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Your Robo-Surgeon Will See You Now: What's Happening in Robots and Surgery

POSTED 07/29/2024  | By: Jim Beretta, Customer Attraction, A3 Contributing Editor

In Star Wars: The Empire Strikes Back, a robot is shown fine-tuning Luke Skywalker’s prosthetic hand after Darth Vader severed Luke’s hand in a lightsaber duel. While the Star Wars universe was in a galaxy far, far away, robot-assisted surgery is becoming more common.

What is robotic surgery? 

Robotic-assisted surgery refers to medical and surgical procedures conducted with the assistance of a robotic arm. Unlike the autonomous “droids” of the Star Wars universe, the surgeon is responsible for manipulating the arms, which may include a camera arm, sensors and operating arms with end-of-arm-tools (EOAT).

The robots used in robotic-assisted surgery must meet strict safety and health regulations. Brandon Harrison of Stäubli Group advised that patient outcome is the most important factor the Food and Drug Administration (FDA) considers when evaluating a new robotic-assisted device. “If there is potential for even the slightest increase in patient risk, the FDA won’t consider the application. However, if there is a potential reduction in surgery open time or recovery time, that has a better chance.”

The nature of the surgery determines what type of incisions will be required. Some surgeries can be performed with small incisions or insertions through natural orifices, using miniaturized instruments, sensors, and a 3D camera. The surgeon puts ports in the incisions, and the tools are inserted through the ports into the patient’s body. The surgeon views the surgical area through a console and manipulates the robotic arms. At the end of the surgery, the tools and ports are removed and the incisions sutured.

Other surgeries will be performed in traditional open surgery with the robot assisting. Occasionally, a robot-assisted procedure may need to become an open surgery if unforeseen complications occur.

The American College of Rheumatology estimates that 790,000 knee replacement and 544,000 hip replacement surgeries are performed in the United States annually, and as the Boomer and Gen X populations age, the number continues to increase. A 2021 report published in the Bone and Joint Journal predicted that 23.9% of joint replacement surgeries will be robot-assisted by 2025.

“Currently, robot surgery market penetration is less than 5%, so there’s huge growth potential. With trends in artificial intelligence (AI) and machine learning, we have opportunities to improve, and we are seeing requests for proof of principle,” said Dave Henderson, CEO, New Scale Technologies.

Advantages of robotic-assisted surgery

Less invasive

Robot-assisted surgery is less invasive for patients. The robot arms have a greater range of motion than the human hand and can rotate the instruments into positions in tight spaces that would otherwise require a much larger surgical area.

Instead of large incisions, surgeons make small incisions or use natural orifices. This results in less pain post-op, smaller scars, shorter surgical time, shorter hospital stays and less risk of infection. In some cases, patients can leave the hospital on the same day. “Robotic-assisted surgery requires less draping, smaller insertions and the robots have a smaller footprint in the operating room. They are easier to sterilize and have a faster changeover. A surgical team is an expensive resource to be sitting around waiting for a room to be sanitized and prepared for the next patient,” said Carsten Horn, Applications Engineering Manager, maxon Precision Motors Inc.

Robot-assisted cardiac surgery is performed through small port incisions in a patient’s side, rather than the 10-inch scar typical of open-heart surgery. Most robot-assisted cardiac surgeries do not require a sternotomy, which means less post-op pain, faster healing and return to normal activities. While not every cardiac surgery can be a robot-assisted procedure, congenital defects, valve repair, and small heart tumors are good candidates for less invasive robot-assisted cardiac surgery.

Courtesy of KUKA RoboticsPrecision

Robotic-assisted surgery has been used in orthopedics for almost two decades. Robots make precision cuts that allow implants to fit well, which lowers the risk of early dislocation. The surgical area can be precisely delineated with cameras and sensors, and if the robot arm leaves the demarcated area, the tool will stop. This provides less risk for accidental damage to muscles, nerves, and surrounding tissue.

Robot-assisted surgery for other conditions such as colorectal, gynecological, urology, thoracic, and spine or brain procedures are becoming more common. When precision and accuracy are paramount, millimeters mean the difference between success and incapacity. “A surgical robot will not make a great surgeon better, but it can allow them to do the job more easily. It also has the potential to make a good surgeon great,” said Corey Ryan, director of medical robotics for KUKA Robotics.

Trends 

Interface

There is constant pressure to improve the human-machine interface. The interface and the application are designed by the end customer rather than the robot manufacturer. Therefore, the integration between the robotic arms, the actuator, applications and EOAT must be seamless so the various components can “speak” to each other.

“One of the advantages of surgical robots is the ability to review and learn from previous operations. By reviewing the successes and failures, the human-machine interface can be optimized for the best patient outcomes,” said Horn. “With the integration of AI and machine learning, automation is the next likely trend, and in the future, the robot will complete routine processes like suturing without direct surgical guidance.”

“When the surgeon is in a different room from the patient, they must have confidence that the interface will provide the required precision and dexterity to perform the tasks as expected for best patient outcomes. Vision becomes critical. Computational sensors with multiple cameras can provide hyperspectral imagining with sharper contrast, filtering, and 3D positioning. This provides the surgeon with a view in the remote console that is as close as possible to the field of operation. Tiny cameras with two lenses and sensors, combined with AI, machine learning, and virtual reality will continue the innovation,” added Henderson.

Safety

Whether in traditional or robot-assisted surgery, patient safety and positive outcomes are the driving factors. “The FDA approval for medical devices is convoluted since the robot base and arm are not considered a medical device without the platform and applications — there are different criteria. However, robots intended for surgery must conform with IEC 60601 certification requirements for elements such as leakage and overload testing,” said Ryan.

Whether the robot is a multiple or single-insertion surgical robot, or a surgical support robot, the trend is to develop smaller, more powerful motors to drive the robot and the components. Smaller robots are easier to clean, require less draping and a smaller footprint makes them accessible to more hospitals. “A smaller actuator with higher torque is more efficient, easier to clean, and creates new possibilities and opportunities for robot-assisted surgery. It provides better drivability for the surgical robots, creating better outcomes,” said Horn.

“The human hand can do impressive things, but it’s big. When you scale down, there are still lots of requirements for power and dexterity, while managing the force required for different surgeries. The same EOAT may be used for cardiac and ortho surgery, but the torque and grip strength will differ,” added Henderson.

“Robots are a significant capital investment, and there is always demand for making them more affordable without sacrificing performance,’ continued Henderson. “Is the EOAT one-time use, or can it be made from materials that can be autoclaved multiple times? It’s an important safety component as well as a quality metric.”

Acceptance

Surgeons must receive specialized training to perform robot-assisted surgery. A 2019 survey of general surgical residency programs published in The American Journal of Surgery reported that of the 114 responding academic institutions, 92% had surgeons participating in robot surgery training.

“There’s a generational component for sure. Experienced surgeons trust their hands and are wary of robots, while new surgeons have been trained in the tech and expect the robots will be available,” said Henderson.

“Patients rarely inquire how frequently a surgeon has performed a procedure; there is an implicit expectation of competency. Ortho has done a great job promoting the advantages of robot-assisted surgery for patient outcomes but the acceptance and familiarity is less in other areas,” said Ryan. “If a robot can perform a cancer biopsy with one poke that provides results in 5 minutes with minimal variation, precision and accuracy, then doctors and patients will embrace the tech with confidence.”

Data

One advantage of robotic-assisted medical devices is the data that is generated. This data is compiled, and then can be aggregated, evaluated, analyzed and reported, and the results can inform future surgical procedures. Video of previous surgeries can be used as a teaching tool, an evaluation tool, or proof of concept.

With cloud technology and the Internet of Medical Things (IoMT), robotic-assisted medical procedures can be shared with other medical facilities as a source for training and reference. It also provides information about surgical competency, can identify deficits or the need for upgraded skills training, and identify skills to emulate.

“One of the advantages of pairing AI with robotic-assisted surgery, is the robot can evaluate and predict each surgeon’s skillset and adapt the process, often in real-time. For example, the robot will store information about how much force a surgeon exerts when using a tool, and then adjust so that each procedure can meet a common threshold of excellence. AI and machine learning allow the robot to ‘learn’ and improve future outcomes,” said Henderson.

Combining robot-assisted surgical devices with AI, machine learning, and virtual reality will continue to generate data to guide future innovation, improve patient outcomes and drive adoption. These may be the droids the industry is looking for, after all.

Vision in Life Sciences This content is part of the Vision in Life Sciences curated collection. To learn more about Vision in Life Sciences, click here.