Surgical Robots

Surgical Robots – the new heroes in medicine?

by Violetta and Noemi

What do you think of when you hear the word surgery? You probably imagine one or two doctors and a few nurses standing around a person in anesthesia, doing surgery. But since 2000, many surgeries do not look like that anymore. That is the time when robotic surgery became more and more common.

Now, you are probably wondering: What exactly are these medical robots used for and how do they work?

They are used in the medical science and are supposed to support the surgeon. This blog is about a specific type of medical robotics, the surgical robots. Robots like these can perform many surgeries, including Kidney transplants, Hip replacement and many more. They were invented in 1990 and the first robotic surgery found place in Germany in 1998.

The da Vinci Surgical System was one of the first inventions in this area.

This is how it works:

A very small 3D camera and dime-sized surgical instruments are placed inside the patient through tiny incisions. Throughout the surgery, the surgeon sits at a special console. The camera gives a 360-degree view of the operative field. The da Vinci System translates he surgeon ́s hand movements in real time, so the robotic system can put it into action by using its precise instruments.

A new robot-assisted surgical device is the eye-sensing technology, which tracks the surgeon ́s pupils. It is astonishing and a little bit scary to imagine a surgeon performing a surgery only by using his eyes. Zooming in or out is also possible by moving toward or away from the console screen. Due to these new technologies, surgeries have become easier for the physician and the patient.

The use of robotics in medicine seems to be a great achievement for the medical industry. But is this new technology as progressive and effective as we once envisioned?

Most of the respondents of our survey would prefer to have a surgery which contains robotic technology. The main reason for that decision was that they consider robot-assisted surgery to be less risky that an open surgery. Nevertheless, a quarter of the surveyed were of the opinion that the use of robotics in medicine would open up new risks.

“Robot-assisted surgeries – the future is here.”

it said in the news after the first da Vinci robots were on the market. It is quite evident that this technology has an enormous potential since robotics makes it possible for physicians to work more precise and delicate.

There is a huge amount of marketing, which promises the patients to have less blood loss, a faster recovery, smaller scars and of course less risks. The company Intuitive Surgical presents the surgical robot as a big step to a better health system.

“Surgical robots are rather an expensive and ineffective technology than a revolution in medicine.”

Unfortunately, this technology costs the health system hundreds of millions of dollars. For the patients, it costs ten times as much as a traditional open surgery. Furthermore, there are many clinical costs since the physicians need to be trained in using the new tools etc. Therefore, there are many criticisms about the technology not making such a big difference in spite of the high price point. Moreover, there is criticism that the company is exploiting its monopoly position because some of the tools have a limited usage number.

“It is a fancier way of doing what we have always been able to do.” (Dr. John Sarta, medical director)

Years of studies show that the promises of the great marketing were not completely fulfilled. Notably, there are illnesses, where an open surgery would be more effective and comfortable than the use of robot-assistants. Besides, there are plenty of injuries and even death cases caused by the surgical robots. This shows that the use of robotics in medicine opens up new risks, since there is the danger that the system crashes during the surgery or the robots are programmed incorrectly.

Nevertheless, there are many cases, where the use of medical robots is necessary since it has many advantages in contrast to other less pricy possibilities. It makes complicate surgeries easier for the surgeon and results in greater success.

Illnesses are able to impact on a person`s life in probably the worst way one can think of since they can inflict pain and limit someone in many ways. It is a very optimistic and utopian way of thinking that in the future, medicine would be advanced enough to prohibit any kinds of diseases.

There might be criticism which say that this a stupid utopian vision which leads to nothing since it can be very annoying and even risky to develop new technologies, it always takes a time until a new invention is as perfect as everyone wants it to be. Nevertheless, it is not appropriate to let medicine stay on the old traditional level since medical advances are desired by humanity.

We are of the opinion that it cannot be wrong to have the high aim to improve the medical possibilities for the sake to make the would healthier in the future.

As long as surgical robotics is evolving, there might be difficulties people need to face, like for example the high price point.

However, surgical robotics already is improving our health system and has cured many illnesses more efficiently than it would be done in the past.

To sum it up, robotic-assisted surgeries might not be perfect yet, but this technology is upgradable and has a great perspective in improving the health system of humanity.

Genetics and medicine

Improvement of Medicine – blessing or curse

by Lucera and Emma

Especially during the cold season we are more likely to catch a cold. Then we have to ask ourselves whether we go to work or stay in bed to get healthy again. Most of us probably just take some pills of medicine, because we have so much to do that there is no time to be ill. Do we really have to take medicine to fight a non- threatening disease?

In our survey, 60% of the respondents, only take medicine during an illness. The development of medicine has helped to get rid of several infections and viruses. Moreover one can easily prevent many diseases with vaccinations. Another important point is that life expectancy has increased due to medical improvement. Many people, especially those, who depend on medical treatment, benefit from the progress in medicine.

The problem is that it is difficult to determine who really needs a daily medical treatment. Our survey shows that there is a high number of people (40%) who take medicine regularly or on a daily basis.  It often happens that people get over-diagnosed and therapied by doctors. An international survey of the European Center for Disease Prevention and Control (ECDC) has shown that 30% of the doctors give their patients  antibiotics, even though it wouldn’t have been needed. This unnecessary, too early treatment is one reason for the high consumption of medicine. The results are multi-resistant germs, which are hard to be counteracted. As a consequence, better medicine needs to be created. But often medicine only gets more expensive but it neither increases the effectiveness nor the security. In many cases, making money is the main goal.

Medicine has surely helped us to exterminate illnesses, people have gotten sick from in earlier times. Especially at a high age you depend on medicine even more because you are proner for illnesses.

Apart from these scientific reasons, society also plays an important role in the intake, and overuse, of medicine.

It is easy as that: When you are at home in bed to rest, you are expected to get healthy soon. This vast amount of pressure leads to the fear of missing out on something important. The point is that nobody has time to be ill. The body does not get the time to completely cure a disease by itself. The medicine only suppresses the disease for a certain amount of time.

If we have a cold we should consider home remedies, such as ginger tee or a chicken soup, as an option.  They also are very sufficient if not better for our bodies. This way, there is a chance of getting healthy  in a natural way.

Unfortunately, this is too much work and effort for most of us. We’d rather take a pill of medicine and feel better instantly.

Another point is that nobody goes outdoor anymore. We surely spend more time in- than outside, which weakens our immune system. Nowadays many people have to sit in a closed office for hours. In  the evening they are too tired that they rather lay on the sofa and watch TV than doing sports or going outside.

Coming to conclusion one can see that the development of medicine is both, blessing and curse. It is not necessary that we quit taking medicine completely, but we should make sure to watch our consumption. There are cases where taking medicine is essential for your heath, but in most of the time there are better alternatives. Is it seriously that difficult to make yourself a cup of tee and watch your health?

Genetic engineering

by Jasmin and Lena

Genetic engineering- huge invention or big nightmare?

Genetic engineering could be seen by parents as a big present they got, but otherwise it could be abused as a modification of babies. Genetic modification must not be used only for humans. It’s also possible to use it for animals and food.

What is genetic engineering? How does it work?

It means the manipulation or cultivation of organs or organisms. There are two different ways. The first works for humans as well as for plants. Stem cells get extracted (humans stem cells are in the spinal cord) and are grown as an organ or organisms. Another way to create a designer baby or to mend disabilities is to manipulate an artificially fertilised egg cell.

What are the different research areas?

Genetic engineering is used for more efficient food production including manipulated plants not to mention animals. The medicine is also able to use it for humans. Here you can create a designer baby or deal with disorders.

Why do scientific and business communities do the research of genetic engineering?

Scientific communities try to help eliminating hundreds of diseases, pain and anxiety. With doing this they want to bring human happiness and productivity. Scientists see much potential in this topic. Waiting thousands of years for beneficial mutations is needless, if you can start by your own. It is worthwhile as soon as you can minimise human suffering, because every human has the right to be born free of preventable diseases. Scientific business thinks that everybody could make choices for themselves. It’s true that polygenic interventions are more difficult than single gene interventions, but it became much safer than people think.  Being powerless to change something is not the goal of these businesses. Improved human conditions are the main point. With genetic engineering a fair world could be created where everybody has the same level.

Is genetic engineering a good invention?

First of all there are positive and negative arguments for and against genetic engineering. Even if genetic engineering was highly researched a lot of people are afraid of allergic reactions. We are never absolutely sure that there will be no unintended selection or transfer of genes. So abuse is still a big topic. Scientists often work with antibiotics which gives antibiotic resistance as a result. By cloning plants like corn a lot of biodiversity could be lost and there could develop invasive plants which are stronger or more resistant as not manipulated plants. This could lead to economic problems and the research also needs electricity and materials which strengths the climate change. Even if the research is only reduced at plants there is an ethical discussion.

On the other hand we suffer under overpopulation and hunger which could be minimised by more efficient food production. Nutrient-rich food would be healthier and the plants would have a bigger chance to survive because of a higher resistance against rotting and animals. The doping of genes could also be used for animals. The meat production could be made more efficient. Healthy food makes healthy humans. So our animals have to be healthy which is more possible by using genetic engineering. The growth of animals and plants could also be made faster which would increase the efficiency and the profit.

Should Designer Babies be legalised?

The research for designer Babies is highly developed. Therefor it’s possible to find out if an embryo is ill or not. Moreover medicine is not able to heal babies with disorders by using artificially fertilised egg cells and their manipulation. This would be great to minimise disorders for babies and guarantee them a bright future. But what is really designable and where are the borders? By genetic engineering it would be possible to decide which skin-colour, hair-colour, height, intelligence or which sex the baby should have. Indeed that goes much too far because otherwise there would be super-humans. Definitely it would be good to minimise the risk of diabetes and cancer and there would also be a higher life expectation for them. But  the results of our survey that people are mostly against genetic engineering because of an ethical dilemma. They wish for all the parents out there that their babies are healthy and would allow genetic engineering for minimising disorders or to cure them. In contrast to this wish they are mostly against designer babies for a good reason. The technology is not high enough developed which means higher risks while pregnancy for mother and child. Furthermore by creating super babies other humans would be second class and unequal. Because of high costs the research would only be affordable for really rich people which would divide the society even more. Anyway if this technology would be used for more generations the gene pole would be less diverse which could lead to disorders in the following generations and children’s growing and development could be harmed. In a nutshell the research of genetic engineering  should go on. Nevertheless creating designer babies would be unethical and should be really forbidden. It only should be used for helping minimising disorders.

Utopia or Dystopia?

Genetic Engineering is split into different kinds which partly fits to a utopian world like the manipulation of plants. Here the efficiency could be increased and fewer people would have to go hungry to bed. But on the other hand genetic engineering participated on humans can also be utopian. While only perfect humans seem to be utopian the consequences could be humans second class who are not as perfect as all the others. So perfection can also lead to imperfection. Moreover the abuse of the manipulation of genes could lead to unhappy people with diseases or disabilities. But everyone has to decide for themselves if they would want to live in such a different world or not.


Embryo Screening

by Alek and Selina

Hi fellow future moms,

I´m Ava(37+) already a happy mom of a 5yo boy and planning to get a second child. Unfortunately Eric has a hereditary disease namely down-syndrome. That’s why I need a second opinion of yours on using embryo screening to ensure my next child will be healthy and carefree. Embryo screening is recommended for women over 37, a family history with chromosome problems and multiple miscarriages… So I´ll be perfectly in this recommendation group and this embryo screening process would be painless, simple and fast (that’s what the doctors told me).

The process consists of harvesting of a few fertilized eggs which are observed in a lab for a number of days. The biopsy is performed on the 3rd day of fertilization (each embryo has 6-8 cells). During the biopsy only 1-2 cells are extracted because a higher number would result in a development trouble. After that the embryos are placed back into their incubator until the diagnosis is retrieved. There are two diagnosis procedures PGFA (Preimplantation Genetic Testing for Aneuploidies) and PGT (Preimplantation Genetic Testing): PGFA is screening for present chromosome abnormalities / PGT is screening for specific conditions (e.g. down-syndrome). The diagnosis is heading to evaluate which one of these embryos is the healthiest and has the best chance of survival and implantation. One is selected and implanted into the womb.

So here are my concerns about embryo screenings:

Embryos have a right to live, protection and recognition as a human being. It´s unethical to choose between the chances of survival of several humans based on a “quality analysis”, thus waging a human life against another, and denouncing the unselected embryo as unworthy to live. This also contradicts with our ethics and societal values. Embryo screening leads to a discrimination of disabled people because these people are seen in this case as faulty and a mistake. As a consequence two classes, the ones who were selected or altered and the ones who were born naturally with eventually their own human flaws, can emerge. Embryo screening is expensive and if only the wealthy can afford this procedure this two-class idea doesn’t seem too far-fetched.
In addition many scientists are doubtful because most human traits are influenced by multiple genes interacting not just with each other, but also with the environment. That’s why a healthy life of that embryo is not guaranteed.

But on the other hand there are several equally important reasons to do embryo screening:

If a pregnant woman gets notified, her child is disabled or is very likely to die and she is about to abort her child, it´s mostly a worse and severer operation, than implanting a proved healthy embryo.
This would lead to optimal start conditions for the child. Actually the woman needs to have a freedom of choice on whether doing it or not. If it´s banned women would do it abroad or in dubious circumstances.

In Germany embryo screening isn´t totally banned but regulated. It is allowed to use it in order to scan for hereditary disease, screen for aneuploidy or if the pregnancy can lead to a miscarriage. It is strictly forbidden to use this procedure to choose between immune compatible embryos, gender or other than the previously mentioned cases.

In „Building Baby from the Genes Up“ ethics professor Ronald M. Green’s essay presents his case in support of the genetic engineering of embryos arguing that a eradication of diseases can follow after working on embryo genes. „Eventually, without discarding embryos at all, we could use gene-targeting techniques to tweak fetal DNA sequences. No child would have to face a lifetime of dieting or experience the health and cosmetic problems associated with obesity.”

During my research I stuck on to women´s experience doing embryo screening:

Both future parents were desperate because both of them had a condition called cystic fibrosis and their child had a 50% chance on getting it too. The future mother couldn´t handle a child with this disease and they wanted to save the child from having this painful life.
In Germany the doctors recommended and offered to do ICSI and if their child is ill simply to abort the pregnancy. Therefore they went to Belgium to do a PID (Preimplantation genetic diagnosis). They talked to several doctors and psychiatrists, which explained the process and it´s dangers, they were welcoming and cared for them. The couple felt safe and calmed down. The mother had to take a nasal spray to decrease her hormones and was injected every day. After 8-9 days her ova were ready and 22 ova were stippled which lasted just 10min and was totally painless. The father´s sperms were extracted (she was amused by the way he had to walk after the extraction). 5 days later the embryos were tested only on cystic fibrosis. Another 5 days later 2 embryos with a chance of 98% being cystic fibrosis free were in just 10sec implanted. Two weeks after she got a positive pregnancy test. Both of them were overjoyed but still feared a miscarriage but didn´t test the baby on any disabilities because they would still keep it even if it´s disabled. They asked the doctor to not mention the procedure because they feared; doctors would tend to aCaesarean section more likely. At the end they got a healthy son and doesn’t regret anything.

The second experience describes the first child born via PID in Germany:
Annette Z. had multiple miscarriages and abortions because of a severely disabled child.
One had a fluid retention and was about to die, another died in the 10th pregnancy week and the last had a severe condition of desbuquois-syndrome, a rare skeletal disease which leads to a painful life sometimes to death. Dietrich Z. her husband requested for permission to do a PID which was approved.
4 out of 6 fertilized ova had genetic mutations which would trigger the desbuquois-syndrome.<br>The two healthy ova were implanted and Annette got pregnant.
In an interview she told that she disapproves the use of PID in order to create a perfect baby or anything that is unnecessary. But she accepts and believes that it´s right to do PID to prevent serious diseases.