Tiresias: Why Not?

“Some men see things as they are, and ask why. I dream of things that never were, and ask why not.”

Robert Kennedy

My friends,

Tiresias has previously discussed the addition of AI and machine learning to Optiscan’s confocal laser endomicroscopy (CLE) enabling real time in vivo accurate cell level histopathology. Today he would like to discuss the application of CLE to “robotic surgery” and “microsurgery”. Why the quotes, you ask? The quotes are to indicate that both are misnamed hype and exaggeration. Neither of these are what their name would suggest. Robotic surgery is not done by robots! Microsurgery is not microscopic surgery. The so called “robotic surgery” is done by the surgeon. The surgeon merely uses a slightly refined gripper-reacher tool as you have probably seen when a technician is manipulating radioactive material. The surgeon does not hold the instrument in hand which perhaps removes the tremulousness of the surgeon’s hand and the occasional inadvertent slip when operating. That’s all. It is not done by a robot. It is not autonomous. It is no more accurate than ordinary surgery and it does not have better results. It is certainly a lot more expensive. “Microsurgery”, which has been around for decades is just smaller finer stitches, to perhaps join slightly finer structures. It takes longer and of course costs a lot more.

What has this got to do with Optiscan and, in vivo confocal laser endomicroscopy? Well Tiresias thinks it may have a lot to do with these techniques. Combining in vivo microscopy with machine controlled surgical instrumentation can easily produce true microsurgery and true robotic surgery. Let us take a simple example. At present the biggest application of so-called robotic surgery is prostate cancer. As Tiresias has indicated the results are no different to standard treatment, although every well-heeled older gentleman with prostate cancer, who can afford it, is rushing to have “robotic surgery”. Does this remove the cancer any more accurately? Well of course not, because the surgeon cannot see the cancer cells. Does it reduce the post-prostatectomy side effects? No! What could improve cancer results and reduce side effects? What if the system was informed and with an in-vivo real time cellular pathology? What if the surgeon could see the cancer cells? Well then, his better controlled non-trembling slip-proof instruments might well improve the results. What if an AI assisted cancer cell recognition controlled the operating instrument? This would certainly enable more accurate surgery. It would enable a lot more complete removal of cancer cells whilst avoiding and preserving vital structures, like nerves. This would be actual robotic microsurgery. Could this reduce the complications that are just as common after current so called “robotic surgery”, the most common complications being postoperative impotence and urinary incontinence? Well, Tiresias has no doubts. The day of autonomous real time microscopically guided true robotic microsurgery is at hand.

Why not?