Advancing the horizons of robotic surgery and smart medicine
Dr. Jihad Kaouk – Director, Center of Advanced Laparoscopic and Robotic Surgery, Cleveland Clinic – Cleveland, Ohio
29 December 2020
Seated at the da Vinci Surgical System in an operating room, Dr. Jihad Kaouk reflects on his work with great humility. “I see myself, like many other medical professionals, as pushing the limit with a passion to deliver better care for patients. That's what we want.”
Dr. Kaouk, Director of the Center of Advanced Laparoscopic and Robotic Surgery at the Cleveland Clinic, is one of the leading pioneers in robotic surgery. He and his surgical team at the Clinic recently performed the first successful robotic single-port kidney transplant through one small abdominal incision.
Dr. Kaouk is a trained Laparoscopy surgeon so he is used to doing surgery through keyhole incisions. However, this new technology is a game changer. Dr. Kaouk says that “with robotic surgery, you mount the instruments to the robot and then command the robot with joysticks.”
He believes that this transition is good for the patient because he can be “more precise with the instruments and take minimally invasive surgery to a new horizon and to keep pushing the limit.”
Over the next few years, the technology will contain multi-armed robotics that can have even further benefits for the patient. For example, when a patient is under-going an operation for throat cancer “the surgeon does not have to make multiple incisions or cut through nerves” and expose the patient to complications and infection. With robotics, the surgeon works “straight from the mouth and do the surgery from inside.”
Robotics which use minimally invasive techniques provide a number of greater benefits to the patient such as more precise surgery, reduction of infections, reduced pain, early discharge from the hospital and shorter recovery time. Dr. Kaouk said that previously for a surgical procedures that would require going through the belly, they would need multiple entry ports which may run the risk of infections.
“I don't do any of this. I make one small incision, go straight to the organ and create a baseball-size gas bubble. I work within the gas bubble. So that's the whole trick. You limit the surgical space from large, multiple entry points to only one incision. If we can do the same surgery with less pain and person can be released the next day instead of next week, that's a huge plus” beams Dr. Kaouk.
As a young man growing up in Lebanon he was not thinking about being a doctor as a profession. “I always had passion for mechanical engineering but there were not many work opportunities after we graduated. We didn’t have many factories or high-end technologies there so I always worried about what would I do after I graduate with such a degree.”
At this point he decided to pursue medicine and received his medical degree from the American University of Beirut Faculty of Medicine (AUB). With this degree, he undertook a fellowship in advanced laparoscopy and conducted research in minimally invasive surgery at the Cleveland Clinic. In 2002, Dr. Kaouk was appointed to Cleveland Clinic staff and has become “a first generation robotic surgeon.”
However, Dr. Kaouk emphasised that although the introduction of new technologies will increasingly be part of surgery in particular and medicine in general, students will still need rigorous medical training, excellent hand-eye coordination, empathy for the patient and keeping on top of the latest technological and medical developments.
Also through education, Dr. Kaouk sees the barrier to women entering medicine fading. “I have two very bright young daughters myself. Education is the basis of eliminating the barriers in accessing a profession. If you educate the community, people will realize that humans are humans and there is no reason why women can’t take the same job and be expected to perform the same job as men.”
“When I look at the field of surgery today, I know my hands can deliver an action at the very precise spot where it is needed. Everyday surgeons will stand beside the patient and focus on where their hands should be. But this is all changing. Increasingly when a surgeon is operating, they are looking at a screen. For me, I am looking at the patient through a robot. I may not even be beside the patient. The patient can be several feet away, or in a different city and eventually on the other side of the earth.”
Some of these ground-breaking technologies are available today, however, there are currently in smaller pieces and not yet combined in the way that will take robotic surgery to the next level. Dr. Kaouk speaks about this as “the puzzle parts are not put together yet”’ but developments are happening faster.
“In a few years you will start to see artificial intelligence in operating rooms. The systems will then provide warnings if you might puncture an artery or need to move to the left to avoid other organs” said Dr. Kaouk. He spoke further about the day where a patient can ingest a micro-camera that “will just take images of your GI tract instead of a colonoscopy or gastroscopy to provide endoscopic views.”
“This is not science fiction” Dr. Kaouk says with a smile. “I think the next step is the pre-imaging of a patients’ body and uploading the images and data into the robot. Right now the robot can only follow your joystick movements. But the next step could be a robot, with all the data on the patient uploaded, can become a semi-automatic surgeon. Furthermore, we will hopefully see a lot of cancers be controlled with a pill or with DNA modification.”
The current and future advancements in this field would have seemed impossible a decade ago but with the use of technology and a move towards greater inter-disciplinary learning across the globe, the prospect for medical breakthroughs is giving hope to millions.
“Creativity has no citizenship. I am very proud of our team here that functions like a small United Nations. If you look at all these Innovations and the people behind them, these are people from all over the world. It is amazing how in medicine we do not have geographic boundaries to finding talent and innovation. The limitation is not the ingenuity or power of the human brain but the lack of resources."
ILO Office for the United States · Advancing the horizons of robotic surgery and smart medicine
Dr. Kaouk, Director of the Center of Advanced Laparoscopic and Robotic Surgery at the Cleveland Clinic, is one of the leading pioneers in robotic surgery. He and his surgical team at the Clinic recently performed the first successful robotic single-port kidney transplant through one small abdominal incision.
Dr. Kaouk is a trained Laparoscopy surgeon so he is used to doing surgery through keyhole incisions. However, this new technology is a game changer. Dr. Kaouk says that “with robotic surgery, you mount the instruments to the robot and then command the robot with joysticks.”
He believes that this transition is good for the patient because he can be “more precise with the instruments and take minimally invasive surgery to a new horizon and to keep pushing the limit.”
Over the next few years, the technology will contain multi-armed robotics that can have even further benefits for the patient. For example, when a patient is under-going an operation for throat cancer “the surgeon does not have to make multiple incisions or cut through nerves” and expose the patient to complications and infection. With robotics, the surgeon works “straight from the mouth and do the surgery from inside.”
Robotics which use minimally invasive techniques provide a number of greater benefits to the patient such as more precise surgery, reduction of infections, reduced pain, early discharge from the hospital and shorter recovery time. Dr. Kaouk said that previously for a surgical procedures that would require going through the belly, they would need multiple entry ports which may run the risk of infections.
“I don't do any of this. I make one small incision, go straight to the organ and create a baseball-size gas bubble. I work within the gas bubble. So that's the whole trick. You limit the surgical space from large, multiple entry points to only one incision. If we can do the same surgery with less pain and person can be released the next day instead of next week, that's a huge plus” beams Dr. Kaouk.
As a young man growing up in Lebanon he was not thinking about being a doctor as a profession. “I always had passion for mechanical engineering but there were not many work opportunities after we graduated. We didn’t have many factories or high-end technologies there so I always worried about what would I do after I graduate with such a degree.”
At this point he decided to pursue medicine and received his medical degree from the American University of Beirut Faculty of Medicine (AUB). With this degree, he undertook a fellowship in advanced laparoscopy and conducted research in minimally invasive surgery at the Cleveland Clinic. In 2002, Dr. Kaouk was appointed to Cleveland Clinic staff and has become “a first generation robotic surgeon.”
However, Dr. Kaouk emphasised that although the introduction of new technologies will increasingly be part of surgery in particular and medicine in general, students will still need rigorous medical training, excellent hand-eye coordination, empathy for the patient and keeping on top of the latest technological and medical developments.
Also through education, Dr. Kaouk sees the barrier to women entering medicine fading. “I have two very bright young daughters myself. Education is the basis of eliminating the barriers in accessing a profession. If you educate the community, people will realize that humans are humans and there is no reason why women can’t take the same job and be expected to perform the same job as men.”
“When I look at the field of surgery today, I know my hands can deliver an action at the very precise spot where it is needed. Everyday surgeons will stand beside the patient and focus on where their hands should be. But this is all changing. Increasingly when a surgeon is operating, they are looking at a screen. For me, I am looking at the patient through a robot. I may not even be beside the patient. The patient can be several feet away, or in a different city and eventually on the other side of the earth.”
Some of these ground-breaking technologies are available today, however, there are currently in smaller pieces and not yet combined in the way that will take robotic surgery to the next level. Dr. Kaouk speaks about this as “the puzzle parts are not put together yet”’ but developments are happening faster.
“In a few years you will start to see artificial intelligence in operating rooms. The systems will then provide warnings if you might puncture an artery or need to move to the left to avoid other organs” said Dr. Kaouk. He spoke further about the day where a patient can ingest a micro-camera that “will just take images of your GI tract instead of a colonoscopy or gastroscopy to provide endoscopic views.”
“This is not science fiction” Dr. Kaouk says with a smile. “I think the next step is the pre-imaging of a patients’ body and uploading the images and data into the robot. Right now the robot can only follow your joystick movements. But the next step could be a robot, with all the data on the patient uploaded, can become a semi-automatic surgeon. Furthermore, we will hopefully see a lot of cancers be controlled with a pill or with DNA modification.”
The current and future advancements in this field would have seemed impossible a decade ago but with the use of technology and a move towards greater inter-disciplinary learning across the globe, the prospect for medical breakthroughs is giving hope to millions.
“Creativity has no citizenship. I am very proud of our team here that functions like a small United Nations. If you look at all these Innovations and the people behind them, these are people from all over the world. It is amazing how in medicine we do not have geographic boundaries to finding talent and innovation. The limitation is not the ingenuity or power of the human brain but the lack of resources."
ILO Office for the United States · Advancing the horizons of robotic surgery and smart medicine