Advanced concepts for medical robotic systems

Abstract

With the first recorded medical application of a robot - a CT-based orientation of a needle guide for biopsy of the brain - occurring in 1985, a number of research groups in Asia, Europe, and the USA began investigating other medical applications of robotics. Beside of a big number of research prototypes and scientific outcome, a relatively small number of commercial ventures were resulting from these efforts.

Now, after more than 30 years of activities and compared to many other fields of medical technology, medical robotics still can be considered as of being in its infant state. The number of commercially available setups actually could be increased, but only few of them really have created significant impact. Many research questions have been addressed in order to improve the technology, but the gap between research in laboratories and real use in surgical routine seems to get even bigger. If one looks to the main reasons for this slow adoptation of new technology, it turns out to mostly not being related to technical functioning, but to other factors such as:

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  cumbersome use of robots (complexity, size, missing integration into clinical workflow) which hinders application in clinical routine,

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  high cost for robot system and operational cost (i.e. cost/benefit ratio is not satisfactory in most cases),

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  high setup time and effort (e.g. additional person for operating robot system),

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  limitation in portability and/or mobility,

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  unsolved safety issues.

The presentation will include a short introduction into medical robot systems for surgical applications. Topics include issues such as kinematic configurations, interfaces to existing surgical equipment, but also matters related to standards and regulations. One key aspect for (future) medical robots is related to its main operation principle. Current commercial robot systems are either directly controlled by a human operator or strictly follow a pre-defined path. Automated systems are limited to setups where no direct contact between robot and/or the guided tool takes place, e.g. to compensate (to a certain degree) breathing motion in external radiotherapy or for imaging purposes. On the cognitive side, a long thought-after feature is to estimate what the surgeon would like to do next. This could be taken into account when planning and executing the next movement of the robotized tool or camera. Addition of cognitive capabilities to the robot also has the potential to take a further step toward surgical automation, e.g. for the awareness of the current medical situation and the ability to react in a suitable way. Concrete robot applications - such as for percutaneous placement of needles for tumor ablation, neurosurgical applications, or vitreo-retinal surgery - will further help to illustrate the possibilities but also the limitations of current medical robotics technology.