Friday September 15, 2017

Automate This! Could autonomous robots put surgeons and pharmacists out of a job?

Listen 13:01

Welcome to the second instalment of 'Automate This!,' a Day 6 series about the future of work in an artificially intelligent world.

In 2011, Krista Jones was diagnosed with a rare form of cancer. The next five years were a blur of doctor's visits and operations.

"I think I saw seven doctors over that time period," Jones recalls. "Three surgeries. I was heading towards a double mastectomy, mostly out of fear for the fact that nobody could explain why [the tumours] were reoccurring."

Krista Jones, MaRS

The treatment plan that helped Krista Jones beat a rare form of cancer was developed using machine learning algorithms and big data. (MaRS Discovery District)

Jones' final treatment plan was built using algorithms and big data — some of the precursors to today's A.I. technology.

That plan made it possible for Jones to forgo a painful double mastectomy, and ultimately left her cancer-free.

"Not only did it save my life but it left me whole in so many different ways," she says. "[It] avoided some of the scars, emotionally and physically, that most people who go through cancer treatment are left with."

Today, Jones is the managing director of Work and Learning at MaRS Discovery District in Toronto, an innovation hub that houses A.I.-driven health tech startups like Deep Genomics and Cloud DX.

She's seen the downsides of machine learning technologies, too. Her own son was forced to rethink his plan to become a radiologist after watching his career prospects dwindle thanks to automation.

Still, Jones is convinced that artificial intelligence is the future of health care.

"I think what we need to do is harness the good while regulating the bad," she says, "such that we don't get hung up and stop the development of life-saving treatments."

"The only next step is now replacing those actual physical physicists and doctors that actually say: 'Yes, this is the right treatment plan'. That is going to be replaced by A.I. in the future."

Krista Jones on how software saved her from a double mastectomy1:33


A.I. in the operating room

In 2017, artificial intelligence has already begun to move out of the realm of diagnostics and into the surgical suite.

Many hospitals around the world already make routine use of non-intelligent robots in the operating room to perform certain minimally-invasive surgeries. Today's most commonly-used surgical robot, the da Vinci system, is operated by a human surgeon through a console.

Robotic Hysterectomies

The da Vinci Surgical Robot at a hospital in Pittsburgh. (Keith Srakocic/AP)

Some pharmacies also employ robots to take on tasks once done by human technicians. At the University of California San Francisco (UCSF) Medical Centre, robots mix IV solutions and prepare hospital patients' daily medications.


Pill Picking Machine at UCSF Medical Center0:23

But Dr. Peter Kim wants to take it a step further.

Kim is the associate surgeon-in-chief at the Children's National Medical Centre in Washington, D.C.  

He's also part of the research team behind STAR, an autonomous surgical robot that he says can already outperform human surgeons at some medical tasks.

"This machine sees a little more than the human visual spectrum would permit, and at the same time — unlike what's available currently in the surgical suites — this machine is aware of where things are in three-dimensional space. So it has a situational awareness," says Kim.

"When we compare this machine ... to the same procedures done by very experienced surgeons using open surgical tools and current robotic tools, to our surprise, this machine performed better. - Dr. Peter Kim

"We added a little bit of a touching, or sensing, capacity to the machine. And when we compare this machine doing an anastomosis in a live, large animal model to the same procedures done by very experienced surgeons using open surgical tools and current robotic tools, to our surprise, this machine performed better."

While about 40 per cent of the machine's tests to date have involved human supervision, the machine has completed most of the test operations entirely on its own.

Kim believes it could one day be used in any number of other procedures — including open heart surgery.

surgical robot

STAR, also known as the Smart Tissue Autonomous Robot. (Children's National Health System)

"You can imagine that you can expand into different parts of surgery where you require precision, including dissections," he says.

STAR, also known as the "smart autonomous tissue robot," hasn't been put to use in hospitals yet. But Kim hopes to have the robot ready for human use in time for NASA's next trip to Mars, scheduled for the 2030s.

"[It] was selected by NASA as one of the technologies that they would like to acquire in the future," he says.

"[And] they'll need it. You can't come back if you've got some surgical emergencies and you can't phone; it will take you half an hour to call somebody. So I think in their wisdom, it would be smart for them to get one of ours."

The UCSF pill-pick robot

One of the robots at the UCSF Medical Center. (Dennis Maxwell)


Saving lives, eliminating jobs

Kim believes automating surgery would have huge benefits for patients.

"A lot of tools we have are really dumb, and then they are simply extensions of smart humans," he says.

"You can imagine in the future, if you happen to need a surgery, you can potentially program the very best surgical techniques and judgments into a machine and have it available for everybody, essentially democratizing medicine."

By eliminating the risk of human error, Kim argues that autonomous surgical robots could dramatically decrease the risk of medical complications.

"I welcome the opportunity of having smarter and smarter technologies that can enable me to provide a more consistent, more effective outcome — including smart surgical robots." - Dr. Peter Kim

Automation has already reduced the number of pharmaceutical errors at the UCSF Medical Centre, according to pharmacy director Rita Jew.

"The more we can automate some of these error-prone processes by using robots, the better off we are in trying to get to a point where we can say that we will not make a mistake in dispensing our medications," says Jew.

Jew acknowledges that the robots have eliminated some positions at UCSF, although she says the remaining pharmacy technicians' jobs are more stimulating now that machines have taken over the most menial tasks.

Pill Picking Machine at UCSF Medical Center0:29

But not everyone is convinced that existing surgical robots, including the popular da Vinci system, have proven their worth — including Marty Makary, a surgical oncologist at Johns Hopkins.

"Only after 15 years or so of the [da Vinci] robot's use did we really start to mature to understand its benefit. And its benefit is limited to a subset of operations — but there are a lot of areas where it's overused," Makary says.

Plus, the technology is expensive. Jew's pharmacy robots cost more than a million dollars each.

Future Of Work Robophobia

Surgeons use a da Vinci robot to aid in a hernia operation at the University Hospital Geneva, in Geneva, Switzerland. (Salvatore Di Nolfi/Keystone via AP)

Kim acknowledges that current medical robot technology is prohibitive in cost. But he believes future practitioners will use the surgical devices more selectively, in areas where its benefits are proven.

With STAR, Kim is developing a technology that could one day replace his own services as a surgeon. But it doesn't keep him up at night.

"I look forward to it, actually, if we can improve what I do as a surgeon," he says.

"I welcome the opportunity of having smarter and smarter technologies that can enable me to provide a more consistent, more effective outcome — including smart surgical robots."

Click here for Part One, Three and Four of Automate This!, our special series about the future of work in an artificially intelligent world.

For the full interview with Dr. Peter Kim, download our podcast or click the 'Listen' button at the top of this page.

WorkShift is a month-long radio and digital series examining the profound changes in the way people work.  Subscribe to the WorkShift Newsletter for a chance to share your story with the nation. Or browse through a constantly expanding lineup of great stories.

Annie Bender

This story was produced by Annie Bender, an associate producer at Day 6, and the producer of "Facing the Change." She's also worked with q, As it Happens, and CBC KW's The Morning Edition.