Clinical Robotics: Where are we now?

This is a brief review of the current development of clinical robots as the first monthly theme for the Medicine and Healthcare subject in Laidlaw. Share your thoughts with us in the comments and stay tuned for our following posts!

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From its first emergence in 1985 to the first FDA approval in 2000, robots have been more and more prevalently applied in medical settings, including surgical interventions, rehabilitation, drug delivery, and hospital disinfection. This month, we will focus on different types of robotic applications in medicine and healthcare.

So what can robots do? While our first instinct may be as assistants for surgeons and nurses, the capacity and ability of robots have gone far beyond that. It has been incorporated into daily hospital routines. From invasive surgery to cargo management, the automation and accuracy brought by robots are changing the landscape of clinical practice.

Surgical Robotics

Various advantages favor robotically-assisted surgeries over the traditional surgical routines. The "tireless" nature of robotically-assisted surgical devices allow persistence and accuracy over a long period of operation time. By combining sensing, imaging, and robotics, surgical robots extend the flexibility and scope of minimally invasive surgeries.

One of the most ubiquitous and archetypical of medical robots is the DaVinci system. The system consists of a series of tiny, highly dexterous robot arms that can be manipulated by a qualified surgeon to complete precise cutting and stitching. During the operation, the surgeons will sit in a console checking the anatomy structures of patients through high definition reconstructed 3D images. And their hand and waist movements can be sensed by the system to guide the movement of robotic arms. The system has been introduced to 64 countries and employed in more than 3 million minimally invasive surgeries since its approval in 2000. We can have a taste of its accuracy in its famous grape-peeling operation.

Many other robots are developed to address the demand for greater controllable accuracy in manipulation and visualization. Besides robots, augmented reality(AR) also shows the possibility to alter surgical routines. A 2019 study established an exemplary AR-guided surgery pipeline. From CT-scanning to guided operations, AR can mitigate the complexity of extremity reconstruction surgeries.

Miniature Robots

The development of miniaturized sensors and nanotechnologies have shielded light on non-invasive robotics solutions for diagnosis and drug delivery. Those small untethered robots have the unique capability to non-invasively navigate in narrow and intricate areas for drug delivery and diagnosis. Ranging from several nanometers to few millimeters, these robots are either artificially constructed, such as capsule endoscope, or adapted from natural molecules, like origami DNA robots and magnetically controlled blood-swimming robots.

What these miniaturized machines can provide are bold solutions for surgery and treatments without any invasion. Imagine going to the hospital one day, without getting in bed, all you need to do is to take a dose of robots. While the vision might be ambitious, scientists are taking steps to design systems that allow controllable locomotion, sensing, and functionalization. Some designs, such as the capsule endoscope and mini cardiac pacemaker, have already gained FDA approval.

Supporting and Hospital robots

Besides the robots taking a role in surgical treatments, robots also play an essential role in various other hospital settings. Delivery, for instance, is a critical topic in the hospital. It is estimated that a typical 200-bed hospital moves meals, linens, lab samples, waste, and other items the equivalent of 53 miles per day. Automated robots such as TUG, a self-driving robot developed by Aethon Inc., allows efficient delivery service for various products from bed linen to test results.

Disinfection is another essential and lab intensive problem faced by hospitals. Hospital-acquired infections (HAI) and surgical site infections (SSI) can lead to serious and often costly consequences, yet the problem can be resolved by robots. Xenex LightStrike Robots, for instance, has been employed in more than 400 hospitals across the US for disinfection and even proved efficient to zap COVID-19 in hospital settings.

Rehabilitation and prostheses are also heavily dependent on robotic development. A recent project in Johns Hopkins Applied Physics Lab has developed a neurally controlled artificial limb that will restore near-natural motor and sensory capability to upper-extremity amputee patients. The limb, with its biocompatible interface with patients, reads the electrical signals and moves by the mind-control of the user.


With the promising future given by the development of robots in medical settings, there are still challenges and limitations given the initial development platforms of these robots. While the detailed review for each type of robot will be discussed in the following posts, how do you think robots will reshape the medical field? Perhaps one day, these robots will take over the world. I mean, who knows?

SUN JIERAN

Student, the University of Hong Kong

Hi, I am an undergraduate student at the University of Hong Kong. I have some research experiences in heritage imaging, genome engineering, nanoparticle drug carrier, and surgical augmented reality. And I am currently learning more about computational bio-molecule stimulation and screening model for further studies. I'd love to communicate, share, and build wholeheartedly about the past, present, and future stories.

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