‘Surgery-by-wire’: A new cross-domain perspective on robotic control

As robotic surgery provides clinical benefits and increases on a global scale, it also signifies the transition from direct manual control of surgical instruments to digital connectivity and teleoperation. The digital coupling between human control inputs and surgical motion replaces the previous physical link. Robotic surgery is therefore in effect ‘surgery-by-wire’, the term capturing the engineering phenomenon that has also occurred in the ‘fly-by-wire’ of aviation and ‘drive-by-wire’ of cars. This paper reviews the fundamental commonality across domains. Intrinsic to ‘by-wire’ control is digital processing, which generates the control signal to the effector. This processing enables a progressive spectrum of motion modulation, from precision and stability of motion, through assistance and envelope protection, to automation. Precision now manifests in all three domains. In modern aircraft and cars, higher-order assistance is commonplace, such as flight envelope protection, with analogous support in driving, as well as significant automation. In robotic surgery, such assistance and automation have not yet entered wider clinical practice, with concepts such as envelope protection requiring further definition. The digital interface combined with telecommunication has also enabled teleoperation in all domains. Therefore, motion ‘by-wire’ has enhanced performance across industries. A cross-domain perspective will be increasingly useful to facilitate technology transfer and catalyse progress in robotic surgery. As the pan-industry digital transformation evolves, important principles can be derived for application in robotic surgery.