Sample Final Essay and Bibliography. Grade: 100.

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Ahmed Bassam Hamed Salama
Professor Rebecca Mitchell
603-HSD-VA sect. 00004
19 November 2023
Robotic-Assisted Surgeries: A Promising Future Hindered by Corporate Greed
Two millennia ago, the physician Hippocrates honorably pledged to serve humanity.
The very first words of the renowned Hippocratic Oath read: “I will respect the hard-won
scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is
mine with those who are to follow” (Stubbs). Unfortunately, Hippocrates’ sanctimonious oath
has been consistently violated ever since – be it by treacherous physicians, pharmaceutical
companies, or medical organizations – who cartelize medicine’s hard-earned knowledge. With
the ongoing technological revolution, various medical companies have avariciously monopolized
the technical expertise of medical advancements. A screeching example of this tragedy is the
topic of this research paper: surgical robots in robotic-assisted surgeries. As such, this paper aims
to show the importance of promoting robotic-assisted surgeries in medicine due to the cascade of
technical, surgeon-reflected, and health advantages that far outweigh any monetary disadvantage.
Further, this research will discuss essential considerations regarding adopting robotic-assisted
surgeries as well as their intriguing reflection in fiction.
Firstly, it is essential to know a brief history behind robotic-assisted surgeries to
understand their advantages, main drawback, and hence this paper’s thesis. At the height of the
science-fiction craze that hit the world with the first release of Star Wars in 1977, NASA and the
U.S. government were working on different concepts to incorporate robots in surgeries, ranging
from developing robots to assist surgeons in the operations room to seemingly fictional long-

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distance battlefield surgery robots (Shah et al.). A mere eight years later, fiction turned into
reality when PUMA 200, a newly built surgical robot, etched its name into the annals of medical
history by successfully helping surgeons perform an extremely delicate brain biopsy. This 1985
historic breakthrough caused a paradigm shift in the surgery world (Shah et al.). The result? An
avalanche of other successful breakthroughs in the field of robotic-assisted surgery – or R.A.S.
for short. Certainly, dubbed the golden era of surgical robot development, the 1990s produced an
array of competent surgical robots. However, this golden era ended too soon, as with the start of
the new century, only one robot would come to dominate the R.A.S. scene due to its
technological prowess: the Da Vinci robot. What makes the Da Vinci robot so powerful is its
adaptability to different surgical operations, unmatched precision, and the ability to offer either
completely remote or in-person operations. As one can guess, this led to a tyrannical monopoly
where Da Vinci’s company, Intuitive Surgical, holds nearly 80% of today’s surgical robot
market share (Cimino). In short, while surgical robot technology has enormously advanced since
the eighties through the rise of the Da Vinci robot, the unrivaled monopoly that Intuitive Surgery
holds strangles today’s surgical robot market via the consequentially high costs.
Secondly, through precision, the minimally invasive nature of robotic-assisted surgeries,
and the surgeon’s ease of use, R.A.S. results in an avalanche of health benefits for both the
patient and the surgeon. In fact, numerous recent studies – such as the three-month-old study of
Dr. Chuchulo and Dr. Ali – confirm that surgical robots possess the three general advantages
above. Indeed, ever since 2009, Dr.Van Koughnnet confirmed in her article that surgical robots
have a better “precision of motion” than surgeons as robots eliminate hand “tremors” (Chuchulo
and Ali). Subsequently, this results in a “minimally invasive surgery” (Chuchulo and Ali) – that
is, a surgery free of large and sometimes dangerous incisions. From “the surgeon’s perspective”

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(Van Koughnett), R.A.S. equally offers “ergonomic” (Bakalar) positives and an unparalleled
ease of use in complex procedures. Therefore, the resulting patient and surgeon-reflected health
benefits are as follows: the minimization of human error, reduced infections, faster recovery
time, the alleviation of surgeons’ physical burdens and an increase in surgeons’ career spans.
Truly, according to many trusted surgical centers and clinics, like Cleveland Clinic, the majority
consensus is that R.A.S. “minimiz[es] human error” (Cleveland Clinic). The consequence is a
dramatic reduction of “post-surgery infections” (Cleveland Clinic) and thus a faster recovery
time – nearly 20% less time spent in the hospital post-surgery (U.C.L.). As for surgeon-reflected
advantages, Dr. Gerard Doherty, surgeon-in-chief in Boston’s Brigham Women’s Hospital,
fittingly says: “We move the arms of the robot while sitting comfortably. I have one surgeon
who told me it will extend his career by a decade” (Bakalar). Crucially, in their 2023 study
published in the American Medical Association’s Journal of Ethics, Dr. Chuchulo and Dr. Ali
succinctly write:
“The surgical platform for robotic-assisted surgery . . . offers prospective benefits to
patients (eg, shorter hospital stays, earlier recovery, and less pain) and operational
benefits to surgeons. Surgeons . . . are generally able to perform complex procedures
with the robotic platform due to its ergonomic suturing instrumentation, tremor
stabilization, 3D visualization, and 4-arm control by a single surgeon” (Chuchulo and
Ali).
The importance of the above citation cannot be understated, as both doctors manage to perfectly
summarize nearly all the aforementioned health benefits. In brief, the precise and minimally
invasive surgical robots facilitate the surgeon’s job, all while saving – and improving – both the
patient’s and the surgeons’ health.

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Thirdly, the surgical robots’ cost is the main obstacle preventing their widespread use in
robotic-assisted surgeries. In fact, the cost of R.A.S. is its “Achilles’ heel,” being the rightful
point of criticism for its detractors and cynics. According to Gail Wilensky, economist and
previous welfare issues advisor to George HW Bush, one Da Vinci robot can cost up to “$2
million” (Wilensky). As a result, the incremental “costs associated with the Da Vinci procedure .
. . rang[e] from $3,000 to $6,000 more than traditional . . . surgery” (Wilensky). Note that
Wilensky simply refers to robotic-assisted surgeries as “Da Vinci procedures” (Wilensky) due to
the previously mentioned yoke held by Intuitive Surgery on surgical robots. Undoubtedly,
Intuitive Surgical holds close to 80% of the surgical robot market share (Cimino) – a textbook
definition of monopoly. The situation is so dire that Dr. Gerard Doherty describes it as living in a
constant “hope” (Bakalar) that new machines can compete with the Da Vinci – but to no avail.
Indeed, Dr. Doherty exasperates: “We’ve been saying that for a decade,” adding that Intuitive
Surgery “has been pretty aggressive about maintaining their market” (Bakalar). Consequently,
and in a clear violation of Hippocrates’ sacred Oath, the common use of robots in surgeries is
severely hampered, depriving patients and surgeons of the hard-earned health advantages.
Briefly, as it stands, the staggering cost of surgical robots caused by Da Vinci’s undisputed
dominance is a significant obstacle to collective benefit.
Fourthly, while there are some solutions to the monetary issues above, such as shattering
Intuitive Surgery’s monopoly, it is essential to reflect upon the future considerations of the
eventual widespread adoption of robotic-assisted surgeries. Considering the solutions first,
governments should shatter Intuitive Surgery’s monopoly and create new rival surgical robots
through state healthcare subsidies. This heavy-handed solution successfully ended Rockefeller’s
Standard Oil Company (Duignan), which held a domineering monopoly over America’s oil in

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the late 19th and early 20th centuries, thus benefiting the oil market. Similarly, no monopolies in
the R.A.S. market will allow new players to equalize the playing grounds and enforce favorable
competition. As for future considerations, maintaining both robot and surgeon quality is
fundamental to ensuring a beneficial continuation of surgical robots. For example, technology
editor John Koon urges health authorities to regularly enforce surgical robot maintenance and
safety from “hacker-invoked” (Koon) system crashes lest these risks endanger patients’ lives,
especially with the increased connectivity of surgical robots to the internet. Furthermore,
practicing physicians must continuously take “standardized” (Chuchulo and Ali) surgical robot
training courses to guarantee consistent and safe operation results. In short, efficient surgical
robot use can only rise from the ashes of the broken-up monopoly. However, health authorities
maintain the quality and security of the eventual widespread adoption of surgical robots through
rigorous maintenance and staff training.
Fifthly, the two chosen fictional works to be analyzed – the 1985 novel Ender’s Game and
the 2005 movie Star Wars Episode III – similarly portray robotic surgeries in fiction due to real-
life historical robot advancements but with a more imaginative twist. For example, Card’s novel
illustrates a scene where Ender, the story’s protagonist whose goal is to save an “imperiled
humankind” (Card) after an alien invasion, undergoes a brain biopsy by the shuttle’s surgeon,
who uses a highly advanced surgical robot. Interestingly, during the same year, the first-ever
surgical robot operation – a brain biopsy too – took place (Shah et al.), where the technological
buildup to this historic instance no doubt inspired Orson Scott Card to reflect it in his novel. The
obvious imaginative twist is the inclusion of space shuttles and aliens. However, a wilder twist is
that of the 2005 movie Star Wars Episode III, where the crucial difference is that Anakin
Skywalker undergoes surgery by fully autonomous surgical robots! Fascinatingly, George Lucas

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– the famous millionaire and Star Wars movie director – predicts the future of the surgical robot
field in this scene, probably based on the powerful wave of robotic advancements spearheaded
by Honda’s first fully autonomous robot codenamed ASIMO (Lyon) at the start of the 21st
century. To summarize, Card’s Ender’s Game and Lucas’ Star Wars Episode III offer an exciting
reflection on how the present field of robotic-assisted surgeries is portrayed in fiction by
including fictional adaptations based on historical surgical – and non-surgical – robot
technological advancements.
Finally, robotic-assisted surgery has seen remarkable advancements since its conception in
the mid-eighties, as evident by today’s powerful Da Vinci robot, the brainchild of Intuitive
Surgery. Undoubtedly, via their precision and minimally invasive nature, surgical robots ease the
surgeons’ work and, as such, positively benefit the patients’ and surgeons’ health. Yet, the
grossly inefficient cost of surgical robots caused by Intuitive Surgery’s monopoly prevents their
rapid adoption and hence collective benefit, a benefit only possible through the breakup of Da
Vinci’s dominance to force healthy competition. Nevertheless, it is a matter of time before
R.A.S. becomes widely used, and health authorities must maintain the quality and security of
surgical robots through meticulous surgeon training and robot maintenance. Fascinatingly, the
fictional works Ender’s Game and Star Wars Episode III offer an intriguing window reflecting
the historical advancements of robotic-assisted surgery and robots. Lastly, based on the
prediction of George Lucas, and with the A.I. revolution the world is now witnessing, this
research paper raises this question: Will surgical robots ever be fully automated and AI-powered
like those in Star Wars?
[1716 Words]

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Works Cited and Annotated Bibliography
Cimino, Adria. “Intuitive Surgical: Buy, Sell, or Hold?” Nasdaq.com, 2023
, www.nasdaq.com/articles/intuitive-surgical:-buy-sell-or-hold. Accessed 4 Nov. 2023.
Cleveland Clinic. “Robotic Surgery: Robot-Assisted Surgery, Advantages, Disadvantages.
” Cleveland Clinic, 2021, my.clevelandclinic.org/health/treatments/22178-robotic-surgery.
Accessed 5 Nov. 2023.
Bakalar, Nicholas. “Are Robotic Surgeries Really Better?” The New York Times, 2021,
www.nytimes.com/2021/08/16/well/live/robotic-surgery-benefits.html. Accessed 31 Oct.
2023.
Nicholas Bakalar, writer and author of more than two dozen books covering a variety of
subjects such as medicine, sports and nutrition, attacks the question of robotic-assisted
versus conventional surgeries. Using Dhanani et al.’s study and an array of expert
medical citations, the author argues that, in the present day, robotic-assisted surgeries
have an advantage (via an increase in precision and the resulting health benefits as well
as an alleviation of the surgeon’s physical burden) over traditional surgeries – albeit a
modest one due to the operating costs. There are no clear biases, as the article “laid
down” and critically analyzed each fact in front of the reader. While lacking more
scientific studies, Nicholas still incorporates the words of more than three doctors, one
recent study, monetary statistics, and medicinal as well as market facts that advance his
thesis. The relevancy of this nearly “all-encompassing” source cannot be understated, as
it briefly touches on almost every advantage and disadvantage that will be more
profoundly discussed in subsequent sources used for this research paper, thereby
enforcing this paper’s conclusions.

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Card, Orson Scott. Ender’s Game. Tor, 1985.
A screenwriter and an English teacher, Orson Scott Card has minimal expertise with the
topic of robotic-assisted surgeries. However, inspired by the first ever use of robots in
surgeries in 1985 via a brain biopsy (Shah et al.), Orson includes in his best-selling
science-fiction book “Ender’s Game” a gruesome passage of a robotic-assisted brain
surgery performed on Ender, the story’s protagonist. Given that this source is only used
for paragraph V that explores fiction, the author has no applicable nor relevant thesis that
relates to this paper’s scientific research findings. Yet, the story itself remains rather
relevant to the paper, as it reflects the influence of robotic-assisted surgeries on fiction.
Chuchulo, Anastasya, and Ali, Abubaker. “Is Robotic-Assisted Surgery Better?” AMA Journal of
Ethics, vol. 25, no. 8, 2023, pp. 598–604, journalofethics.ama-assn.org/article/robotic-
assisted-surgery-better/2023-08, https://doi.org/10.1001/amajethics.2023.598. Accessed
31 Oct. 2023.
Two professional surgeons and doctors of medicine, Dr. Anastasya Chuchulo and Dr.
Abubaker Ali, examine the significant benefits of robotic-assisted surgeries and provide a
rebuttal of the technology’s cynics. Using a wide array of very recent and peer-reviewed
sources within their medical article and over 169000 patients, both doctors argue that the
health benefits for both the patient and the surgeon (such as the minimally invasive nature
of robotic surgeries, reduced recovery times, lower risks of infection and improved
ergonomics for the surgeon) are far more important than the cost robotic-assisted
surgeries. There are, however, some biases within the thesis. For example, both concede
that the cost of robotic-assisted surgeries are higher than conventional ones, simply

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dismissing that with experience, the current trend, and time, the cost is bound to decrease.
Yet, this fails to mention the specific monopolies over the medical robot industry, mainly
Intuitive Surgery’s monopoly (Nicholas), are the reason behind the dramatic costs of said
robotic surgeries. Overall, this article is significantly strong as it is the most recent study,
it is peer-reviewed by other surgeons, and it uses new and credible references. What is
missing is simply a deeper rebuttal concerning the valid critics of the costs of robotic-
assisted surgeries. Dr. Anastasya Chuchulo and Dr. Abubaker Ali’s article is hence best
described as the backbone of this paper’s research, and their article heavily affirms this
paper’s conclusions.
Duignan, Brian. “Standard Oil | History, Monopoly, & Breakup.” Encyclopædia Britannica
, 2019, www.britannica.com/topic/Standard-Oil. Accessed 8 November 2023.
Koon, John. “Risks Rise as Robotic Surgery Goes Mainstream.” Semiconductor Engineering,
2022, semiengineering.com/risks-rise-as-robotic-surgery-goes-mainstream/. Accessed 31
Oct. 2023.
A technology editor, John Koon has a moderate level of expertise with the topic of
robotic-assisted surgeries, where, in his article, he discusses the potential risks and
considerations associated with the usage spread of robots in the operations room.
Providing historical, technical and economic information on surgical robots, Koon
affirms in his thesis that technical failures – such as security breaches in the robot’s
network – can be fatal to the patient. The main strengths of the thesis includes the valid
security concerns raised, while a considerable weakness is the absence of supporting
sources. Given the lack of supporting sources, Koon’s article is clearly not a good source.
But, due to the insightful security points raised, this is not a bad sources either as its use

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will be potent in paragraph IV – future considerations. The contribution to this paper’s
research is also middling, as this source does not contradict nor support this paper’s
thesis. Rather, it simply raises the point that robotic-assisted surgeries with no safety
mechanisms in place can be deadly.
Lyon, Peter. “Honda’s Globetrotting Pint-Sized Robot Asimo to Retire.” Forbes, 2022,
www.forbes.com/sites/peterlyon/2022/03/28/hondas-globetrotting-pint-sized-robot-
asimo-to-retire/?sh=22f4b0dd7618. Accessed 9 Nov. 2023.
Shah, Jay, et al. “The History of Robotics in Surgical Specialties.” American Journal of Robotic
Surgery, vol. 1, no. 1, 1 June 2014, pp. 12–20,
www.ncbi.nlm.nih.gov/pmc/articles/PMC4677089/,
https://doi.org/10.1166/ajrs.2014.1006. Accessed 31 Oct. 2023.
Surgeons and medical doctors, Dr. Jay Shah and two of his colleagues explore the
fascinating history behind the robotic-assisted surgeries. The thesis of the article is
simply to highlight the various milestones in robotic surgical technology, especially the
earlier ones. No biases are present, as this is simply a regurgitation of the history of said
robots using pure factual evidence. As such, the article itself is potent due to its
chronicle-based nature, leaving nothing out. This source, therefore, acts as a fundamental
base to the first paragraph that introduces the history behind robotic-assisted surgeries.
Star Wars: Episode III - Revenge of the Sith, directed by George Lucas, performance by Hayden
Christensen, LucasFilm, 2005.
A filmmaker, millionaire and philanthropist, George Lucas equally possesses minimal
expertise with the topic of robotic-assisted surgeries. In the science-fiction realm of Star
Wars, George Lucas includes a scene of autonomous robots performing a leg-

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replacement surgery on Anakin Skywalker, an important character in the series. As this
source is only used for paragraph V, the author has no relevant thesis that relates to this
paper’s scientific research. Yet, as always, the 2005 movie is still important to the paper,
as it shows an interesting “evolution” (compared to the robotic-assisted surgeries of
Ender’s Game) or even “prediction” regarding the future of robotic surgeries, where
robots are shown performing the surgery by themselves with no external intervention.
Stubbs, Joseph. “Sharing Knowledge Is Part of a Modern Hippocratic Oath.” Acpinternist.org,
2009, acpinternist.org/archives/2009/06/presidents.htm. Accessed 5 Nov. 2023.
U.C.L. “Robotic Surgery Is Safer and Improves Patient Recovery Time.” U.C.L. News, 15 May
2022, www.ucl.ac.uk/news/2022/may/robotic-surgery-safer-and-improves-patient-
recovery-time.
Van Koughnett, Julie Ann, et al. “Are There Advantages to Robotic-Assisted Surgery over
Laparoscopy from the Surgeon’s Perspective?” Journal of Robotic Surgery, vol. 3, 2009,
pp. 79–82, https://doi.org/10.1007/s11701-009-0144-8. Accessed 31 Oct. 2023.
Dr. Julie Ann, along with five other surgeons, demonstrate the advantages of robotic-
assisted surgeries. In the thesis based mainly on scientific sources and studies, the
sextuple argues that robotic-assisted surgeries are far more beneficial for the patient and
mainly the operating surgeon. A weakness is that this article is from 2009 – more than a
decade old – and thus some scientific information might be outdated. An advantage is the
co-authoring of several surgeons that gives substantial weight to the benefits that concern
surgeons in robotic-assisted surgeries. This source overwhelmingly supports the
conclusion that robotic-surgeries have numerous ergonomic and health benefits for the
operating surgeons.

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Wilensky, Gail R. “Robotic Surgery: An Example of When Newer Is Not Always Better but
Clearly More Expensive.” The Milbank Quarterly, vol. 94, 2016, pp. 43–46,
www.milbank.org/quarterly/articles/robotic-surgery-an-example-of-when-newer-is-not-
always-better-but-clearly-more-
expensive/?gclid=CjwKCAjw9L_tBRBXEiwAOWVVCeWMe4gCHYVSPq4ArXhYDC
O0tlZlFiRgt3sanwNUe9mP1aPl5_TKLRoC6XsQAvD_BwE,
https://doi.org/10.1111/1468-0009.12178. Accessed 31 Oct. 2023.
Economist and welfare issues advisor to George HW Bush, Gail Wilensky entertains the
various economic obstacles of robotic-assisted surgeries. In her article, she argues from
an economic standpoint that adopting robotic-assisted surgeries is simply not cost
effective currently as, in her eyes, the health advantages are “not there yet” to allow for a
widespread adoption of this new technology. To advance her thesis, she cites various
facts, where the most marking fact used is that one Da Vinci robot from the previously
aforementioned Intuitive Surgery company can cost up to 2 million dollars per unit.
Obviously, coming from an economist, her analysis regarding the economic aspects of
robotic-assisted surgeries is simply brilliant and logical. Yet, lacking both sufficient
medical sources and expertise, Wilensky either downplays or presents a weak overview
of the massive health benefits of said robots. As such, Wilensky’s article both goes
against this paper – by downsizing the health benefits of robotic-assisted surgeries despite
mentioning them – and supports this paper through the demonstration of the staggering
fiscal issues of using robots in operations.