While robots and artificial intelligence aren’t yet the equal of human physicians, they can assist with more accurate diagnoses, providing remote care through telepresence, and conducting precise minimally invasive surgical procedures.
To be successful, developers must identify the types of operations where robots can be helpful, as well as address concerns about safety, security, regulatory compliance, and affordability and commercial viability. Here are some examples of surgical procedures that can now include robotic assistance.
1. Taking out brain tumors
The placement and size of brain tumors can have life-changing consequences for patients. For example, a tumor left untreated may cause facial paralysis and deafness. It can also lead to the loss of the ability to swallow and balance. Since the brain is such a delicate and vital area, precision is crucial.
Some surgeons use robots to assist them with brain tumor removal procedures. In one recent case involving a teenage patient, a doctor used a high-tech robotic microscope during surgery. The doctor said the tool has a robotic arm, a GPS component that shows where his tools are, and a heads-up display with a better view of the area during the operation.
The patient was back to her typical life only six months after surgery. She said she’s doing better than before the procedure happened.
Corindus Vascular Robotics recently completed the first in-human, robot-assisted stroke intervention, as well as multiple remote surgeries.
2. Surgical procedures on the retina
Surgical procedures to correct vision are exceptionally delicate, and robots can help with parts of the operations. For instance, Netherlands-based Preceyes’ system went into a clinical trial phase in 2016. With it, a surgeon can use a joystick to operate a robotic arm during procedures the retina, located at the back of the eyeball.
In the 12-patient trial, each person needed a surgical procedure that removed a membrane from the retina. Half of them got a conventional surgery, while the others received the robot-assisted technique.
For the latter group, the surgeon inserts a robot through a tiny incision slightly below the pupil. All the surgeries were a success, but the research showed that robots boosted effectiveness in some cases.
3. Total knee replacements
Severe arthritis can make it painful for patients to move and do many activities. One option is a total knee replacement, whereby metal and plastic components replace the arthritic joints.
During a complete knee replacement, the surgeon addresses all three components of the knee. This intervention is often best for people who have severe arthritis, deformities, or issues with improper alignment.
When orthopedic specialists perform orthopedic surgeries with robots, they typically use an arm to shape the surrounding bone. Then, they insert an implant that replaces the affected part of the knee. Video feedback enables surgeons to confidently manipulate the robot through areas that are hard to see.
One example is the MAKO robotic arm from Stryker Corp., which was used in more than 76,000 knee and hip replacements last year.
Last month, Think Surgical received approval from the U.S. Food and Drug Administration (FDA) for its TSolution One system for total knee replacement.
The Robot Report is launching the Healthcare Robotics Engineering Forum, which will be on Dec. 9-10, 2019, in Santa Clara, Calif. The conference and expo will focus on improving the design, development, and manufacture of next-generation healthcare robots. Learn more about surgical robotics at the Healthcare Robotics Engineering Forum, and register now.
4. Surgical procedures on the spine
Research and development phases for new robotic tools can last years, hindering adaptation. Yet after the first successful surgery with a robot, people started to get excited.
In early 2019, one patient received the spinal surgery involving a robot. The person needed treatment to correct scoliosis, which causes the spine to curve. The system offers 3D surgical planning to help with the pre-operative stage. Plus, it has robotic guidance and navigation technology to make operations more accurate and reduce the risk of complications.
A robotic arm helps with each step of the operation. Moreover, a complementing imaging component gives real-time feedback. Nottingham Trent University is developing a system to correct scoliosis using two Universal Robots collaborative robot arms.
In addition, Medtronic launched its Mazor X Stealth robot-assisted spinal surgery platform early this year. It also released its Hugo system in September.
5. Operations on the heart
Surgical specialists depend on robot-assisted heart surgeries for many reasons. For example, robots can fix valves in the heart, take out cardiac tumors, and treat defects. Because of this technology, some procedures on the heart are less invasive, which speeds the recovery time and reduces the chances of complications.
In a particularly impressive achievement, surgeons used the CorPath GRX from Corindus Vascular Robotics to perform remotely controlled surgical procedures. The medical specialist used several joysticks to control the robot while being miles away.
In one set of operations, five patients needed stents put in their hearts to accommodate narrowed blood vessels due to plaque buildup. They all recovered from the procedure with no complications and were discharged the next day.
6. Removal of uterine fibroids
Uterine fibroids develop inside the womb, often in women of childbearing age. When the tumors are small, they typically cause no symptoms. As they get larger, however, a patient may experience issues like abdominal and back pain, heavy menstrual cycles and excessive urination.
In one patient who had a uterine fibroid removed with a robotic procedure, her only symptom was an expanding waistline. She found out about the fibroids during a routine gynecology visit. The patient had a so-called “keyhole” procedure, where the robotic system took out her fibroid. The process required five incisions, and the surgeon sat at a console to operate the arms.
This approach can shorten the average recovery time by several weeks, notes the Mayo Clinic, but the FDA cautions that specialized training is required for cancer treatment. The patient described above was discharged sooner than those who get conventional procedures.
Robots show promise for surgical procedures
This list highlights examples of how robot-assisted surgical procedures can help physicians improve the delivery of care. Any surgery has associated risks, but the application of machine vision and AI, robot arms with precise end effectors, and carefully designed human-robot interfaces can “democratize” specialist abilities.
After years of few challengers to Intuitive Surgical Inc.’s da Vinci system, investors and physicians have noticed surgical robotics’ potential. The global market for surgical robots will grow from $3.9 billion in 2018 to $6.5 billion in 2023, predicts Markets and Markets, while Data Bridge Market Research forecasts growth from $6.7 billion in 2018 to $19.4 billion in 2026.
Providers of surgical robots including Stelkast, CMR, and Titan Medical raised funding, and Stryker acquired two companies in September. Healthcare startups and providers will put this funding to use to further develop and test their systems, and more operating rooms will make use of robots to assist in the operating room.
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