Australasian Association for History, Philosophy and Social Studies of Science

I had the pleasure of attending a two day conference of The Australasian Association for the History, Philosophy, and Social Studies of Science. A number of papers impressed me but perhaps none more than Michael Arnold. I was writing on a small pad of paper and hope I have represented his comments accurately. I take full responsibility for errors and apologise in advance for my poor notetaking.

Michael researches: social studies of technology (technology and death, community informatics, domestic technologies, communications technologies)

Michael presented on his recent research endeavour- robotic surgery. Here are some of the handwritten notes I took from his presentation:

-          An auto-ethnographic study

-          Post phenomenological

-          “I”, world

-          Highly experiential, existential, and self-conscious

-          Context:

o   The ‘I’ in this instance is a humanist and idealist

o   Thought and belief are one and the same

o   All humans have agency

Michael put to us the following:

-          I-Technology-World

-          [I-Technology]-World

-          I> [Technology-World]

In the context of Michael’s study this now can be represented as:

-          [surgeon-robot]>me

-          Surgeon> [robot-me]

Option presented to the auto-ethnographer were:

-          Conservative approach to his cancer

-          Radical approach to his cancer

After assessing the options, the ethnographer went for the radical approach which were the full removal of the organs where the cancer was residing. This included prostate and bladder.

Michael describes the operating theatre as a vector of assemblage of human-technology hybrids. This might include air conditioning units, beds, medical apparatus, the telerobotic machine and more. He represented this simplistically as:

[da vinci robot + surgeon]

[da vinci robot + me]

With respect to the da vinci controller robot a doctor must “dock” into the robot with his face against the goggles. This is an active state. When a doctor moves his face away from the goggles, for example to sneeze, operation of the remote arms ceases. The remote robot apparatus then docks to the body of the patient. Literature depicts the robot on the side of the bed, but really the machine stands close to the body, usually the patient has his or her legs apart and the robot docks close.

Presently the da vinci robot is responsible for about 200,000 annual operations worldwide. Last year in 2016 in the last quarter, there was a 16% increase in the number of operations done with the assistance of the da vinci.

The patient had 7 ports, and at any one time 2 arms were being used of the robot of 4. Surgeons operating the da vinci can use switches, clutches, and other mechanisms depending on what they want to achieve.

Mediated vision was described by the ethnographer:

-          - No touch

-          - no haptic feedback

-          - does not sense pressure

-          Sight privilege

Katina’s reflection: Da vinci is built by Intuitive. Some issues with the company with respect to deaths at the hand of the machine. World wide court cases. Some 177 disputes in motion presently. Reportedly the machine has been responsible for 74 deaths. Is it possible to blame the machine for the deaths? What role or responsibility does the surgeon have? If any? In the case of Intuitive it was found to have taken IP to help with procedures. Other competitor machines have haptic feedback, and will likely be able to do more automated steps in the future..

The surgeons have no further periphery vision than what they see in the robot goggles. The surgeons report that they do not require haptic feedback and they feel they have all the vision they need. Quote from one of the surgeons paraphrased was: “You are down there. You are in there. No doubt about that.”

It is all quite cybernetic in many ways as the surgeon is 3m away from the surgeon. There was an IP dispute about the surgeon ‘requiring’ to be in the room with the patient and not in another room.

Mediated action was described by Michael Arnold. Human-machine correspondence is what is going on. When the surgeon clasps their hand, the nodes operating clasp their hands. Instinctive surgeon actions take place on one side and the other. Some soreness reported by the surgeon when clasping robotic levers for some time on the console.

Davinci is able to operate arms beyond what humans can. The reach and flexibility is greater. Human wrists are like hinges whereas davinci hands have ball joints and can twist, swirl, turn, 360.

Practice. Rehearse.

Davinci remote unit and the controller unit calibrate about 1300 times a second to ensure there is no lag in instrumentation and action. The intuitive system is build on more than a million lines of code. Human hands tremor but the tremor is removed through the algorithms in davinci. When you watch the surgeon it looks like they are conducting gross movements but that is an amplification of the actions they are making on the body which are millimetre to centimetre level.

In the next phase of the davinci development might be:

-          Bounds and rules regarding types of “allowed” movements in segements of the body

o   What is enabled or disabled for instance

-          Vision systems so that arteries and organs and veins are identifiable

o   Clamp this but don’t let an ‘artery’ be cut otherwise patient can bleed to death etc

Michael also described that the “movement” the surgeons do is different. Not like a reproducing movement.

The instrumentation is decentralised:

-          There is a vision system

-          Scalpal

-          Scissors

-          All at the tips of the arms of the probe.

-          Each instrument is disposable after a certain number of uses and can cost on average about $5000 AUD

What is me?

-          Multiple translations

-          Multiple ontologies

-          Materialise semiotics

Full personhood à then partial patient à then open tissues (personhood is erased) à simply data representation à then come out of that in reverse

What is me?

-          A data body representation of me. And that data is mobile.

-          The personhood is temporarily surpressed.

-          Surgeons say: “you forget you are operating on a specific person.”

-          But “I am a living body”.

Native robot

-          “Sutchers” and “surjeeps”

-          Huge number of data points to go back and to analyse

-          There are angles and pressure applied and so much more.

-          Might it mean in the future that the Robot can learn from these and conduct their own “surjeeps” and that the doctors will simply point to a place and their function might well be replaced altogether?

I asked but what about the law suits on the da vinci robot in progress? What about the alleged deaths? What happens then? Who takes the blame? What about competitors? How is intuitive responding to these?

How does one become the machine? The trend is not to blame the surgeon.

You can find these on incident reports:--

-          Big data

-          Algorithms

-          SurgicalWatch group(?)

-          Embedded ethics

-          Intuitive’s patent means that the patient and the surgeon now need to be in the same room. Operations cannot be done remotely.