It’s a notable feature of (my favourite) Sci-Fi movies, that they tend to include some sort of improbably advanced medical technology, whether it’s the much-envied Med-Bays in Elysium, or Hiro’s comically overbearing robot friend from Big Hero 6. But how far are we from actually implementing these technologies in the real world? In this article, we’ll take a quick look at some of the innovations which are aiming to make those Hollywood dreams a reality.
Robot assisted surgery has been around for a while and its advantages are well understood. In fact, the first surgical robot was used way back in 1985 by a team of surgeons to perform a relatively simple brain biopsy (PUMA 560). Today’s surgical robots have multiple robotic arms which are independently controlled by a single surgeon, and they have miniaturised manipulators so they can mirror the surgeon’s hand and wrist movements (Intuitive - da Vinci®).
The use of robots allows the surgeons to use smaller surgical instruments allowing them to make more precise incisions, which leads to less blood loss and reduced scarring of the patient. Robots also help reduce the impact of the surgeon’s natural tremor. This all means that patients recover faster, with less risk of infection and the promise of smaller scars.
Surgical robots don’t just benefit the patients, they also improve the surgeon’s experience as well. Lengthier procedures can be physically and mentally demanding for a surgeon. A typical robot is operated from a console, which (to my eyes, at least) resembles a futuristic gaming station, complete with hand shaped joysticks and foot pedals.
By detaching the surgeon from the operating table, the robots allow surgeons to adopt more natural sitting, or standing, position – affording greater comfort for longer procedures, and potentially extending the career of the practitioner. A more comfortable surgeon is likely to lead to better outcomes for the patient, but this arrangement also provides a physical separation between the surgeon and patient. which helps to reduce the risk of pathogen contamination.
Whilst in most cases the surgeons are still present in the operating theatre so that they can easily interact with other members of the surgical team, the use of robotics also opens up the possibility of surgeons operating remotely.
A key benefit of remote surgery is that it can allow surgeons with specialist training and experience to operate on patients across a wider geographical area - leading to greater equality of outcomes for patients. Remote operating systems can also be beneficial over much smaller distances. For example, they can allow a surgeon to operate from an adjacent room, such that they don’t have to ‘scrub in’ for the procedure, which could save crucial minutes in an emergency situation.
Although not exactly commonplace, the use of robots to perform remote operations is by no means a new idea. In fact, the first tele-surgery (as it was known then) was trialled in 2001, when a team of surgeons in New York performed a gallbladder removal on a patient in Strasbourg (Operation Lindbergh). However, recent advancements in robotics (not to mention telecommunications) are likely to make these kinds of surgical procedures more accessible in the future.
Newer surgical robots have arms with fully articulated wrists which are capable of up to seven degrees of rotation (CMR – Versius®). This compares favourably to your average human wrist which only has three degrees of rotation. This increased manoeuvrability means that the robots achieve direct hand to instrument mirroring, which allows safer navigation through tortuous parts of the human anatomy. In particular, the ability to access deeper into parts of the human anatomy leads to reduced radiation doses, which is safer for both patient and surgeon.
The integration of 3D high-definition video allows the surgeon to view the treatment site with greater accuracy. Compared to conventional 2D video, 3D imaging provides greater depth perception which enables the surgeon to utilise the enhanced dexterity and control provided by the robot (Intuitive - da Vinci®).
As with all things technical, there is a nascent opportunity to incorporate artificial intelligence (AI) into surgical robotics. In particular, AI could be used to augment a surgeon’s physical capabilities and may also be used to recognize life-threatening conditions more efficiently during surgery. An alternative application of AI may be to simplify the controls, and thereby reduce the training time for new or inexperienced surgeons (STAR Robot).
Existing robots have only limited application for certain surgical procedures due to the lack of haptic feedback to the surgeon. There are existing feedback systems on the market which use force sensors to provide tactile and force feedback, but the force sensors are difficult to implement effectively, because of the inherent restraints on size, geometry, biocompatibility, and sterilization. New advances in this field are aiming to allow placement of force sensors right at the instrument tip, thereby enabling more accurate “point of surgery” feedback to the surgeon (Teksan™).
This unconventional type of medical robot uses microscale mechanical particles to deliver a treatment to a specific target site within the body. Micro-bots may not require any sort of surgical incision, but instead can be introduced into a patient’s circulatory system and transported to a specific destination to carry out a surgical procedure, or deliver a drug therapy. For example, it is envisaged that one day micro-bots will be used to deliver radiation directly to a tumour, or to reduce the side effects of the medication by constraining it within a particular organ, where it is needed. A particular area of interest relates to the delivery of small molecule therapies to help patients suffering from severe brain disorders (Bionaut™).
To the future
Whilst we may still be some way off the Hollywood vision of medical technology, there is promise that the advancements in surgical robotics can increase surgery volumes, whilst improving patient outcomes, which will help to meet the ever-increasing demand for affordable healthcare.
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