A Hand is a Terrible Thing to Waste
2017; Elsevier BV; Volume: 104; Issue: 1 Linguagem: Inglês
10.1016/j.athoracsur.2016.10.060
ISSN1552-6259
Autores ResumoIt was with great interest that I read the recent editorial regarding the similarities and differences between robotic surgery and automated flight [1Lazar J.F. Is the future of robotic surgery mirroring aviation and the glass cockpit?.Ann Thorac Surg. 2016; 102: 679-680Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. While one must agree with the author’s statement, “What currently separates the current robotic technology from the A320 (airplane) is that none of the surgical devices are automated,” surgeons do share an essential component of the glass cockpit with our aviator colleagues—the video monitor. Contrary to the author’s observations that, pilots are “jokingly” referring to flying in the computerized environment of the glass cockpit, I believe that pilots are deeply troubled by the loss of manual flight skills that have been replaced by computerized flight. Carr cautions, “Aviators have learned, not all of them (automated controls) are beneficial. Automation can take a toll on our work, our talents and our lives” [2Carr N. The Glass Cage: Automation and Us. W.W. Norton, New York2014Google Scholar]. Airplane control levers, once physically connected to the rudder and flaps of the plane, have been replaced with microprocessors and sensors. Pilots can no longer feel the stall of the foils that precludes loss of control of the aircraft, and may not have the manual skills and reflexes to recover from a sharp decent. As Carr references in his book, the overall death rate from commercial aviation accidents has dramatically declined from 133 deaths per million passengers in the decade ending 1971 to 2 deaths per million passengers in the decade ending in 2011, and undoubtedly the role of advanced computers in flight management, weather monitoring, and automated flight has had a beneficial effect on overall mortality. However, despite this improvement in safety, there continues to be a regular incidence of airplane crashes, many with the loss of the aircraft and all on board. Recent disasters over Buffalo, New York, and off the coast of Brazil have been investigated, and the blame has been placed on operator error. In 2013, the Federal Aviation Administration issued Safety Alert for Operators 13002 [3Safety Alerts for Operators (SAFOs). Available at http://www.faa.gov/other_visit/aviation_industry/airline_operators/airline_safety/safo. Accessed October 18, 2016.Google Scholar]. The alert cautioned that the “continuous use of autoflight systems could lead to degradation of the pilot’s ability to quickly recover the aircraft from an undesired state.” Further, the stated purpose of the alert was chilling: “This SAFO encourages operators to promote manual flight operations when appropriate.” Are pilots and surgeons letting their manual skills grow rusty while they stare at the video screens? In the operating room, in a quest for smaller incisions, less chest wall retraction, and 1 day less in the hospital, surgeons have exchanged their fingertips for the back end of long instruments and the ergonomic grips of the robotic computer interface, but at what cost? And what does the future hold? We should learn from our aviation colleagues that a skillful hand and a practiced mind are a terrible thing to waste. Is the Future of Robotic Surgery Mirroring Aviation and the Glass Cockpit?The Annals of Thoracic SurgeryVol. 102Issue 3PreviewIn 1988, Airbus Industrie revolutionized passenger aviation with the introduction of the A320 airplane, as its “fly-by-wire” control system irrevocably severed the visceral pilot-plane relationship. Before the A320, every decision made by the pilot was physically transmitted through the yoke, pedals, levers, or dials with an immediate haptic reaction from the plane as cables, pumps, and hydraulics responded. This visceral ballet mastered by the pilot over many years of flying was bypassed by the A320’s neural network of silent wires transmitting a constant influx of flight data to computers solving intricate algorithms and reflecting back across six screens that filled the cockpit. Full-Text PDF ReplyThe Annals of Thoracic SurgeryVol. 104Issue 1PreviewI would like to thank Dr Burack [1] for his response to my editorial [2]. I completely agree with his conclusion that “a skillful hand and a practiced mind are a terrible thing to waste” [1]. It is the parallel he draws between the reliance of pilots (and modern surgeons) on monitors as an underlying cause for aviation disasters that diverges from the premise of the editorial. (“Are pilots and surgeons letting their manual skills grow rusty while they stare at the video screens?”) [1]. Full-Text PDF
Referência(s)