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Robotic Surgery, Human Fallibility, and the Politics of Care Mark J.V

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Robotic Surgery, Human Fallibility, and the Politics of Care Mark J.V Robotic Surgery, Human Fallibility, and the Politics of Care Mark J.V. Olson A dissertation submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Communication Studies. Chapel Hill 2009 Approved by: Della Pollock (Director) Cathy N. Davidson Lawrence Grossberg Christian Lundberg Barry Saunders Priscilla Wald ©2009 Mark J.V. Olson SOME RIGHTS RESERVED Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License ii ABSTRACT Mark J.V. Olson Robotic Surgery, Human Fallibility, and the Politics of Care (Under the direction of Della Pollock) “Robotic Surgery, Human Fallibility, and the Politics of Care” leverages the methods and theoretical paradigms of performance, visual, and new media studies to explore the contradictions, aspirations, and failures of modern technologized medicine. In particular, I consider the use of robots in the operating rooms of a large research hospital. “University Hospital” illuminates a contemporary articulation of human bodies and robotic technology that focuses and amplifies existing and emergent tensions and contradictions in modern medicine’s investment in providing both care and cure. Intuitive Surgical, Inc.’s da Vinci Surgical System provides a “platform” for this exploration, both as a concrete, material, and particular assemblage of hardware, software and human wetware, and as a technology that offers a specific and perhaps more productive vantage point—a modest step stool—for understanding the contemporary politics of surgical pedagogy and practice. I locate the dVSS in a broader context of ambivalence that surgeons experience with regard to the manual practices of their craft, an ambivalence amplified by the increasing sophistication and automation of surgical tools and the changing ontologies of surgical practice. The surgical interface of the dVSS prosthetically enhances—as well as displaces and replaces—embodied surgical skill. At a time when all facets of medical care grapple with the problem of medical error, I outline an emergent sensibility of machinic virtuosity, articulated to both human and robotic surgical practice alike, geared toward addressing and overcoming the perceived pitfalls of human fallibility. Rather than simply enacting a technological dehumanization of medicine, robotic surgery suggests a more complicated terrain where the nature of the human and the machine bleed into each other. What I term the “becoming machine” of the surgeon and the “becoming surgeon” of the medical device occurs on the cutting edge of the robot-surgeon interface. The implications of this emergent medical sensibility are far from clear or unilateral. In closing, I reflect on the iii uncertain impact of the ideal of machinic virtuosity on the politics of care. This reflection considers software and machine ethics alongside medicine’s aspiration to manage contingency according to the “procedurality” of medical and surgical protocols. iv DEDICATION To Melissa and Noah, without whose boundless care-taking, support, and love nothing that follows would be possible. Words fail . v TABLE OF CONTENTS Chapter I. INTRODUCTION .........................................................................................................................................1 Scene .....................................................................................................................................................................4 The Million Dollar Step Stool ...............................................................................................................10 Visuality & Performativity in Surgical Pedagogy ..........................................................................14 (New) Media & Medicine .......................................................................................................................15 New Media: A Disclaimer ......................................................................................................................20 Interdisciplinary Objects: Meaning, Materiality, Anxiety......................................................... 22 Sites of Inquiry I - Robotic Surgery at University Hospital ..................................................25 Sites of Inquiry II - Intuitive Surgical, Inc. .........................................................................................28 II. THE DA VINCI® SURGICAL SYSTEM: MATERIALIZING TECHNOLOGY, MEDICINE AND CARE ...........................................34 What is the dVSS? ................................................................................................................................................37 The “(R)evolution” of the Surgical Interface .................................................................................38 Open Surgery ................................................................................................................................................39 Laparoscopic Surgery: The “Minimally Invasive” Revolution ...............................................43 The “Next” Revolution: Emergent Surgical Paradigms ..........................................................48 Three Components ....................................................................................................................................50 Component I: Surgeon’s Console .....................................................................................................52 Component II: Vision Cart ....................................................................................................................57 vi Component III: Patient-Side Cart ......................................................................................................60 Command and Control: Master/Slave Robotics .......................................................................63 Distance ............................................................................................................................................................67 Prosthetics of Human Encounter .......................................................................................................71 Touch ..................................................................................................................................................................73 III. THINKING (AT) THE INTERFACE ...................................................................................................83 Docking the Robot .....................................................................................................................................83 What is an Interface? ..................................................................................................................................86 Graphical User Interface as Skin ..........................................................................................................92 The “Object Orientation” of the Interface ...................................................................................94 On the specter of the mutual articulation of bodies and machines ............................102 Embodiment and/in Technology ........................................................................................................105 Productive Bodies / Disciplined Bodies — Bodies, Technologies and Power .......................................................................................................111 En-Framing the Body — Informatic Bodies and Posthuman Spectacle ............................................................................116 Interface Exigencies: The Surgical “Demand” for an Interface ........................................121 The Skilled Surgeon - Autonomy Lost? Between authority, automaticity and automaton ....................................................................124 The Robot is In: Displacing Surgeons‘ Authority ...................................................................126 Automobility ................................................................................................................................................129 From the Auto-Mobile to the Automatic ...................................................................................131 The Automaton .........................................................................................................................................132 Machinic Virtuosity — Automaticity as Virtue ..........................................................................133 (Human) Fallibility and Machinic Virtuosity .................................................................................134 vii To Err is Human: The Problem of Error in Medicine ..........................................................136 Informating at the Surgical Interface: The daVinci® Research Interface ....................................................................................................138 IV. CONCLUSIONS ......................................................................................................................................142 Part I: The Becoming Surgeon of the Robot ...........................................................................142 The Meme ....................................................................................................................................................143 The Commentary .....................................................................................................................................144
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