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In the wake of Industry 4.0, it's time for Surgery 4.0

December 4, 2018
By Amir Hooshiar

A friend of mine, Lucas Hof, a member of the first cohort of Concordia Public Scholars and now an associate professor at École de technologie supérieure (ETS) in Montreal, posted a blog in January that introduced the characteristics and implications of Industry 4.0 as an emerging trend in the worldwide manufacturing industry.

To recap, Industry 1.0 refers to the mechanization of work that occurred because of the industrial revolution, such as the birth of steam engines. Industry 2.0 came about by the expansion of electricity usage and mass production, and we often recognize Industry 3.0 as the era of industrial automatization, including the expansion of car factories with big yellow welding robots.

As Lucas indicated in his blog, we associate Industry 4.0 with economizing the manufacturing of custom-designed and single-volume batch parts. This would inevitably demand new tools and processes of manufacturing. You can find ample interesting examples in his blog.

I see Industry 4.0 as inevitable, caused by the culmination of information technology (IT), the expansion of connectivity (Wi-Fi, 5G, etc.), internet-of-things (IoT), the explosion of massive amounts of data and the emergence of artificial intelligence (AI).

Interestingly, one can correlate ground-breaking innovations in surgical technology with the industrial generations, from Industry 1.0 to 4.0. In the following figure, I depict the evolution of surgical technology alongside the industrial revolutions.

The notion of Surgery 4.0 is trending in the wake of Industry 4.0, but what really constitutes this latest evolution in surgical technology?

According to Hubertus Feussner, founder of the Minimally invasive Interdisciplinary Therapeutical Intervention (MITI) research group at Technical University of Munich,Surgery 4.0 is known for its interoperability, information transparency, technical assistance and decentralized decision-making features.

In other words, Surgery 4.0 necessitates that we connect surgical devices via IoT or Internet-of-People — ordinary internet that you are using to read this blog. Nevertheless, we require decentralized decision-making to analyze the data and make real-time decisions based on what’s streaming live from different surgical devices.

For instance, below is a simplified model I can envision for the future operation rooms.

This is a simplified model containing only the bare minimum devices that we will use in future operating rooms (OR). Decision-making takes place within the surgery control system, which gathers necessary information from a series of monitoring devices, such as respiration and heartbeat monitors. From there, the system issues commands to the different devices, much like a surgical robot, as well as the surgeon! That’s right, the surgeon!

In the context of Surgery 4.0, we hope the surgery control system will be capable of overriding and correcting unnecessary or incorrect commands by the surgeon. This feature proved feasible in my own research. For example, if a surgeon mistakenly pushes the knife on a nerve during spine surgery, the system would recognize the risky motion and prevent the robot from obeying the surgeon's command.

If a surgeon is about to wrongly implant a stent inside a patient's heart, the robot could interfere at different levels. There could be an audio-visual-vibrational warning that would stop and ask the surgeon to reconsider. If the risk is too high, the robot could stop the procedure altogether or correct the maneuver. The latter, however, seems a little far-fetched for now, but researchers are working diligently to address this need.

Considering this simplified model, one could realize the huge amount of data that is transmitted, processed and stored every single second. This volume of data needs an IT structure beyond the capacity and performance of our home PCs. In this regard, the emergence and expansion of 5G connectivity networks are happening at the right time.

Similarly, an unbelievable growth in machine-learning — understanding the content of data signals — and deep-learning — understanding the content of images — is also happening at a fast pace.

During the last decade — and through the help of novel sensing systems — individuals have a certain level of confidence in surgical robots, at least for straightforward procedures like removing an appendix. In Surgery 4.0, we will equip autonomous surgical robots with super-fast connectivity, artificial intelligence-based decision making, intuitive user interfaces and haptic feedback.

In this era of Surgery 4.0, the horizon for imagination seems boundless for safer, faster, more versatile, more accessible and better surgical care.

About the author

Amir Hooshiar received his Bachelor's and Master's in Biomedical Engineering with Honours from Amirkabir University of Tehran, Iran. He served as a Certified Medical Devices Expert for nine years before joining Concordia. Amir is a Vanier Scholar and the recipient of the prestigious NSERC Gilles-Brassard Doctoral Prize for Interdisciplinary Research in 2018. His doctoral research is under supervision of Dr. J. Dargahi on recreating tactile sensing and haptic feedback for surgeons during robot-assisted cardiovascular interventional surgery.

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