“CMC Dubai: Pioneering the Future of Robotic Surgery”
As the healthcare landscape rapidly evolves, the integration of surgical robotics and artificial intelligence is revolutionizing operating rooms across the globe. Clemenceau Medical Center Hospital in Dubai stands at the forefront of this transformation, a pioneer in adopting advanced technologies to deliver world-class care. “Hospitals” Magazine interviewed Mark Adams, CEO of CMC Hospital Dubai, to explore surgical robotics, current state and future potential, the role of AI and machine learning in enhancing clinical precision, and how these innovations are reshaping the surgical experience for patients and providers. From accessibility and efficiency to the dawn of autonomous systems, Mr. Adams shares his insights into how CMC is setting new benchmarks in robotic-assisted surgery and redefining the future of surgical practice in the region.
The relentless advance of surgical robotics
Robot-assisted and remote robotic-telesurgery technologies are combining with advanced communications networks to deliver significant benefits to patients worldwide. The former, where surgeons are present on site, can help medical staff perform delicate surgical interventions with more dexterity and precision using magnified, 3-D high-definition images of the surgical field, leading to less scarring, reduced blood loss, fewer or smaller incisions, quicker recoveries and, ultimately, shorter hospital stays.
Remote telesurgery takes advantage of all the latest advances in robotic-surgery systems, but gives surgeons the freedom to perform operations from many thousands of kilometres away. Early last year, a surgeon stationed in Rome performed a prostate-removal procedure on a patient in Beijing and, more recently, a surgeon operating from a control console in Shanghai carried out prostate cancer surgery on a patient some 12,000 kilometres away in Morocco. In September last year, another surgeon in the French city of Bordeaux oversaw the world’s first ever transcontinental partial nephrectomy – a procedure to remove the cancerous part of a kidney – on a patient 8,000 kilometres away in Beijing, who was discharged from hospital the next day with no complications.
As a result of both the advances in robotics, and the reliable communications they depend on – surgeries have been performed using both broadband and 5G networks – this disruptive technology is set to make the world’s most experienced surgeons accessible to more and more patients. After all, it removes the need to travel thousands of kilometres for routine or specialised surgery and allows medical students to access surgical training more frequently and at lower cost.
With machine learning (ML) and advanced artificial-intelligence (AI) systems now featuring in almost every corner of healthcare management, the multiple data-capture points available from these robotic systems’ cameras, sensors and robotic arms, create a wealth of new possibilities for automation in robotics. Patient trust in AI arguably still has some way to go, but how far might we be from the day when routine surgery is carried out entirely by AI-powered robotic systems?
Where are we now and how will robotics enhance accessibility, precision and efficiency
Telerobotics isn’t exactly a new phenomenon – it was first used successfully to perform a brain biopsy way back in 1985 – but we’ve seen plenty of milestone advances in its capabilities and uses since then. With the prostate patient in Morocco last year, for example, because the latency or network-transmission delay was minimal – networks can now give long-distance latency of just 100 milliseconds – the French surgeon in question, Youness Ahallal, was able to perform the procedure with no deformation of technique, even though the transmission distance – estimated to be over 30,000 kilometres – was even longer than the crow-flies distance between Morocco and Shanghai. Primary links for telesurgery now commonly enjoy two backup links as well as an optional tertiary link.
Although this surgery was performed with Chinese technology, other robotic systems have more than established their credentials in the race to offer the best robotic-assisted outcomes and choices for patients. In Dubai, for example, CMC Dubai has installed multi-speciality robotic-surgery technology in the form of the da Vinci Surgical System, capable of a wide variety of interventions in general surgery, gynaecology and urology surgery. In short, it can perform anything from a hernia to a keyhole hysterectomy. In the UK, Guy’s and St Thomas’ Hospital in London started using early da Vinci systems in 2004, and the hospital now hosts the largest robotic surgery facility in the country. In 2023, it passed the milestone of 10,000 surgeries with the system. “Almost all prostate, kidney and lung cancer surgery”, says the hospital’s clinical lead, “is now completed robotically at our Trust. Several complex operations have been pioneered at Guy’s and St Thomas’, having never been performed with standard key-hole surgery techniques”. And in 2021, the robotic system helped the surgical team at Guy’s and St Thomas’ successfully perform the first paediatric robotic surgical procedure for testicular cancer.
For patients, the immediate clinical benefits of minimally invasive surgery include faster procedures, lower levels of anaesthesia over shorter operating times, reduced blood loss, smaller scars and generally less opportunity for infection. Combined, these benefits result in quicker recovery times and therefore shorter hospital stays, with reduced post-operative infection leading to less chance of readmission. From a clinician’s point of view, the 10X magnification of surgical fields gives a far better view than the human eye of what’s going on during surgery, and it also allows surgeons to perform micro-surgery that has historically been difficult with a human hand, time-consuming or impossible with traditional surgical methods. For example, robotic micro surgery can now be used to perform faster and more precise reconstructive procedures to repair parts of an anatomy measured in just millimetres, such as small blood vessels. As CMC Dubai notes, “the robotic arms’ ability to eliminate even the slightest hand tremor ensures that delicate anatomical structures are managed with utmost care, thereby reducing the likelihood of accidental damage to surrounding tissues.”
The American Urological Association (AUA) reported this month that surgeons in China have performed over 1,000 remote robotic procedures in urology alone, using fibre or 5G technology over distances of some 5,000 kilometres. “These systems are actively pursuing and performing telerobotic surgery,” says the AUA, “with increasing frequency”. Complex prostatectomies and cystectomies performed with robotic telesurgery are now common occurrences in China, and these advances are benefitting patients in remote areas of the country whilst offering further opportunities to train medical students in surgical techniques. As the AUA notes, “this humanitarian opportunity is the next evolution of robotic surgery, providing opportunities for rural and underserved patient populations to get care locally that would be inaccessible.” And medical training and education is being democratised, it says, by allowing surgical experts to offer a degree of mentorship to surgeons undergoing training anywhere in the world.
AI machine learning in robotic surgery: what might the future hold?
It’s a question asked with increasing frequency: just how far are we from AI-driven robotic systems actually performing surgery autonomously?
The potential for further disruptive advances can be seen from these systems’ ability to integrate seamlessly with other technologies. For example, AI-driven image-recognition is already used for image enhancement and intraoperative safety, but the ability to assimilate AI-powered diagnostics and data analytics could give robotic systems such as da Vinci the power to enhance preoperative planning, predict outcomes more accurately and envisage surgical treatments in the context of a patient’s recent MRI and CT scans, and their holistic health profile.
In the case of frequent procedures in which robotic systems have already been widely used, the opportunity for machine learning to train AI-powered robotic systems will increase dramatically. After all, the robotic environment as it stands provides fertile ground to further enhance automation and dextrous surgical techniques with the introduction of ever more complex machine learning (ML) algorithms. As mentioned above, the systems commonly in use today allow for multiple data-capture opportunities from highly dextrous robotic arms, cameras and sensors. When combined with a holistic analysis of a patient’s complex medical history and data, AI will likely occupy an ever more integral role as robotic surgery continues to widen accessibility, reduce invasiveness, shorten hospital stays and accelerate recovery times.
Robotics, AI and autonomy: surgical practices redefined
Overall, robotic systems currently in use today are delivering faster recoveries and fewer days in hospital. And the direction of travel for surgical robotics points to nothing short of a complete reimagining of surgical practice. Precision, efficiency and patient outcomes will be significantly enhanced, and economies of scale will broaden accessibility for previously underserved populations such as sub-Saharan Africa, where only 3% of the population has access to quality surgical care.
The growth in fibre and 5G technology now offers communications dependability over distances of many thousands of kilometres, with levels of reliability unimaginable when the first tele-surgical procedure was performed in 1985. As the American Urology Association notes, “coupling these communication pathways with the availability and interest from newer and diverse robotic systems, affordable and reliable telesurgery is now a reality.”
