robotics in medical applications
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Report OnROBOTICS IN MEDICAL APPLICATIONS
Submitted By: Guided By:
RAUNAK JOSHI Mr. ANIL .K.MAHTOB.tech IV (2008-12) Assistant ProfessorProduction Engg. Mechanical Engg. Dept
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CERTIFICATE
This is to certify that ―Mr. RAUNAK JOSHI‖ of
B Tech IV sem. 7th has satisfactorily completed his report on
―ROBOTICS IN MEDICAL APPLICATIONS‖
Signature of guide:
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CONTENT
INTRODUCTION
WHAT IS ROBOTICS
ROBOTICS IN MEDICAL FIELD
THE DA VINCI Surgical System
Nano Robotics
Hospital Robots
APPLICATIONS
CRITICSM
CONCLUSION
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INTRODUCTION
Robotic surgery, computer-assisted surgery, and robotically-assisted surgery are terms for technological
developments that use robotic systems to aid in procedures. Robotically-assisted surgery was developed to
overcome both the limitations of minimally invasive surgery or to enhance the capabilities of surgeons performing
open surgery. In the case of robotically assisted minimally invasive surgery, instead of directly moving theinstruments, the surgeon uses one of two methods to control the instruments ; either a direct telemanipulator or by
computer control. A telemanipulator is a remote manipulator that allows the surgeon to perform the normal
movements associated with the surgery whilst the robotic arms carry out those movements using end-
effectors and manipulators to perform the actual surgery on the patient.
In computer-controlled systems the surgeon uses a computer to control the robotic arms and its end-effectors, though
these systems can also still use telemanipulators for their input. One advantage of using the computerised method is
that the surgeon does not have to be present, indeed the surgeon could be anywhere in the world, leading to the
possibility for remote surgery. In the case of enhanced open surgery, autonomous instruments (in familiar
configurations) replace traditional steel tools, performing certain actions (such as rib spreading) with much
smoother, feedback-controlled motions than could ever be achieved by a human hand. The main object of such
smart instruments is to reduce or eliminate the tissue trauma traditionally associated with open surgery withoutrequiring more than a few minutes' training on the part of surgeons. This approach seeks to improve that lion's share
of surgeries, particularly cardio-thoracic, that minimally invasive techniques have so failed to supplant.
In 1985 a robot, the PUMA 560, was used to place a needle for a brain biopsy using CT guidance. In 1988, the
PROBOT, developed at Imperial College London, was used to perform prostatic surgery. The ROBODOC from
Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement.
Further development of robotic systems was carried out by Intuitive Surgical with the introduction of the da Vinci
Surgical System and Computer Motion with the AESOP and the ZEUS robotic surgical system. (Intuitive Surgical
bought Computer Motion in 2003; ZEUS is no longer being actively marketed.)
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WHAT IS ROBOTICS ?
A robot is a mechanical or virtual intelligent agent that can perform tasks automatically or with guidance, typicallyby remote control. In practice a robot is usually an electro-mechanical machine that is guided by computer andelectronic programming. Robots can be autonomous, semi-autonomous or remotely controlled. Robots range fromhumanoids such as ASIMO and TOPIO to Nano robots, Swarm robots, Industrial robots, mobile and servicing
robots. By mimicking a lifelike appearance or automating movements, a robot may convey a sense that ithas intent or agency of its own.
―ROBOTICS‖ is the branch of technology that deals with the design, construction, operation, structural disposition,manufacture and application of robots. Robotics is related tothe sciences of electronics, engineering, mechanics mechatronics, and software.
The concept and creation of machines that could operate autonomously dates back to classical times, but researchinto the functionality and potential uses of robots did not grow substantially until the 20th century. Today, roboticsis a rapidly growing field, as we continue to research, design, and build new robots that serve various practicalpurposes, whether domestically, commercially, medicine or militarily.
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The da Vinci Surgical System
Da Vinci Surgical System
The Da Vinci Surgical System is a robotic surgical system made by Intuitive Surgical and designed to facilitate
complex surgery using a minimally invasive approach. The system is controlled by a surgeon from a console. It is
commonly used for prostatectomies and increasingly for cardiac valve repair and gynecologic surgical procedures
The da Vinci Surgical System comprises three components: a surgeon’s console, a patient-side robotic cart with 4
arms manipulated by the surgeon (one to control the camera and three to manipulate instruments), and a high-
definition 3D vision system. Articulating surgical instruments are mounted on the robotic arms which are introducedinto the body through cannulas. The original telesurgery robotic system that the da Vinci was based on was
developed at SRI International in Menlo Park with grant support from DARPA and NASA. Although the
telesurgical robot was originally intended to facilitate remotely performed surgery in battlefield and other remote
environments, it turned out to be more useful for minimally invasive on-site surgery. The patents for the early
prototype were sold to Intuitive Surgical in Mountain View, California.
The da Vinci senses the surgeon’s hand movements and translates them electronically into scaled-down micro-
movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's
hand movements, so that they are not duplicated robotically. The camera used in the system provides a true
stereoscopic picture transmitted to a surgeon's console. The da Vinci System is FDA cleared for a variety of surgical
procedures including surgery for prostate cancer, hysterectomy and mitral valve repair, and is used in more than 800hospitals in the Americas and Europe. The da Vinci System was used in 48,000 procedures in 2006 and sells for
about $1.2 million. The new da Vinci HD SI released in April, 2009 currently sells for $1.75 million. The first
robotic surgery took place at The Ohio State University Medical Center in Columbus, Ohio under the direction of
Dr. Robert E. Michler, Professor and Chief, Cardiothoracic Surgery.
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Nanorobotics
Medical robots that get under the skin.
Nanorobotics is the emerging technology field of creating machines or robots whose components are at or close to
the microscopic scale of a nanometer (10−9 meters). More specifically, nanorobotics refers to
the nanotechnology engineering discipline of designing and building nanorobots, with devices ranging in size from
0.1-10 micrometers and constructed of nanoscale or molecular components. The
names nanobots, nanoids, nanites, nanomachines or nanomites have also been used to describe these devices
currently under research and development.
Nanomachines are largely in the research-and-development phase, but some primitive molecular machines have
been tested. An example is a sensor having a switch approximately 1.5 nanometers across, capable of counting
specific molecules in a chemical sample. The first useful applications of nanomachines might be in medicaltechnology, which could be used to identify and destroy cancer cells. Another potential application is the detection
of toxic chemicals, and the measurement of their concentrations, in the environment. Recently, Rice University has
demonstrated a single-molecule car developed by a chemical process and including buckyballs for wheels. It is
actuated by controlling the environmental temperature and by positioning a scanning tunneling microscopetip.
Another definition is a robot that allows precision interactions with nanoscale objects, or can manipulate with
nanoscale resolution. Such devices are more related to Microscopy or Scanning probe microscopy, instead of the
description of nanorobots as molecular machine. Following the microscopy definition even a large apparatus such as
an atomic force microscope can be considered a nanorobotic instrument when configured to perform
nanomanipulation. For this perspective, macroscale robots or microrobots that can move with nanoscale precision
can also be considered nanorobots.
The NanoRobotic Concept• Nanorobots would constitute any ―smart‖ structure capable of actuation, sensing, signaling, information
processing, intelligence, manipulation and swarm behavior at nano scale
• Bio nanorobots – Nanorobots designed (and inspired) by harnessing properties of biological materials (peptides,DNAs), their designs and functionalities. These are inspired not only by nature but machines too.
• Nanorobots could propose solutions at most of the nanomedicine problems. Nanorobots are at the brink of revolutionizing the medical world. Once they are created, scientists believe tinynanorobots will be the answer to many serious conditions and diseases. Small enough to slip into the blood stream,nanorobots will treat and find disease, and restore lost tissue at the cellular level. Like any developing scientificfield, there are objections about side effects and ethical concerns. But the eventual medical advantages areunmistakable.
The word, nano is Greek for dwarf. But that can't begin to describe the size of a nano. Each one ranges from 0.1 to100 nanometers in size. A nanometer is one-billionth of a meter.TARGETED DRUG DELIVERY:Nano-sized machines have a future in drug delivery. With nanorobotics, specific areas can be targeted with nano-bullets or treated with smart bombs. Other nanoparticles may be used to starve cancer, providing an alternative tochemotherapy.DIAGNOSTICS:Tiny nanorobotic probes may be the future of diagnosis. Monitoring, diagnosing and fighting sickness will be thework of microscopic agents. Nanorobots will be able to monitor neuro-electric signals and stimulate bodily systems.
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HOSPITAL ROBOTS
Robots are the newest members of the hospital support and nursing staff. From dispensing medication, to makingdeliveries and visiting patients, robots are improving the way hospitals function. Robots are helping doctors reachpatients across distance. They stepin to handlenursing and support staff shortages and streamlinemanytediousadministrative tasks.
McKesson ROBOT-Rx This automated system stores and dispenses single doses of drugs for entire hospitals.Pharmacists enter prescriptions into the computer, the robot collects the dosage by scanning the barcodes on themedications, and bags them, all the while keeping track of all medication. This robotic system ensures that the rightmedicine reaches the right patient.
The Numbers:
1/3 of the medium and large pharmacies in U.S.hospitals own a ROBOT-Rx.
It sorts half a billion medications error free per year.
25,000 - the number of doses a ROBOT-Rx can store.
The Advantage of ROBOT-Rx:
Prevents medication errors
Manages dispension numbers
Eliminates the tedious task of sorting medicine
Works 24-hours a day
Keeps track of stocking needs
Saves money/time
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Mechanized Couriers
Robots are efficient messengers. They transport materials like food, x-rays, and linens throughout the hospital. TheRobotCart travels a set path and prevents collisions by using sonar. The HelpMate and Aethon TUG are othermechanized couriers work to create better hospital environments.
Robot Doctors
kiwi-robot-doctor In New Zealand
Doctors are examining patients from continents away with interactive robots and hi-tech visuals. Mobile robots suchas the In Touch Health Remote Presence (RP-6 and RP-7s) are facilitating faster service and doctor-patient facetime. These robots are fully mobile, with computer screens for heads and real-time video cameras for eyes and ears.Doctors operate them using a joystick and wireless technology. Another advantage to these robots is saving staff from cross-infection.
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APPLICATIONS
BRAIN SURGERY: The Neuro Arm robot performs brain surgery
Canadian scientists have designed a robot that operates on the brain. Doctors will use the neuroArm and MRItechnology to perform risky surgical procedures with dexterity and precision. The MRI provides a clear, 3-D imageof the entire process. Doctors control the entire operation from another room, using handles to control everymovement of the robotic arms and gauge pressure and texture.
HEART SURGERYThe da Vinci robot and new software from the UK are making major heart surgery easier and better. With only afew tiny cuts, a tiny camera, and miniature tools, doctors can operate with less risk to the patient and more accuracy.
There is no longer any need for long incisions, making for less pain and faster recovery. Unlike human hands,robotic tools take up little room, and work with great precision. The new software makes stopping or slowing theheart during the procedure unnecessary because the robotic arm is able to work in synch with the movement of theheart. The AESOP and Zeus R. Surgical Systems are other robotic operating systems. They are voice-controlled.
THE ROBOTIC LEECH
It is a revolutionary robotic tool not only can it inject drugs, heal hearts, and connect pacemakers, but it is alsoengineered to destroy damaged tissue.
OTHER SURGERIES
Lung surgeries and difficult procedures such as kidney transplants have been performed successfully with robot
assistance. With shorter recovery times and non invasive keyhole procedures, physicians hope surgeries will grow inpopularity.
LONG-DISTANCE SURGERIES
With robot-assisted surgery, doctors can perform operations in rural communities or dangerous settings withouthaving to be present. Whether the patient is located in a remote location or on a battlefield, surgeons can control theoperation without traveling or endangering themselves. Not only will health care have a greater reach, but it can takeplace earlier.
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GENERAL SURGERY
In early 2000 the field of general surgical interventions with the daVinci device was explored by surgeons at OhioState University. Reports were published in esophageal and pancreatic surgery for the first time in the world andfurther data was subsequently published by Horgan and his group at the University of Illinois and then later at thesame institution by others. In 2007, the University of Illinois at Chicago medical team, led by Prof. Pier CristoforoGiulianotti, reported a pancreatectomy and also the Midwests fully robotic Whipple surgery. In April 2008, the same
team of surgeons performed the world's first fully minimally invasive liver resection for living donor transplantation, removing 60% of the patient's liver, yet allowing him to leave the hospital just a couple of days after the procedure,in very good condition. Furthermore the patient can also leave with less pain than a usual surgery due to the fourpuncture holes and not a scar by a surgeon.
CARDIOLOGY AND ELECTROPHYSIOLOGY
The Stereotaxis Magnetic Navigation System (MNS) has been developed to increase precision and safety in ablationprocedures for arrhythmias and atrial fibrillation while reducing radiation exposure for the patient and physician,and the system utilizes two magnets to remotely steerable catheters. The system allows for automated 3-D mappingof the heart and vasculature, and MNS has also been used in interventional cardiology for guiding stents and leads inPCI and CTO procedures, proven to reduce contrast usage and access tortuous anatomy unreachable by manualnavigation.
The Hansen Medical Sensei robotic catheter system uses a remotely operated system of pulleys to navigate asteerable sheath for catheter guidance. It allows precise and more forceful positioning of catheters used for 3-Dmapping of the heart and vasculature. The system provides doctors with estimated force feedback information andfeasible manipulation within the left atrium of the heart. The Sensei has been associated with mixed acute successrates compared to manual, commensurate with higher procedural complications, longer procedure times butlower fluoroscopy dosage to the patient.
At present, three types of heart surgery are being performed on a routine basis using robotic surgery systems. Thesethree surgery types are:
Atrial septal defect repair — the repair of a hole between the two upper chambers of the heart,
Mitral valve repair — the repair of the valve that prevents blood from regurgitating back into the upper heartchambers during contractions of the heart,
Coronary artery bypass — rerouting of blood supply by bypassing blocked arteries that provide blood to the
heart.
As surgical experience and robotic technology develop, it is expected that the applications of robots incardiovascular surgery will expand.
GASTRO-INTESTINAL SURGERY
Multiple types of procedures have been performed with either the 'Zeus' or da Vinci robot systems,including bariatric surgery. Surgeons at various universities initially published case series demonstrating differenttechniques and the feasibility of GI surgery using the robotic devices. Specific procedures have been more fullyevaluated, specifically esophageal fundoplication for the treatment of gastroesophageal reflux and Heller myotomyfor the treatment of achalasia.
Other gastrointestinal procedures including colon resection, pancreatectomy, esophagectomy and robotic approachesto pelvic disease have also been reported.
GYNECOLOGY
Robotic surgery in gynecology is one of the fastest growing fields of robotic surgery. This includes the use of the daVinci surgical system in benign gynecology and gynecologic oncology. Robotic surgery can be used totreat fibroids, abnormal periods, endometriosis, ovarian tumors, pelvic prolapse, and female cancers. Using therobotic system, gynecologists can perform hysterectomies, myomectomies, and lymph node biopsies. The need forlarge abdominal incisions is virtually eliminated.
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NEURO SURGERY
Several systems for stereotactic intervention are currently on the market. MD Robotic's NeuroArm is the world’s
first MRI-compatible surgical robot.
ORTHOPEDICS
ROBODOCIntegrated Surgical Systems, Inc.CUREXO Technology CorporationThe Acrobot Company Ltd. sells
the "Acrobot Sculptor", a robot that constrains a bone cutting tool to a pre-defined volume. Used for total hipreplacement, total knee replacement and anterior cruciate ligament reconstruction.Also usedfor knee replacementoperations.
PEDIATRICS
Surgical robotics has been used in many types of pediatric surgical procedures including: tracheoesophagealfistula repair, cholecystectomy, nissen fundoplication, morgagni's hernia repair, kasai portoenterostomy, congenitaldiaphragmatic hernia repair, and others. On January 17, 2002, surgeons at Children's Hospital of Michigan in Detroit performed the nation's first advanced computer-assisted robot-enhanced surgical procedure at achildren's hospital.
RADIO SURGERY
Stereotactic Radio surgery
CyberKnife Robotic Radiosurgery System uses image guidance and computer controlled robotics to treat tumors
throughout the body by delivering multiple beams of high-energy radiation to the tumor from virtually any direction.The system uses a German KUKA KR 240. Mounted on the robot is a compact X-band linac that produces 6MV X-ray radiation. Mounting the radiation source on the robot allows very fast repositioning of the source, which enablesthe system to deliver radiation from many different directions without the need to move both the patient and sourceas required by current gantry configurations.
UROLOGY
Robotic surgery in the field of urology has become very popular, especially in the United States. It has been mostextensively applied for excision of prostate cancer because of difficult anatomical access. It is also utilizedfor kidney cancer surgeries and to lesser extent surgeries of the bladder. New minimally invasive robotic devicesinclude ultrasound probes for selective excisions of kidney tumors, steerable flexible needles for use in prostatebrachytherapy. In 2000, the first robot-assisted laparoscopic radical prostatectomy was performed.
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ADVANTAGES OF ROBOTICS IN MEDICAL APPLICATIONS
Heart operations, kidney transplants, and brain surgery: When it comes to complex surgical procedures, doctors arelooking to robotics. Robots are making operations less painful, invasive, and risky, while increasing accuracy.
THE ADVANTAGES OF ROBOT-ASSISTED SURGERY
For the Patient:
Less pain
Smaller incisions
Fewer, smaller scars
Shortened recovery period - days instead of weeks
Fewer infections, complications
For the Surgeon:
Greater precision
Steady instruments
Less invasive procedures
Major advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmannedsurgery. Some major advantages of robotic surgery are precision, miniaturization, smaller incisions, decreased bloodloss, less pain, and quicker healing time. Further advantages are articulation beyond normal manipulation and three-dimensional magnification, resulting in improved ergonomics. Robotic techniques are also associated with reducedduration of hospital stays, blood loss, transfusions, and use of pain medication.
Advantages of this technique are that the incisions are small and patient recovery is quick. In traditional open-heartsurgery, the surgeon makes a ten to twelve-inch incision, then gains access to the heart by splittingthe sternum (breast bone) and spreading open the rib cage. The patient is then placed on a heart-lung machine and
the heart is stopped for a period of time during the operation. This approach can be associated with postoperativeinfection and pain, and prolonged time to complete recovery. Because patient recovery after robot-assisted heartsurgery is quicker, the hospital stay is shorter. On average patients leave the hospital two to five days earlier thanpatients who have undergone traditional open-heart surgery and return to work and normal activity 50% morequickly.Reduced recovery times are not only better for the patient, they also reduce the number of staff neededduring surgery, nursing care required after surgery, and, therefore, the overall cost of hospital stays.
Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better controlover the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to standthroughout the surgery and do not tire as quickly. Naturally occurring hand tremors are filtered out by the robot’s
computer software. Finally, the surgical robot can continuously be used by rotating surgery teams. While the use of robotic surgery has become an item in the advertisement of medical services, critics point out that studies thatindicate that long-term results are superior to those after laparoscopic surgery are lacking. The robotic system doesnot come cheap and has a learning curve. Data is absent that proves the increased costs can be justified. In medical
literature, very experienced surgeons tend to publish their results with robotic systems. However, these may not berepresentative of surgeons with lesser experience.
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CRITICSM
While the use of robotic surgery has become an item in the advertisement of medical services, critics point out a lack
of studies that indicate long-term results are superior to results following laparoscopic surgery. On the other hand,
there is no question that some procedures that have traditionally been performed with large incisions can be
converted to "minimally invasive" endoscopic procedures with the use of the Da Vinci, shortening length-of-stay in
the hospital and reducing recovery times. But because of the hefty cost of the robotic system it is not clear that it is
cost-effective for hospitals and physicians despite any benefits to patients since there is no additional reimbursement
paid by the government or insurance companies when the system is used. Data are absent to show that these
increased costs can be justified. Another problem is that in the medical literature very experienced surgeons tend to
publish their results. These, however, may not be representative of surgeons with lesser experience. And there is a
steep learning curve for surgeons who adopt use of the system.
Robots and other forms of automation will ultimately result in significant unemployment unless the economy is
engineered to absorb them without displacing humans, as machines begin to match and exceed the capability of
workers to perform most jobs. At present the negative impact is only on menial and repetitive jobs, and there is
actually a positive impact on the number of jobs for highly skilled technicians, engineers, and specialists. However,
these highly skilled jobs are not sufficient in number to offset the greater decrease in employment among the generalpopulation, causing structural unemployment in which overall (net) unemployment rises.
With the cost of the robot at $1,200,000 dollars and disposable supply costs of $1,500 per procedure, the cost of theprocedure is higher. Additional surgical training is needed to operate the system. Numerous feasibility studies havebeen done to determine whether the purchase of such systems are worthwhile. As it stands, opinions differdramatically. Surgeons report that, although the manufacturers of such systems provide training on this newtechnology, the learning phase is intensive and surgeons must operate on twelve to eighteen patients before theyadapt. Moreover during the training phase, minimally invasive operations can take up to twice as long as traditionalsurgery, leading to operating room tie ups and surgical staffs keeping patients under anesthesia for longer periods.Patient surveys indicate they chose the procedure based on expectations of decreased morbidity, improvedoutcomes, reduced blood loss and less pain. Higher expectations may explain higher rates of dissatisfaction andregret.
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CONCLUSION
Robotic technology has successfully produced valuable tools for rehabilitation, surgery, and medical training, as
well as new and improved prosthetics and assistive devices for people with disabilities. Future applications of
robotic technology will continue to provide advances in these and other areas of medicine. The most significant roleof medical robot will most likely be to perform tasks that are otherwise impossible, such as enabling new micro
surgery procedures by providing high-dexterity access to small anatomical structures, integrating imaging modalities
into the OR, providing functional replacements for lost limbs, and enabling new human machine interfaces and
techniques for delivering neuro-rehabilitation therapy.
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