Adam Smith’s invisible hand in robotic surgery

Many economists believe in Adam Smith’s concepts of the invisible hand and price competition. Temporary monopolies created by technological research and investments generally produce incentives. The key players in the market, entrepreneurs, venture capitalists, innovators, and influencers will invest in a competitive instrument [1]. The notion of the invisible hand is not the hand of the robot, it refers to the hand in the field of economics, which distributes the gains equally to those involved in the same business. The invisible hand is the concept of providing unintended social benefits and public good by investors who initially engage in a venture for their own self-interests. The concept was first introduced by Adam Smith in The Theory of Moral Sentiments, written in 1759 [2].

The robotic platform is most frequently used for surgery of the prostate and uterus, followed by kidney, colon, heart and lung surgery. The Da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was cleared for use by the American Food and Drug Administration in 2000. To date, >8.5 million minimally invasive procedures have been performed through 4 generations of minimally invasive, robotic-assisted technology and over 24,000 peer-reviewed articles have been published regarding its use [3].

As Intuitive’s patents on the robotic platform have recently expired, start-up and established healthcare companies alike, are on their way to enter the market with their own models. The manuscript by Aresu et al. [4] evaluating Versius in a preclinical study assessed the feasibility of the device for thoracic surgery in a cadaver model. The early results presented in this study will surely be a topic of great interest to thoracic surgeons who utilize the robotic platform. Versius was developed in a process of IDEAL-D framework, which serves as a guideline for the development of surgical innovation through an evidence-based approach [5]. An expert consensus group decides the ideal studies and reporting, which may be used for new surgical procedures, from the first use through to adoption [6].

In the Versius preclinical study, the authors successfully completed 22 of 24 (91.7%) thoracic procedures, which encompassed 17 out of 18 lobectomies, 2 out of 3 thymectomies and 3 out of 3 diaphragm plications. These procedures were performed in 9 cadavers. One thymectomy could not be completed due to cadaver anatomy and 1 lobectomy was not completed due to a console system fault. Port and bedside unit configurations were successfully validated for all procedures, and lead surgeons deemed the device to be well-suited for thoracic surgery. The authors have claimed that incremental changes to instruments, hardware, and software were implemented, to improve the design of the robot and the surgical set-up for each thoracic procedure tested. In doing so, Versius may have the potential to address unmet needs with current robotic technology. With the use of individual and mobile units, which are separate for each arm, the surgeon has flexibility in deciding to what extent the robot plays a role. In fact, we believe that there is greater opportunity for the primary surgery to resume a bed-side role during the surgery, with the robotic instrument serving more of a first assistant role, if desired.

The authors, by developing this system to meet end-user needs, anticipate that this device will overcome some of the barriers currently present with the use of the robotic platform. These include financial barriers, which may be preventing widespread implementation of robotic technology. With the development of newer robotic models and studies, which show feasibility in clinical use, invisible hands may indeed be working to even the playing field in robotic surgery.

REFERENCES