Words matter: When a robot is not a robot, and why we should care

摘要

Central MessageUse of the terms "robot" and "robotic" to describe computer-assisted surgical platforms and the procedures done with them is inaccurate and misleading. The practice should be abandoned.See Commentary on page XXX."If thought corrupts language, language can also corrupt thought. A bad usage can spread by tradition and imitation even among people who should and do know better."—George Orwell, Politics and the English Language Use of the terms "robot" and "robotic" to describe computer-assisted surgical platforms and the procedures done with them is inaccurate and misleading. The practice should be abandoned. See Commentary on page XXX. Words matter. They educate and entertain us, inspire us, and bring us to tears. Their purpose is to communicate, but with that simple purpose comes the power to shape our reality. George Orwell demonstrated the power of words to corrupt thought to great effect in his seminal work, 1984. As physicians entrusted by our fellow human beings with caring for their health, we should be cognizant of that power. We should choose words for their clarity and precision and eschew those that mislead and obfuscate. Since its introduction by Intuitive Surgical in 2001, the da Vinci surgical platform has been referred to as a surgical robot, and procedures done with its assistance are called robotic surgery. Our journals and meetings attract a flood of papers, abstracts, and videos describing robotic surgery done by robotic surgeons. We have arrived at the point where robotic surgery is widely understood to mean surgery using the da Vinci platform. Ambiguity doesn't exist because no competing platform exists. However, words matter, and it is past time to reconsider our pervasive use of "robotic" to describe certain procedures and the surgeons who do them. Characterizing da Vinci procedures as robotic is inaccurate and misleading. The fundamental characteristic of a robot is its capacity to use sensory input and computer analytics to evaluate its environment, make decisions, and act without the need for immediate human intervention. The da Vinci platform is a technological marvel but it does not possess this characteristic. With the exception of stapling, it does not leverage environmental sensing and computational skills to perform any component of the operation independently. To be clear and precise, the da Vinci platform is not a robot, a procedure done with it is not a robotic procedure, and surgeons who use it are not robotic surgeons. This assessment is not new and is generally understood by all of us as well as by many nonphysician observers. Yet we continue to use the term because we are all "in on the joke." We know what we mean, but we have not seriously considered the consequences. The less-obvious consideration is that calling these procedures robotic is a miscommunication that has consequences. These consequences may be significant and should motivate us to find better words. When the da Vinci platform was introduced, the substantial difference between it and traditional video-assisted surgery required adoption of a distinct nomenclature. While the term chosen to make that distinction has great marketing power, it undermines our ability to communicate clearly as new technologies emerge. Imagine a not-too-distant future in which Intuitive or another company develops a truly robotic surgical platform, one that can execute components of procedures independently without a surgeon's intervention. We name it "Asimov" in recognition of that author's seminal writings about robots. Surgeons around the world will begin to use the Asimov, exploring the range of procedures that can be done with it and perhaps developing new procedures. As experience grows, the literature will mature from case reports and small case series to larger series, then on to clinical trials that compare outcomes of procedures done with the Asimov to those done with the da Vinci. How will we communicate about procedures done