evaluating the potential implications of presently emerging technologies, as well as the changes and steps that have to be implemented in order to make those emerging technologies a reality in the future. It is crucial to consider not only the future benefits each technology may bring, but also the possible costs they may impose on certain stakeholders, so as to avoid unintentionally inflicting harm to those directly or indirectly related. 

The basis of this topic is about looking forward into the future, where there are opportunities. It is therefore important for businesses to be forward-looking if they want to remain successful, and those companies who are caught up with their past and present situation are bound to get left behind.

Interesting Observations & Ideas:

Prof began the session by showing us a video of how Siemens has successfully captured and leveraged on a few of the future megatrends. The video shows how Siemens has proven itself to be rising star company by not only identifying the megatrends it could potentially exploit on, but also how they plan on achieving those goals. The 2 megatrends that Siemens has leveraged on are demographic change and urbanisation. They have predicted the changes in people’s needs, such as ensuring a sustainable water supply, increasing demand for personal security, rising healthcare needs and convenient transportation services, and have accordingly thought of the potential infrastructures they would put in place in order to satisfy those future consumer needs and  demand.

For example, to address the growing demand in healthcare services, Siemens plans to build a digital hospital which completely electronifies patients’ data, saving valuable time, increasing productivity and cutting costs.   Besides preparing them for the future, their innovative and forward looking strategies and solutions allows them to remain ahead of their competitors and protects their position and relevance in the market. Siemens’ way of disclosing its future plans and strategies may seem foolish to some, as it exposes itself to its rivals. This move indeed presents this disadvantage, yet, it provides Siemens with abundant advantages as well. It enables the company to obtain meaningful feedback and criticisms from its target customers and shareholders, thereby affording them the ability to make adjustments to their plans that are aligned with customers’ preferences. This smart move also opens the company to opportunities for useful, powerful alliances and partnerships with like-minded companies.

The ever changing consumers’ needs and environmental conditions, are not the only few drivers for constant technology assessment and forecasting. There is a rapid emergence of various novel technologies with revolutionary or revolutionary effects, thereby creating the need to obtain a thorough understanding of the resulting economic, ethical, social, legal and environmental changes and implications. For example, bringing in automated cars is highly innovative and possess many advantages, however, we need to consider the fact that driving cabs provide an avenue for people who are jobless, thus to bring forth the introduction of automated vehicles would essentially deprive these people of their last source of income. Furthermore, given our limited resources and capabilities, we need to prioritise while developing and implementing new technologies, deciding upon only those which provide us with more benefits than costs. This is especially so for those developing countries. Who you are is a crucial factor to consider when investing in new technologies, if you are a small company with scarce resources, you would want to concentrate on technologies that will produce gains in the short run. Conversely, if you are large, with abundant resources, say a government running a country, you would most likely be interested in the long term gains.    

Key takeaway points:

I feel that the key takeaway message from this session is to bear in the mind the need to be forward-looking and avoid getting too involved in the past and present situation. Considering the fast and rapid pace of things today where change is the only constant, visioning the future is the way to avoid getting left behind and becoming obsolete. Moreover, we have to bear in mind the potential implications when selecting an emerging technology to invest in, because it is easy to lose ourselves to the exciting advantages they may bring. We wouldn’t want to bring about consequences that may offset and deprive us of substantially the entire benefits.  

Session Rating:  7/10

Session 9: Emerging & Future Technologies

Brief Overview/ Introduction

This week’s session was on emerging and future technologies, where we viewed a few of the interesting and potentially revolutionary new and emerging technologies in today’s market. Prof reminded us that it is important to keep in mind the possible implications, social or ethical, of these technologies, and whether the benefits that will ensue from them are worth risking the negative implications that they could bring. Some of these technologies pose very promising solutions to several pressing global problems like rising carbon emission or finding alternative energy sources.

Interesting Observations & Ideas:

We started today’s exploration of some of the numerous emerging technologies with Claytronics, which is a technology that combines nanoscale robotics with computer science to create individual nanoscale computers called claytronic atoms or catoms. These catoms can interact with one another and be programmed to form tangible 3-D objects that humans can then interact with. I found this technology really cool as it can really change the way we communicate our ideas with one another. Imagine being able to design and invent whatever you want, transferring all your ideas into real-life. I think this would be extremely helpful in eliminating language barriers in communication, or for handicapped-persons such as deaf persons who have trouble speaking. Such people can better communicate their ideas in their daily human-to-human interactions, and help loved ones to understand the personality and needs more. This would be especially useful for parents, whose hearing-impaired children have yet to master the art of sign language. This technology would be extremely useful for personal security too! Clothing made from catoms can be programmed to become as strong as steel while maintaining its light weight in times of danger. They can be programmed to ‘sense’ danger and act as a shield from bullets from example, or they can even become like cushions to protect us from car accidents! Claytronics definitely has the potential to greatly affect many areas, be it in business transactions or daily life, it’s simply amazing, and definitely one I can’t wait to see happen.   

Another technology which caught my interest was plastic electronic as this technology holds the promise for a more sustainable tomorrow. Someone in class asked whether the use of plastic here is sort of contradicting our goal of sustainable development and cutting down the use of non-biodegradable plastics that pollute the environment. However Prof explained that the potential low-energy production that will be brought about by it through printing press can ultimately reduce our reliance on precious earth-mined resources.

The area of robotics also piqued my interest…especially when Prof showed us a video on a female robot that can basically be your ideal romantic partner. Woah. Although I feel it’s really creepy (especially when the robot in the video Prof showed us has eyes like those … :S ahahha I wouldn’t want to wake up in the middle of the night and come face-to-face with them when I turn over in bed. Scarreh. ), I do acknowledge the pros of having a robotic partner…they won’t argue with you, cheat on or divorce you…they could very well be the ideal partner. Robots have greater possibilities other than being the perfect companion, they can be programmed to fight wars too for example, instead of humans, however, as robots are increasing built with in-built knowledge and decision-making capabilities, it gives rise to the possible threat of their having information and knowledge that surpasses that of humans, and then potentially turn against us, just like in Will Smith’s I,robot.   

The global electronic library from reading 4 is really promising too, as it could potentially change our perception of intelligence, from being able to memorise the knowledge and information we see, to being able to retrieve information the fastest. It may seem as though we are close to this amazing technology, with information from google or whatnot, but with copyright and intellectual property issues, we cannot be more far from attaining a global electronic library, where all the information is available online. I feel that this technology can be one of the major solutions to achieving one of the MDGs of education for all, although it has to first achieve the goal of allowing everyone to have access to the internet.  

Key takeaway points:

I feel that not only is it important to understand some of those new and emerging technologies that are potentially revolutionary, and how they can possibly raise the quality of life and eradicating inequality, it is always important to keep in mind the potential implications that they could bring when evaluating them. All this while we have been taking a passive stance towards dealing the ethical and social implications of technologies. However it may be more effective to take a proactive stance instead, by predicting the implications of new and emerging technologies before they are implemented on the mass scale, instead of waiting for problems to develop before seeking solutions. This would help to increase the positive implications of the developing technology when it is finally available in the market, and we would then be able to appreciate it even more. This is especially since many of the emerging technologies are promising solutions to sustainable development, or eradicating inequality, capable of improving society’s overall quality of life. One prime example would be surveillance technologies, which would inevitably bring about implications to personal privacy and even security. It is important to think of such possible implications and develop effective or rigid rules of usage or policies which will prevent users from using the technology immorally.

There are a lot of different drivers of the development of technology such as unmet market potential or modifying and building on existing technologies, however I feel that the common factor in most, if not all, of them is the ability to think of new ways of doing things, be it from standard protocol. The one thing that differentiates leaders from followers would be their ability to innovate and to think of limitless possibilities.

Session Rating:  8/10

Session 8: Energy & World Change

Brief Overview/ Introduction

This week’s session was on energy and world change, and it mainly revolved round the issue of rising energy consumption and the pressing need for sustainable energy sources for the future generation.

As a starter Prof showed us a quote which was shown previously in earlier sessions which said that if everyone were to consume as much energy as the average Singaporean or American president, the world’s oil reserves will be depleted within 9 years. Global energy consumption levels have been increasing drastically these few years, and as global population is estimated to 9.07billion by 2050, energy levels are only going to shoot up even more drastically. This is an extremely worrying problem when the world’s energy resources, oil and fossil fuels, is fast thinning out…and not going to be renewed anytime soon.

Economic development is key to eradicating poverty and hunger, and other problems that less affluent nations are faced with. Unfortunately, economic development goes hand-in-hand with energy consumption. As countries become more developed, their energy consumption levels will increase too, and at a much faster rate than economic progress.

As such, there is a need for us to redouble our efforts and investment in finding alternative energy sources, as well as continue our and find ways to generate and adopt alternative energy sources, and fast.

Interesting Observations & Ideas:

One of the key considerations in the goal of generating alternative energy sources is making these alternatives available to the less affluent people too. It is interesting to know that poorer people are already living in a much more sustainable manner tan affluent people. Not being able to afford the rising oil and fuel prices, less wealthy families have already resorted to other sources of energy that are far less wasteful and much more inexpensive., such as biomass stoves and solar fridges. A prime example is Brazil, due to its lack of petroleum resources, the country was driven to find alternative solutions. The Brazilians turned to what they knew best- agriculture, and found a way to use ethanol as energy through harvesting the alcohol produced from sugar cane production. Presently, there are no longer any light vehicles running on gasoline in Brazil, ever since the government mandated blending the green ethanol with gasoline in 1976. As such, Brazil become the world’s first sustainable biofuels economy and industry leader, acting as a policy model for other countries way since an estimated 40 years ago.

Another interesting observation made was that biomass was actually invented long ago, but the richer people eventually got distracted and obsessed with fossil fuels. I remembered coming across something way back on Biochar. Biochar is a type of charcoal created through pyrolysis of biomass, and is currently under research, having the potential to cut carbon emissions and contributed to sustainable sources of energy. This energy efficient resources was actually used long ago by pre-Columbian Amazonians as a soil enhancer, by smouldering agricultural waste (biomass) with soil in trenches. Sustainable use of biocharring could potentially reduce global CO2 emissions, as biochar is able to trap carbon in the soil for thousands of years like coal. As such, it is an extremely promising sustainable energy resource, withdrawing CO₂ from the atmosphere at the same time.

It was also surprising to find out that we have been pursuing the wrong approach, by focusing on biomass. It turns out that solar energy or photovoltaic is a better alternative in the long run, as it is much more efficient than biofuels, and provides many times more energy than a single unit of biomass. In fact, there are some concerns regarding adopting biomass as a widespread energy alternative, as crops like corn and usgar cane that are sources for biomass production require land that should be used for growing food and tackling the issue of food security. Algae helps avoid this problem, but yet again it requires land space. Solar energy not only generates more energy, it is free from all these encumbrances, as it doesn’t require land space as it can be capture from existing rooftops, and it doesn’t emit any carbon and contribute to the growing problem of greenhouse gases as it produces power. Wind and hydropower are good alternative sources of energy as well, both proving more energy and are more efficient than biomass. I was also rather surprised to find that although China is one of the largest coal and oil consuming countries in the world, it has spent large amounts of investment in researching on solar energy.

The current driving force for innovation on alternative energy sources is cost. Fossil fuel is not only wasteful but very costly as they consume large amounts of resources quickly. In comparison, energy-efficient devices require far less resources while producing the same amount, if not more, of energy. Hence, eco-friendly and energy-saving technologies are able to save large amounts of money in the long term, and its cost-saving potential is the factor that drives companies to develop more energy-saving technologies.

Key takeaway points:

I feel that it is important for us to widen our perspectives and plan for the long term. Although energy-saving technologies have a higher initial market price than conventional fossil-fuel powered devices, they provide significant cost-savings in the future. Likewise, although biomass is a good eco alternative to fossil fuels, the truth is that we are consuming at a much faster rate than we can develop biofuels. We should therefore reconsider our action plan and focus, concentrating on other energy sources that require far less effort to produce and can be readily available to everyone in the world, such as solar, wind, and hydro energy.

Session Rating:  8.5/10 Before this week’s session, I have never really paid much interest in biofuels and the need for alternative energy sources, so the session was a real eye-opener.

Robotic Surgery: The New Future of Surgery?

Robotic Surgery: The New Future of Surgery?

Suherman Kartika Sari (kssuherman.2013@business.smu.edu.sg), 1^st Year student, Bachelor of Business Management, Singapore Management University

Executive Summary

Considering the presently known advantages of robotic surgery, it clearly has the potential to become a revolutionary technology which will bring about further colossal changes in the way surgical procedures are performed. This paper serves to evaluate the potential success of this technology, by first examining the history and initial development of robotically-assisted surgery, together with the major achievements and breakthroughs it has since contributed to the area of surgery. Subsequently this paper delves into the current application and reception of the technology in the medical field, as well as its present advantages and limitations. The paper also addresses whether those limitations can be overcome. Finally, the various possibilities that await the development of robotic surgery, and the resulting changes to the surgical field will be touched upon and explained in the future considerations section of the paper.

Introduction

Technology has impacted the world in numerous ways, with technological advancement and innovation playing major parts in diversifying and improving human activities and capabilities, including the medical field. Over the years, technological advancements have continuously shaped and changed the variety of medicine and medical procedures performed. Currently, one of the most innovative and potentially revolutionary technology raging in the medical field is: Surgical Robots.

Robotic surgery is a type of surgical procedure where robotic systems are employed to carry out surgical procedures. Generally, in robotically-assisted surgeries, a surgeon conducts an operation through a computer which controls the movements of multiple minute surgical tools attached to a robot. This innovative surgical method was initially developed and introduced with the aim of replacing minimally-invasive surgery, or laparoscopy, by making up for the latter’s limitations, as well as to enhance surgeons’ capabilities in cases of open surgery. As such, there are presently 2 types of surgical situations where these robotic systems are used: i) robotically-assisted minimally-invasive surgery & ii) enhanced open surgery.

In the case of robotically-assisted minimally-invasive surgery, robotic systems were incorporated with the purpose of overcoming the limitations of the popular minimally-invasive surgery. Laparoscopy was first introduced in 1987, and has steadily gained the favour of surgeons and patients alike, by bringing advantages such as smaller incisions and wounds, lower risk of infections, shorter recuperation and resource employment period. However, its limitations has hindered its successful application in more serious and complex surgical procedures. These limitations are mostly centred on the dexterity and coordination of its technical and mechanical nature, such as hand-eye coordination and restricted degrees of motion, thereby limiting its adoption in delicate and complex procedures. Surgical robots were hence developed to overcome these limitations, and extend the scope of application of conventional laparoscopy. As for enhanced open-surgery, traditional steel surgical instruments are replaced by autonomous robotic instruments capable of performing several procedures and actions much smoother and better-controlled than the human hand. This effectively decreases tissue trauma.

The several advantages of using robotic systems in surgical processes are just a few of the numerous benefits of the technology. These other benefits will be further elaborated in the later sections of the paper, along with the present limitations of the technology. However, before the paper explores those areas, it will first introduce the historical developments and progress of the technology, and well as the achievements that have since been realized. This will then be followed by the estimation of the potential of the said technology.

Limitations of Report

One of the limitations of the report would be the absence of statistical evidence of the success and adoption of robotic surgery throughout the world. Furthermore, were it not for length constraints, this paper could have examined the historical origins of laparoscopic and its development in order to better explain the inspiration for the idea of incorporating robots into the surgical process. Similarly, the paper could have perhaps delve into the multiple types of robotic surgical systems that were developed over the years, together with their corresponding achievements, to date, in greater detail.

Historical Perspective

The Information Age has brought about numerous additions to the range of human activities and capabilities. Just like how technology has revolutionised various fields such as manufacturing and production, it has similarly made significant contributions to the area of medicine. As mentioned previously, the limitations of laparoscopic surgery spurred the research and development of a better technology, i.e. robotic surgery. Seeing how robots have been successfully introduced and incorporated into other areas, in manufacturing for example, innovators have since sought to do the same for the medical field.

The year of 1985 saw the very first documented use of robotics in surgery, when the PUMA 560 surgical arm, an originally standard industrial robotic arm was modified and used by Kwoh et al. in a neurosurgical biopsy with the aid of a computed tomography (CT). The PUMA robotic arm is conjoined to a 1980 series controller which uses a programming language, VALII, to translate simple commands into electrical signals that drives the robot (Rutherford, 2012).  The robotic arm was adapted to hold a fixture beside the head of a patient so drills and biopsy needles could be implanted with greater precision into the desired location during brain biopsies (Albani, 2007). Despite the successful preliminary results which showed that the robot could perform brain biopsies with greater precision, the company selling the PUMA 560 protested the usage of the robot for surgical purposes, stating that it unsafe as it was originally intended to be within a barrier preventing any human contact. (Gupta)

Nevertheless, the encouraging 1985 surgery results eventually led to the first robotically-assisted laparoscopic surgery in 1987. The following year, in 1988, the PUMA 560 was again employed, this time by Davies et al. for a prostate surgery. This consequently spurred the development of the PROBOT, a robotic surgical system specifically designed for prostate surgery purposes, in 1992 at the Imperial College London. The PROBOT was the world’s first pure robotic surgery, but it failed to gain the approval of the Food and Drug Administration (FDA). In the meantime, another robot, ROBODOC, was being developed by Integrated Surgical Supplies Ltd. for the purpose of performing hip replacement surgeries with greater precision. This time, the FDA finally approved of the ROBODOC, and it thus became the first certified surgical robot. (Mishra, 2011)

Amidst the continuous research and development of robots for surgical purposes, in the mid-to-late 1980s, a party of the National Air and Space Administration (NASA)-Ames Research Center researchers, who were then researching on virtual reality, were keen on using the information on robotic surgery to invent tele-presence surgery, or tele-surgery. Tele-surgery allows a surgeon to perform surgery from a location that is geographically removed from the actual surgical site, by manipulating a robotic surgical system at the remote site (Sherk). Spurred by the massive potential of tele-surgery, a few of the scientists from the NASA-Ames team joined forces with researches from the Stanford research Instisture (SRI), along other experts in robotics and virtual reality, to continue the development of surgical robots.  The US Army subsequently became interested in this development, as it presented the possibility of conducting surgeries on wounded soldiers without having to take the risk of transporting surgeons over to the war-site. With the funding of the US Army, a robotic system which enabled a soldier to be remotely operated on by a surgeon at a nearby Mobile Advanced Surgical Hospital (MASH) was successfully developed. It was hoped that this system would help to decrease the likelihood of wounded soldiers dying from blood loss before reaching the hospital. (Lanfranco, Castellanos, Desai & Meyers, 2004)

Several members of the team who developed the robotic system for the US Army saw that the system possessed great potential commercial value, and thus through forming several commercial ventures, they pioneered the introduction of robotics to the civilian medical society. Over time, the numerous research and development carried out on the area of robotic surgery led to 3 noteworthy inventions, namely, the AESOP, the Da Vinci surgical system, as well as the Zeus system. The AESOP, or the Automated Endoscopic System for Optimal, is a voice-commanded robotic arm that manipulates an endoscopic camera that was developed by Computer Motion Inc. The ZEUS and Da Vinci surgical systems, developed by Computer Motion, Inc. and Intuitive Surgical, Inc. respectively, have similar capabilities whereby both are master-slave machine, i.e. not a pure robot with incorporated intelligence, consisting of multiple robotic arms that are manipulated from a removed computer-enhanced console consisting of video-assisted visualization.

Out of the 3, the Da Vinci surgical system is the more commonly used robotic surgical system to date, as it was officially approved by the FDA for use in most types of laparoscopic surgery in July 2000 (Mishra, 2011). Examples of its applications will be covered under the following section. The Da Vinci system comprises of 4 interactive robotic arms, 3 for surgical tools and 1 for an endoscopic camera, controlled by the surgeon through a single master console. It is presently the only commercially available robotic surgical system that gives a surgeon the dexterity, control, and precision of traditional open surgery while merely requiring 1-2cm incisions. (Intuitive Surgical, 2013)

Current Situation

As seen from the previous section, these past few decades have seen advancements in robotic surgery that has led to countless breakthroughs and advancements in the surgical field. Likewise, the usage of robotic surgery has also been steadily increasing vis-à-vis the development of the procedure. The popularity and receptivity of this technology, among surgeons and patients alike, has rapidly escalated over the years, especially in the US. More and more surgeons recommend the use of robotic surgery to patients due to the advantages over traditional procedures, and patients themselves, too, often enquire and request for this option whenever possible. In the US alone, the total number of robotically-assisted operation shot up from 80,000 in 2008 to 205,000 in 2010. (Lipschitz, 2010) Some of the surgeries which employs robotic systems will explained in detail in the subsection below. 

Applications of Robotic Surgery

Initially, robotic surgery was more commonly used for the removal of gall bladders, but today, robots are employed in a variety of operations, namely:

General Surgery

The Da Vinci surgical robot has been employed in several common general operations, such as in esophageal and pancreatic surgery, and even in liver transplants. This robotically-assisted procedure provides the advantages of laparoscopic surgery, for example decreased pain and scarring, as well as make up for its limitations.

Cardiovascular surgery

At present, robotic surgery is frequently applied to these 3 types of heart surgery: Atrial septal defect repair, mitral valve repair, and coronary artery bypass. An atrial septal defect repair involves the mending of a hole between the 2 upper heart chambers, while a mitral valve repair involves the restoration of the valve that prevents blood from flowing back into the upper heart chambers during heart contractions. A coronary artery bypass is for the removal of blockage in the coronary arteries. 

Gastrointestinal surgery

There are numerous types of gastrointestinal operations where robotic systems are used, such as in gastric bypass surgeries, which reduces the amount of food absorbed during the digestive process by stitching a part of a patient’s stomach together to make it smaller. Robotic surgery is also applied in operations for the treatment of gastroesophageal reflux (i.e. acid reflux) and colon resection surgeries. The Da Vinci robot and ZEUS system are typical used for these procedures, although the latter has been recently phased out. 

Gynaecology

One of the most common and rapidly growing application of robotic surgery is in gyneocology, such as in gynecology and gynecologic oncology. The Da Vinci surgical system is usually used for such surgeries. The robotically-assisted procedure eliminates the need for large abdominal incisions, and is applied to treat endometriosis, pelvic prolapse, abnormal periods, fibroids, and even female cancers. Furthermore, gyneocologists are able to use the system to perform hysterectomies, myomectomies, and lymph node biopsies as well.

Neurosurgery

Several robotic systems for use in neurosurgery have been developed and marketed in the past few years, beginning with the NeuroMate in 1997, which has since been used in 8000 brain surgeries over the US, Europe, and Japan, by 2009. Others include the Rosa, Renaissance, and NeuroArm, the world’s 1^st MRI-compatible robot to be commercialised internationally.

Orthopaedics

The Renaissance robot mentioned above is also employed in surgeries involving the spine, such as spinal deformity corrections and fusion, in multiple countries. Other orthopaedic operations with robotic assistance are hip and knee replacements, as well as ligament reconstructions. The robotic surgical systems allow greater precision in bone-cutting procedures for these surgeries.

Paediatrics

Surgical robots have even been employed in various operations for children as well. The Children’s Hospital in Boston was the 1^st paediatric hospital to acquire a robotic surgical system back in 2001, and has since used the technology in more operations than any other hospital in the world. The surgeons in their Centre for Robotic Surgery possess high-level of expertise paediatric robotic surgery, and even conduct trainings for surgeons from other countries on the procedures. 

Radiosurgery

Robotic surgery have even been used in radiosurgery to treat cancers and tumours. One example is the CyberKnife Robotic Radiosurgery System which enables the treatment of tumours in any part of the body by delivering numerous high-energy radiation beams directly to the tumour. This robotic system allows the delivery of radiation beams from multiple directions without having to move either the patient or the radiation source, which is required in traditional procedures.

Urology

Urology is another field in which robotically-assisted procedures have gained popularity in usage, especially in the US. It is most commonly used in prostate cancer operations, due to the difficult anatomical access in traditional open-surgery methods. Robotic systems are used in kidney cancer and bladder operations too.

Advantages

The widespread application of this technology, as shown above, is due to its abundant advantages, for both surgeons and patients, over tradition open-surgery procedures. Each of the current advantages of robotic surgery will be covered in detail in the respective subsections below:

Increased precision & accuracy

One of the main benefits of robotically-assisted surgery would be the greater level of precision and accuracy of the robotic systems give to surgeons, compared to traditional surgical instruments. For example, in both the ZEUS and Da Vinci surgical systems, one of the robotic arms is a 3D camera, or Automated Endoscopic System for Optimal Positioning (AESOP). This gives surgeons a more real-life image, compared to 2D images using normal endoscopic procedures. Furthermore, AESOP is conveniently adjusted through voice command, by either zooming in or out. The magnifying capability of the device is especially beneficial to surgeons with poor vision, or in surgeries involving miniscule or microscopic parts, such as veins or nerves. With this enlarging function, a millimetre-wide vein, for example, can be magnified into as big as a pencil. Also, the motions of the other robotic arms wielding surgical instruments can be scaled according to the desired scale, which means, for example, that a surgeon’s 1cm movement can be adjusted to result in a 1mm movement. (ThinkQuest)

Greater dexterity & accessibility

The 3D camera mentioned above is small and flexible, and thus enables surgeons to see regions that are usually obstructed to the human eye in open-surgeries. The other robotic arms are extremely thin, flexible, and dexterous, thereby allowing greater accessibility and mobility in tight areas, especially in children operations, that are traditionally only accessible by making long incisions.

Minimally invasive

Additionally, due to the thinness and flexibility of the robotic arms, only small incisions are needed. For example, in a traditional heart-surgery, in order to get to the heart, the surgeon would have to make a very long 25-30cm cut, as well as splitting the breast bone and parting the rib cage. With robotic surgery, these procedures are redundant, for heart-bypass surgery can now be done on a closed and beating chest, which is an enormous achievement in the medical field. This minimally invasive procedure are far less painful, and not to mention, leave much smaller scars. (Cavayero, 2013)

Risk reduction & faster recuperation

Furthermore, the smaller required incisions result in decreased blood loss and fewer blood transfusion requirements. In addition, robots can remain in a sterile environment and minimize bacteria exposure, unlike humans, thereby decreasing the risk of infections. This not only benefits the surgeons, but patients too, with regards to minimal pain, faster recovery, and quicker return to normal activities. The shorter hospital stays help reduce the number of staff required for after-operation nursing care. By freeing up hospital resources, more patients and surgeries can be handled during a particular period. This likewise leads to lower hospital costs for patients and hospital alike. (ThinkQuest)

Human error reduction

Another clear advantage in robotically-assisted surgeries is in long operations, especially those involving miniscule or microscopic parts, like tissue or nerve reconstruction, and long complex operations. A typical coronary bypass lasts as long as 3-6 hours. Surgeons often get tired during such lengthy surgeries, and this affects their concentration level, judgment, stability and accuracy, which are all very vital in any surgery. Conversely, the robotic systems do not tire like humans, and can therefore operate within long periods of time without compromising precision and stability, thereby reducing human error, risk, and increasing chances of success. Furthermore, in robotic surgeries, surgeons can remain seated rather than stand, and the magnifying capability of the telescopic camera decreases the strain on their eyes as well.

Disadvantages

Despite the plentiful benefits of robotic surgery, there are several drawbacks to the technology that limit its widespread application and reception. These drawbacks will be explained below:

Higher costs involved

One of the frequently cited disadvantages of robotic surgery is the hefty additional costs incurred for both hospitals and patients. The purchase cost of some robotic surgical systems can cost as much as $1 million, with maintenance costs generally amounting up to $100,000 a year. In 2011, the latest Da Vinci surgical robot was selling for $1.8 million, with annual maintenance costs at approximately $140,000. Replacing each of the four arms of the robot cost around $1,000 (Smith, 2011). In addition, operating the robotic system require surgeons to have a specific degree of expertise, in which they would have to go for a series of rigorous specialized training before they can be fully certified to use the equipment. Hospitals would have to bear these additional training costs required, as well as the opportunity cost incurred in terms of time lost that could have been better used to operate on patients. Often, hospitals would then make up for these extra costs by increasing the cost of hospital bills for patients. The higher cost of robotically-assisted operations are also not usually covered by patients’ health insurance or Medicare. On this basis, critics of robotic surgery often argue that in spite of the benefits conferred by the technology, the higher medical costs involved limit its benefit to the small group of affluent patients who can afford it. Whereas patients who cannot afford to bear extra costs are not able to benefit from the use of the technology.

However, although the initial absolute costs of robotic surgery is higher than that of conventional procedures, the major portion of these additional costs is due to the large purchase cost of the equipment, and the annual maintenance costs. These factors are attributed to the relatively new stage of the technology, and thus are projected to decrease significantly as the technology advances further. Moreover, the savings hospitals can obtain from reductions in operative time, hospital stays, and personnel costs, will duly compensate the hospital for its initial investment in the technology in the long run. (Lanfranco, Castellanos, Desai & Meyers, 2004)

Steeper & longer learning curve

As mentioned earlier, surgeons are required to possess specialised skills to master the use of the technology and thereby qualified to perform a robotically-assisted operation. Learning how to use the robotic systems take a long period of time, usually requiring at least hundreds of both simulated and real operations before surgeons can honestly express that they have mastered the technology. The benefits of robotic surgery cannot be fully realised if surgeons have not truly mastered the procedure yet, as a result, patients sometimes bear the consequences of the learning curve, as seen from the slightly less-than-satisfactory successful robotic surgery results. Also, most of the surgeons who are qualified to learn the skills required are well experienced and established in their surgical fields, which means that they generally have very little time to undergo training. Not to mention, the opportunity costs incurred, in terms of serving other patients or training to enhance a surgeon’s skill in traditional surgeries, is very high. Additionally, as the technology is still considered to be at its initial stages, proper training curricula have yet to be optimally developed, thus at present, surgeons face a very steep learning curve. (Satava)

Nevertheless, like the preceding argument, given the eventual further advancements and developments of the technology, more effective and appropriate surgical curricula and simulations are bound to be drawn up, which would ultimately offset this disadvantage.

Risk of system malfunction

Just like any other technology or electronic device, there is always a possibility of the robotic systems malfunctioning or experiencing device-related complications in the midst of an operation. This is especially so given the higher complexity of robotic surgeries compared to traditional operations. Once again, just like any other technology, this risk can be gradually reduced as further developments in the robotic systems are made. (Johns Hopkins, 2013) Furthermore, hospitals can put in place back-up procedures and policies in anticipation of any possible complication, by having a secondary robot ready, or requiring surgeons to continue the surgery using conventional procedures.

Future Considerations

Robotic surgery has only been around for slightly more than a decade, yet the advantages attached to it has led to its rapidly gaining popularity over traditional open surgery in many areas of surgery. The amazing part about this revolutionary technology is the fact that it is just at its initial stages of development. It has massive potential to completely change the way surgeries are performed, and there are still so many possibilities just waiting to be discovered and explored.

Automated surgical robots

It was said earlier on that presently employed robotic systems are master-slave robots that are unable to make decisions independently, like the Da Vinci system for example. These type of robots require a surgeon to be present at the master console to give the system commands that will accordingly dictate their actions. However, there is a possibility that the developments of the technology will introduce a new generation of robotic systems that are capable of making decisions and performing procedures independently and automatically in the near future. Robotic surgeons might even substitute human surgeons, thereby eliminating human error and increasing efficiency. Their greater precision, sterility, and lower invasiveness will increase the likelihood of success for simple and complex procedures alike.

Tele-presence surgery

One of the major anticipated contributions that robotic surgery will bring to the area of medicine is the development in tele-presence surgery, or tele-surgery. Earlier in the paper, it was mentioned that the US Army invested heavily into the development of robotic surgery, as they hoped that it would make tele-surgery possible, and allow them to deliver timely medical assistance to wounded field soldiers. However, the geographical distance between the place of actual surgery and the surgeon was not very far in their case.

Now, as continuous improvements are made over time, doctors are expecting the expansion of this geographical distance, whereby surgeons could operate on a patient from a different city, country, or even continent. Imagine the substantial benefits that would bring to patients all around the world. There will be greater accessibility to medical assistance and solutions for even the most rural and desolated of villages. This would in turn help to significantly decrease world mortality rates that are associated with the lack of timely or appropriate medical solutions, and raise healthcare standards in less-developed countries.

In fact, a long-distance surgery has already been conducted in 2001, between New York and Strasbourg, France, for gallbladder removal. Although “Operation Lindbergh”, as the surgery was dubbed, was successful, the delay caused by lag time due to telecommunications made the surgery impractical. Nonetheless, given the rapid improvements of the internet and wireless technology, this is but a small problem that can be easily surmounted.

Single-incision ports & Nanosurgery

A different surgical method that robots are expected to bring about is the single-incision port. Currently, robotic systems used in laparoscopic surgeries employ a minimally-invasive method where only a few small incisions need to be made, through which the flexible robotic arms are inserted. In the case of a single-incision port, as the name suggests, only one incision is needed for the robotic arms to go through. That would definitely reduce the risk of blood loss, infection, pain, and recovery time even more significantly. (Polland, 2012)

Additionally, there is the emerging research and development of nanosurgery which involves the use of nanorobots, robots with sizes ranging from 0.1-10 micrometres with nanoscale (10⁻⁹ metres) components that have the thinness of human hair, in surgical procedures. This would introduce a whole new level of precision and accessibility in the field of robotic surgery, and cause great advancements in the quality and standards of medical solutions and services. For example, in cancer surgeries, according to Associate mechanical and industrial engineering Professor, Nader Jalili, of Northeastern University, Boston, in the areas within the body where traditional surgical instruments are unable to access, say within a millimeter of a tumor, a nanorobot can be precisely directed to the location and show images of the tumor that could never be seen before. (Northeastern University, 2009)

Higher medical quality & education standards

With the development and implementation of tele-surgery, other than reducing the distance between patients and doctors, it would similarly raise the degree of competition between doctors who are competing for surgical bids and patients worldwide. Patients will have the ability to choose from a whole range of medical practitioners from all over the world and pick the best from the market. Consequently, the standards and quality of medical services would inevitably be pushed considerably up, and doctors have to continually improve their skills in order to not get left behind.

Another area that will receive potential improvement is in the standards of surgical education. As mentioned before, the learning curve of robotic surgery for surgeons is very steep. Besides the complexity and uniqueness of the skills needed to operate the systems, there is a lack of educational materials and medical curricula available as well, due mainly to the newness of the technology. Nevertheless, as more medical institutes come to realise the great potential of robotic surgery, more effort will be put into developing the educational curriculum and training required to carry out robotically-assisted surgeries for interested and qualified surgeons. (Ryerson, 2013)

In fact, robotic surgery could even improve the learning curve for surgeons for all types of surgical procedures in the future. The technology could be used to generate simulations or reconstructions that emulate real operations for surgeons under training. Besides helping to shorten the learning time for surgeons-in-training, it could also increase the effectiveness of training exercises, thereby lessening surgical errors and improving patients’ safety. (Lanfranco, Castellanos, Desai & Meyers, 2004)

Conclusion

In summary, as seen from the historical and current situation of the technology, the substantial time and effort used in developing robotic surgery has been duly recompensed by the countless benefits and achievements it has brought to the world of surgery. The technology’s employment in the various areas of surgery have not only reshaped the way surgical procedures are performed, it has also made possible countless breakthroughs in the realm of medicine and improved the overall quality of medical services available to patients. Limitless possibilities await the development of robotic surgery, and its further progress is set to completely reshape the way surgeries are performed in the future. It would only be unwise to ignore its massive potential. 

 References:

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Albani, J. M. (2007). The role of robotics in surgery: A review. Missouri Medicine, 104(2), 166. Retrieved from http://www.urologyspecialistskc.com/sites/default/files/pdf/missouri_med.pdf

Cavayero, C. (2013). A practicality analysis pertaining to minimally invasive robot-assisted urologic surgery.Undergraduate Research Journal, 6(2), 45-55. Retrieved from http://www.urj.ucf.edu/docs/cavayero.pdf

Gupta, S. (n.d.). Developments in robotic surgery and types of robotic surgery machines. Retrieved from http://bme240.eng.uci.edu/students/10s/sgupta1/Developments.html

Intuitive Surgical. (2013). Features. Retrieved from http://www.davincisurgery.com/da-vinci-surgery/da-vinci-surgical-system/features.php

Johns Hopkins. (2013, September 3). Robotic surgery complications underreported, Johns Hopkins study suggest. Retrieved fromhttp://www.hopkinsmedicine.org/news/media/releases/robotic_surgery_complications_underreported_johns_hopkins_study_suggests

Lanfranco, A. R., Castellanos, A. E., Desai, J. P., & Meyers, W. C. (2004). Robotic surgery a current perspective. Annals of Surgery, 239(1), 14-21. doi: 10.1097/01.sla.0000103020.19595.7d

Lipschitz, D. (2010). Robotic surgery is all the rage, but price is high. Retrieved from http://www.creators.com/health/david-lipschitz-lifelong-health/robotic-surgery-is-all-the-rage-but-price-is-high.html

Mishra, R. K. (2011, October 7). History of robotic surgery. Retrieved from http://www.laparoscopyhospital.com/history_of_robotic_surgery.htm

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Northeastern University. (2009, December 21). The next medical frontier: nano-surgery. Retrieved from http://phys.org/news180637694.html

Polland, J. (2012, August 1). Watch: this robot is poised to change surgery forever. Retrieved from http://www.businessinsider.com/the-future-of-robotic-surgery-2012-7

Rutherford, J. (2012). Using the puma 560 robot. Retrieved from http://rutherford-robotics.com/PUMA/USING THE PUMA ROBOT.pdf

Ryerson, N. (2013, May 16). Dr. vipul patel on the future of robotic surgery. Retrieved from http://www.dotmed.com/news/story/20841?p_begin=1

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Smith, A. (2011, January 4). Growing number of medical operations in Syracuse are done with da vinci surgical robot. The Post-Standard. Retrieved from http://blog.syracuse.com/cny/2011/01/growing_number_of_medical_operations_in_syracuse_are_done_with_da_vinci_surgical_robot.html

Schwitzer, G. (2011, July 30). Surgeon blogs that robotic surgery is all hype and no substance. Retrieved from http://www.healthnewsreview.org/2011/07/surgeon-blogs-that-robotic-surgery-is-all-hype-and-no-substance/

The Associated Press. (2009, October 14). Robotic prostate surgery riskier: study. CBC News. Retrieved from http://www.cbc.ca/news/technology/robotic-prostate-surgery-riskier-study-1.844265

The Robotic Surgery Center (2012). What is robotic surgery?. Retrieved from http://www.robotic-surgery.med.nyu.edu/for-patients/what-robotic-surgery

Valeo, T. (2010, April). Scarless surgery: The benefits and drawbacks of robotic thryroidectomy. ENTtoday, Retrieved from http://www.enttoday.org/details/print/684941/April_2010.htmlVCU School of Medicine. (2012, September 26). Robotic surgery at vcu urology. Retrieved from http://www.vcu.edu/urology/robotics/history.html

Wrongdoctors. (2010, May 2). [Web log message]. Retrieved from http://wrongdoctors-diseases.blogspot.sg/2010/05/da-vinci-robotic-surgery-pros-and-cons.html

Session 7| Biobusiness Revolution: Agribiology, Environmental life sciences, & Industrial biotchonology

Brief Overview/ Introduction

Prof began this week’s session by showing us 2 quotes and a video as a starter to the topic on the Agribiology, Environmental life Sciences, and Industrial Biotechnology portion of the Biobusiness revolution. The first quote was:

“There’s enough on this planet for everyone’s need but not for everyone’s greed.”
- Mahatma Gandhi  -

What this quote is trying to say is basically we are all exploiting the world’s resources without thinking about the consequences of our wasteful consumption. Personally, I feel that our greedy usage of the world’s resources, is partly due to the majority’s ignorance of how pressing and crucial the need for sustainable development is. There are still a lot of people in the world who are unaware of just how limited the world’s resources are, as such, many of us still take for granted the things that we currently have. However, I believe that as more and more people become aware of the consequences of our reckless consumption through wide-spread education, more people will come to their senses and do their part in using resources responsibly.

The other quote was from Prof himself:

“When we are able to grow the resources we need,

we will finally be on the road to sustainability”

- Gurinder Shahi –

Using the Earth’s resources responsibly is not enough to ensure sustainable development. Even if we control our energy consumption, our rate of consumption is still much faster than the rate at which resources can be renewed. Hence, if we find a way to generate and cultivate our own resources, instead of solely depending on the earth’s resources, we will, like what Prof says, finally be on the path of sustainable development.

Next up was the video, “Humans!”, which basically shows how we’re damaging the Earth and making it sick from our harmful and negligent activities. When Prof asked if we felt whether it was an accurate representation of us, those who answered generally said that they felt it was an exaggerated portrayal. It was probably so a couple of years back when globalization started, but now those that have realized the extent of the consequences of our actions, have begun to think of ways to minimize our resource consumption levels. And it is a matter of time before everyone is aware of the need for sustainability and how they all can do their part to protect the fate of our future generations.

Interesting Observations & Ideas

Prof told us that the different segments of biotechnology are assigned with specific colours: Red, for biotechnology that applied to humans, biomedical etc., Green, for plants and animals, Blue, for aquatic ecosystems, and White, for Industrial biotechnology. If we are able to satisfy and supply our own needs under the Red biotechnology itself, we will be less reliant on the other colours for resources. This again relates to the crux of the topic, that is, if we’re able to generate and grow our own resources, we wouldn’t be so reliant on that of the Earth’s.

Next, we were shown a graph of the percentages of urbanisation in the different regions. When societies become urbanised, their habits change accordingly. Over the years, urbanised societies have become less active, and have become used to having things done for them, such as food production and processing, unlike those people in rural villages who still cultivate and grow their own food. Perhaps this is why most of us are consuming irresponsibly. Because we have become so used to having things prepared and made available to us, we no longer know and bother about how much energy is in fact used in producing the food we find in the supermarket, for example, thus taking whatever resources we have for granted.

Like the biomedical area for biotechnology, there are numerous summit opportunities with respect to biotechnology in the agricultural field. If we find a way to grow our own food sources without relying on the world’s resources, it is a major step to sustainable development. Already, 70% of the fish we eat are farm-reared fish, and some of our vegetables are from hydroponics. If more such practices come about, we can very well be self-sufficient. For example, Prof talked about sustaining the world’s depleting forests by appointing only several plots of land for cultivating lumber. So we only chop down the trees in those designated plots and then replanting new foods to replace those that have been chopped down. If we embark on such a selective, cyclical method of deforestation we can preserve the world’s forest for future generations. Another summit opportunity is GM foods in the agribiotechnology sector. Japan and countries in the EU are dead-set against GM foods as they believe the consumption of GM foods cause negative health consequences. They want their food to be grown naturally and organically. The US presents a total contrast to this, being the world’s greatest advocator for GM foods. In order to get their citizens to consume GM foods, the US bans the labelling of GM foods and mix them with naturally grown ones. However Prof mentioned a good point that labelling might just get people to accept GM foods. With labelling, if eating GM foods is indeed a health threat, then we would be able to spot the signs easily and find ways to identify what went wrong with GM foods and how we can solve it. And if there really is nothing wrong with GM food and that it is actually beneficial for our health by providing us with the vitamins we lack, then we would be able to easily see this as well. Like Prof said, labelling GM foods might just encourage its wide-spread reception and acceptance in the long run.  

There is also a summit opportunity in the area of waste management. We have to understand just how important it is to dump our waste properly, and learn the ways in which we can do so. Over the years, many lives have been lost to resource contamination due to our negligent disposal of waste, we can no longer afford to make such mistakes anymore. Proper and responsible waste management is a crucial solution to the ever-rising pollution levels. With the proper application of biotechnology, we can actually use the energy or waste gases we give out during garbage disposal to generate energy for our daily activities. For example, we can use the carbon dioxide given out during the garbage combustion process as energy instead. This way we will be less reliant on the earth’s limited fossil fuels.

There are people who are against agribiotechnology as they are saying that it is robbing poor farmers of their jobs and income. However, for sustainable development to take place, farmers have to inevitably become more specialised and knowledgeable in what they do. Most farmers nowadays have gone to colleges or universities in order to learn the different techniques that can help them to achieve desired outcomes, such as higher productivity, efficiency, proper irrigation, etc. It is obvious that we can no longer depend on the earth’s ecosystem for resources, and being self-sufficient requires the application and usage of specialised technology. As such, farmers need to have the required skills and knowledge to know how to use the different technologies available properly, as well as the necessary precautions that they have to take when applying such technology. We wouldn’t want to mistakenly drink spider-gene enriched goats’ milk that was meant for creating spider silk for industrial purposes, for example.

We also learn about industrial enzymes, which is a type of bio-catalyst that facilitates chemical reactions and enable the breaking down of products and materials at a much faster rate. Industrial enzymes make industrial processes much more efficient and energy saving. It also presents a great potential in facilitating the efficient creation of biomass resources, such as bioenergy or bioplastics, from agricultural of process wastes so as to enable us to become less reliant on fossil fuels for energy and to practise responsible waste management. Theses bio-products, such as bioplastics, are made from plant-based resources that are renewable and recyclable unlike fossil fuels. They also give out less carbon dioxide. After all, the key solution for sustainable energy and resources is about using resources that we can regrow on our own, like plants.

That is not all however. Not only do we have to ensure resource security by finding a way to generate our own resources, we have to ensure that the resources we grow are evenly distributed throughout the world. For example, there is an unequal distribution of food in the world, which is why millions are dying from starvation and famine in one part of the world, while others are wasting and throwing away food in the other areas. Eradicating this inequality in the world is not easy however, and there are various action areas requiring attention, and specific methods are need for each different problem area. All of the different aspects that comprise food security and healthy living are summarised in the diagram below:

However, as shown in the starting context at the bottom portion of the model, this model can only work if there is peace and stability in the countries. Mutual peace and respect for one another is crucial in attaining global food security and healthy living as it requires the cooperation and contributions of everyone. We all have to be willing to share ideas and resources with one another. For example, as mentioned by Jinghui in her individual presentation, we can all start by avoiding food wastage and avoid putting more than what we can eat, on our plates. I remember how my Mom always used to make me finish the rice on my plate, saying it’ll “cry” if I don’t hahahhaa.

The individual presentations for this session were all very interesting, nonetheless Yiting’s presentation on how the Japanese have discovered a way to create meat from human excrement was the highlight of this segment of the session. Meat made from poop!! How cool is that?! Hahaha…I kind of want to try and find out how it tastes like. :B Kind of like HuiQi’s edible burger wrappers presentation awhile back. This process of cultivating meat from human waste is not only an excellent form of waste management, but also being self-sufficient, as we are less dependent on animals and plants for food sources. Another good idea of self-sufficiency that Xin Di told me about is In vitro meat, or test-tube meat which is an animal-flesh product that has never been part of a living animal with the exception of the fetal calf serum taken from a slaughtered bred cow! Hui Qi’s edible food wrappers presentation is a good idea for waste minimization as well.

Key takeaway points:

I feel that the key takeaway point in this week’s session is the importance of achieving self-sufficiently in order to achieve sustainable development. We have to become less reliant on the world’s fast diminishing resources and generate alternative sources which minimizes our dependency on the Earth. This therefore presents a variety of opportunities for applying technology and innovation.

Session Rating: 8/10