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

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 with the different platforms so that our audience—our professional colleagues, our patients, and the public—will know exactly what we mean? Will we call them both robotic, even though the da Vinci is clearly not a robot? If we call Asimov-assisted procedures robotic, then what will we call da Vinci-assisted procedures? How will we reconcile the literature of the preceding era that ubiquitously used the term robotic to describe procedures done with the da Vinci when it now accurately applies only to operations performed with the Asimov? And how will we explain to the public that now we really are using a robot and expect them to trust us? (Not surprisingly, a preoperative visit in the current environment often includes an explanation that a robot is not really doing the surgery.) Without developing a distinct and accurate nomenclature, we might soon find ourselves having trouble communicating effectively. Because da Vinci is not a robot by any reasonable historically and etymologically accurate standard, clarity suggests that we ought to use a different term. The simplest solution is to call them da Vinci procedures and da Vinci surgeons. However, we tend to avoid such terminology because of the uncomfortable impression that a fundamental component of what we do is intimately linked to a commercial entity, and that the moniker da Vinci surgeon might suggest that we are trained representatives of the company rather than independent practitioners. Robotic surgeon sounds better because it sounds generic. Investigators are reluctant, and often forbidden (as it is by this Journal), to use proprietary names in the titles of their academic work to avoid the appearance of commercial promotion. Despite this, when we describe techniques that are based on a unique product, using a commercial name is acceptable because it allows clear and precise communication. For example, a PubMed search reveals that the proprietary names Abiomed and HeartMate have been used in the titles of 48 and 609 papers, respectively. Similarly, da Vinci has been used in the title of 714 papers. The term robotic is now also used to promote and describe the new Ion and Monarch navigational bronchoscopy systems. These platforms use computers to generate virtual images and provide guidance to the target, but like the da Vinci, they do not accomplish any significant step of the procedure independent of their human operator. They are not robotic systems, yet the term robotic has been adopted to describe them in papers, presentations, and promotional material. Robotic is the buzzword we use to distinguish the latest and greatest computerized technologies from their more manual predecessors. What these systems have in common, and what distinguishes them from their traditional fully manual counterparts, is not that they are robots, but that they leverage computer technology to assist the proceduralist in manipulating the surgical instruments. They occupy a mid-way point between fully manual and truly robotic procedures. These are computer-assisted procedures, not robotic procedures, so perhaps computer-assisted surgery is a more accurate descriptor for this class of technology and procedures. In fact, the Food and Drug Administration recently addressed this new generation of surgical platforms, intentionally choosing to describe them as “computer-assisted surgical systems” while clarifying that “The device is not actually a robot because it cannot perform surgery without direct human control.”1Computer-assisted surgical systems. U.S. Food and Drug Administration.https://www.fda.gov/medical-devices/surgery-devices/computer-assisted-surgical-systemsDate accessed: September 28, 2022Google Scholar Even computer-assisted seems inadequate. The Ion/Monarch experience shows that any categorical term is not sufficiently precise. While procedures done with these two systems are designed for the same purpose, they are accomplished in fundamentally different ways. We are on the road toward greater accuracy if we replace robotic with computer-assisted, but the term fails to distinguish between platforms. Accurate communication suggests that discussion of this new class of computer-assisted procedures should use the relevant proprietary name: for example, da Vinci lobectomy, Ion bronchoscopy, and Monarch bronchoscopy. Clinical reports about these devices would be unambiguous and the term robotic could be reserved for genuine robots, which surely will eventually appear in our operating rooms. Words are powerful. They color how we understand the world and view reality. However, their meanings can change over time, bending and eventually yielding to a rising tide of common usage. English is a versatile, dynamic, and evolving language. It was originally Germanic, but over many centuries it has adopted words from many other languages, mainly Latin and French. Perhaps, therefore, we should give up on the narrow meaning of robot to describe an independently functioning machine, and, like the 11th century Canute and his rising tide, accept the broader meaning, applying it more generally to computer-assisted technologies. Maybe “the train has left the station,” and efforts to revisit our use of the term are merely academic and futile. We disagree. Expanded use of the terms robot and robotic is confined nearly entirely to surgical devices, so correcting their misuse should be more easily achievable than if their use extended beyond surgery. The concept of a robot as an independent actor is potent and is embedded in our culture: we believe there is value in preserving the meaning of robot without dilution. Based on the foregoing, we suggest that the use of the term robotic to describe procedures done with computer-assisted platforms is too big a step away from common usage—it is inaccurate and breeds intellectual fog. It may impair our ability to communicate clearly with each other and the public at a time when the emergence of new technologies demands it. As Orwell suggested, bad language corrupts thought, and we should know better than to continue using words we know to be imprecise and misleading. In our view, we should abandon robot and robotic in their current surgical use in favor of applying a surgical platform's trade name to the procedure using it—eg, da Vinci lobectomy, Ion bronchoscopy, or Monarch bronchoscopy. This change would restore to our conversations and the surgical literature an accurate and forthright terminology that enlightens communication rather than obscuring it. The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. The central picture is used by courtesy of PAL Robotics, CC BY-SA 4.0, via Wikimedia Commons (https://commons.wikimedia.org/wiki/File:TIAGo%2B%2B_side.jpg). Commentary: Surgical robotics: Taxonomy rather than terminologyThe Journal of Thoracic and Cardiovascular SurgeryPreviewDrs Block and Sade in their opinion piece, “Words Matter: When a Robot Is Not a Robot,” argue that the terms “robot” and “robotic” are not accurate in describing the current computer-enhanced, teleremote surgical systems.1 In a literal sense, they are correct, and there is value in considering more carefully the status and trends in technology in surgery. However, this does not mean, as the authors posit, that this terminology is misleading, potentially harmful, and should be abandoned. Rather, it is an issue of taxonomy, not incorrect terminology. Full-Text PDF