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Robots play a critical -- and growing -- role in modern medicine, from training the next generation of doctors, dentists, and nurses, to comforting and protecting elderly patients in the early stages of dementia. Using robots, medical professionals can make smaller incisions for shorter surgeries, reducing hospital stays and improving patients' prognoses and saving costs. As robots become even smaller and developers continue to further integrate the devices with artificial intelligence, the mediome
t resembles something from a Hollywood sci-fi movie, but Hybrid Assistive Limb 5, or HAL 5, as it is known, is an artificially powered ecoskeleton that helps double the amount of weight someone can carry unaided. Developed by Yoshiyuki Sankai, a professor at Tsukuba University of Japan, the invention is backed by venture capitalist firm Cyberdyne. Expanding beyond Japan, last year Odense University Hospital announced it would use HAL 5 for clinical trials on worker augmentation.
Hospitals may initially want to introduce robots to replace repetitive, necessary, and time-consuming tasks such as some pharmacy operations and pill dispensing. Some hospitals and specialists in remote care are using telepresence robots to deliver specialists to rural or under-served regions. Doctors are asking for surgical robots that eliminate large incisions, reduce patient pain, and minimize the need for more medication and longer hospital stays, allowing the person to return home and start therapy sooner. Simultaneously -- and not surprisingly -- patients want, if not demand, minimally invasive surgeries.
The medical community wants more. For example, physicians want more devices that perform their functions autonomously; they'd like to see automated scrub and circulating nurses; they encourage the implementation of tele-consulting solutions within the operating room, and they'd like to see automation in tissue suturing, bonding and anesthesiology, according to the Robot Review.
As the world's population ages and the available medical community shrinks, governments and healthcare communities around the world are striving to address how they will address this issue. Japan, which has a large elderly population, has developed a number of robot-based technologies that appear to help slow down the advent of dementia, while others help older people with household chores, thereby reducing the risk of injury and the need for confinement in a nursing home or hospital.
History of Robotics in Medicine
Initial applications of robotics in the field of medicine were with the use of rehabilitation devices and assistance for those with disabilities. In his pioneer experience, Dr David Gow created the first bionic arm in 1998 called the Edinburgh Modular Arm System.[2] Robots posterior use was in helping individuals with severe disabilities to perform independent activities of daily living (The Winsford feeder) or integrate them into the workplace (RAID, Robot for assisting the integration of the disabled).[2]
The first robotic system applied in a surgical procedure was the PUMA 560, used to orient a needle for a brain biopsy under computerised tomography guidance.[3] However, its use was discontinued because of safety issues. Later, a London group presented a robotic system called the PROBOT, used to aid in transurethral resection of the prostate.[4] Following the same tendency, in 1992, International Business Machines (IBM) and associates developed a prototype for orthopaedic surgery. The ROBODOC was used to assist surgeons in milling out a hole in the femur for total hip replacements.[5]
A new era was beginning, and the concept of telepresence technology, that would allo the surgeon to operate at a distance from the operating room, was being intensively researched simultaneously at the Stanford Research Institute, Department of Defence, and the National Aeronautics and Space Administration (NASA).[6] The initial purpose was to create a prototype to suit the needs of the military, and the robotic arms were designed to be mounted on an armoured vehicle to provide immediate operative care in the battlefield. Soon thereafter, Intuitive Surgical acquired the prototype and commercialised the system called daVinci. At the same time, Computer Motion unveiled the first laparoscopic camera holder, Automated Endoscopic System for Optimal Positioning (AESOP). Computer Motion later created the Zeus surgical system, which is an integrated robotic system.[6] In March 2003, a fusion of both companies was announced under the name of Intuitive Surgical Inc.Continue Reading
The DaVinci Robotic Surgical System
The daVinci system's main components are: a control console that is controlled by the surgeon (Figure 1), and the surgical cart that consists of three or four arms (in a most recent version) (Figure 2) with a laparoscope and two or three surgical tools. The arms can be operated by the manipulation of two master controls on the surgeon's console. Tremor filtering, movement scaling, increased range of motion and ergonomy are advantages that can be achieved with the use of this system. No measurable delay has been noticed between the movement of the surgeon's controls and instruments response. The instruments used in the daVinci system allow the surgeon to roll, pitch, yaw and grip the laparoscopic tools using seven degrees of freedom.
The imaging system consists of two independent cameras in the dual-channel endoscopes that are fused, providing the surgeon with a 3D magnified image of the operative field.
After its first use in late 1990s, the daVinci system has been gaining an increased popularity and is now being used in many different fields of medicine, such as cardiothoracic surgery, general surgery, gynaecology and finally urology.
Introduction
The word 'robot' evokes many different thoughts and images, perhaps conflicting ones. Some may think of a metal humanoid, others of an industrial arm, and yet more may think, unfortunately, of a lost job. In the field of medical robotics, the word robot is just as fuzzily defined, with many different applications. These range from simplistic laboratory robots, to highly complex surgical robots that can either aid a human surgeon or execute operations by themselves.
The reasons behind the interest in the adoption of medical robots are multitudinous. There is a great analogy to be found with the automation involved in the manufacturing industry. That is not to say that the issues of medical robotics are the same, but that the advantages to be gained are similar. Robots provide industry with something that is, to them, more valuable than even the most dedicated and hard-working employee - namely speed, accuracy, repeatability, reliability, and cost-efficiency. A robotic aid, for example, one that holds a viewing instrument for a surgeon, will not become fatigued, for however long it is used. It will position the instrument accurately with no tremor, and it will be able to perform just as well on the 100th occasion as it did on the first.
The applications of robots in medicine will be further expounded, and the field of robotic (and robotically assisted) surgery will be concentrated upon, along with such issues as safety and implementation.
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Applications
The use of robots is not confined to the operating theatre. Other application areas where medical robots prove useful include:
• Laboratory robots: Laboratory robots carry out hundreds of tests (e.g. blood testing for HIV) in parallel, saving time and freeing manpower for other purposes. They are used mainly because of their ability to perform repetitive tasks at high speeds, reliably and without fatigue.
• Hospital robots: As hospital staff is in short supply, mobile robots in hospitals can help by fetching or distributing medicine, while patient handling robots may assist in the lifting and positioning of patients that are difficult to manage.
Rehabilitation robots: Rehabilitation robots are robots that help permanently or temporarily disabled people with the matters that they cannot deal with themselves. The user controls the robot using their sight as feedback and inputting commands via various input devices. Workstation robots are fixed in position and operate within a semi- ordered environment to perform simple tasks (such as raising food to a mouth or turning a page in a book). Mobile robots, on the other hand, are configured to be used in an unstructured environment. They usually consist of a powered arm, either on a mobile platform or, most commonly, on the side of a motorised wheelchair.
Robotic surgery
Robotic surgery is the process whereby a robot actually carries out a surgical procedure under the control of nothing other than its computer program. Although a surgeon almost certainly will be involved in the planning of the procedure to be performed and will also observe the implementation of that plan, the execution of the plan will not be accomplished by them - but by the robot.
The advantages to be gained through automation are numerous. A robot's motions can be precisely controlled and constrained through its programming. This results in undeviating trajectories, high accuracies with predictable velocities and accelerations with no overshoot. As expected when dealing with automated processes, the benefits of repeatability and reliability are inherent.
An improvement is also experienced in terms of time. Unlike a human surgeon, a robotic one will not hesitate before each step, contemplating the possible outcomes of the next move. Some might say that this is a disadvantage of robotic surgery, but these outcomes will have been considered and reconsidered by surgeons in the pre- operative phase and so do not require further deliberation. Others may have the opinion that time will be wasted on the planning of the surgical procedure and on the imaging requirements. These, however, are necessary steps of any proposed surgery and, anyhow, the time saved in both the quicker procedure and in the reduced recuperation time will outweigh any increase in the pre-operative stage.
In order to look at the different issues involved in the robotic fulfilment of an operation, the separate sections of a typical robotic surgery (although robotic surgery is far from typical) are explained below.
Surgical planning
Surgical planning consists of three main parts. These are imaging the patient, creating a satisfactory three-dimensional (3D) model of the imaging data, and planning/rehearsing the operation.
The imaging of the patient may be accomplished via various means. The main method is that of computer tomography (CT). CT is the process whereby a stack of cross-sectional views of the patient are taken using magnetic-resonance-imaging or x-ray methods. This kind of imaging is necessary for all types of operative procedure and, as such, does not differ from traditional surgical techniques.
This two-dimensional (2D) data must then be converted into a 3D model of the patient (or, more usually, of the area of interest ). The reasons for this transformation are twofold. Firstly, the 2D data, by its very nature, is lacking in information. The patient is, obviously, a 3D object and, as such, occupies a spatial volume. 2D data is just that - two-dimensional; hence it cannot easily provide information pertaining to such issues as volume (of, for instance, a tumour) or, position (with respect to distances perpendicular to the cross-sectional data). Secondly, it is more accurate and intuitive for a surgeon, when planning a procedure, to view the data in the form that it actually exists.
The actual transformation into a 3D model is readily accomplishable through volume graphics methods (see Volume Graphics: The road to interactive medical imaging?). These methods produce computer-graphics-based models that possess such features as the ability to rotate the model, view its interior, zoom in, and so on. That is, all the capabilities of current computer-aided-design (CAD) systems. As may be expected, however, the processing requirements of these modelling systems are rather large, as are the costs of the hardware necessary. It should be noted, however, that the speed of said hardware is increasing all the time and the price will decrease too, as the technology involved becomes more commonplace. This means that the process will be more cost-efficient and increasingly routine in the future.
The third phase of the planning is the actual development of the plan itself. This involves determining the movements and forces of the robot in a process called 'path planning' - literally planning the paths that the robot will follow.