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    Robots in modern medicine

    March 24 2023

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    Reading time 15 minutes

    Contents

    The first medical robots, introduced around April 11, 19851, revolutionized how doctors work and how quickly patients can recover. The robotic systems of that time allowed doctors to achieve extreme accuracy in the process of complex surgical intervention in cardiothoracic surgery. The development of artificial intelligence (AI) technologies has further stimulated the improvement of medical robots, expanding the possibilities of their application in healthcare2.

    What varieties of medical robots exist?

    Today, the list of duties of medical robots includes assisting in operations, disinfecting premises, dispensing medicine, escorting patients in pharmacies, hospitals and nursing homes, and much more. Here is a summary how various robots are used in medicine.

    Surgery robots

    The very first task of robots was to assist surgeons in the operating room3. Robotic-assisted systems for surgical operations are currently becoming much more commonplace.

    For example, in spine surgery, robots are able to hold instruments and implant components perfectly still and move them to the exact location of screws for decompression surgery3. Such stable positioning of the instruments ensures maximum precision and speeds up the operation. Robotic complexes allow for both accurate and minimally invasive penetration. The robot only needs to make a few small incisions, around the size of a small coin. This significantly reduces the risk of damage to healthy tissues and blood vessels, the development of infections and inflammation, and reduces the time for wound healing. The recovery period after such an operation is much shorter3.

    Nursing robots

    Another use of robots is to help medical staff with daily tasks such as blood sampling, temperature measurement or hygiene procedures. Robots that take on simple, repetitive tasks free up time and hands for the nursing staff, allowing them to focus more on individualized patient care. Mobile automated treatment and diagnostic complexes of nursing-oriented robots are involved both in the process of supporting the life of patients and in providing communication with the staff of a medical institution.

    Disinfection robots

    Robots can be made responsible for sanitizing facilities, eliminating the need for hospital staff to come into contact with potentially harmful pathogens3. For example, there are robots for disinfecting hospital devices and equipment: a Xenex robot is able to disinfect a ward using pulsed xenon light in less than 20 minutes4.

    Diagnostics, i.e. laboratory robots

    Robots are actively used in laboratories3. Автоматизация, The automation they provide increases the speed and accuracy of analysis while reducing various errors3.

    Accelerated blood tests are a good example of effective robotization. Two robots are able to process about 3,000 samples per day, at 7-8 tubes per minute: one takes a sample and places it in a barcode scanner, the other takes samples and puts them in a feeder for centrifugation and analysis13.

    Flexible robotic medical assistants on remote control are involved in endoscopy: by controlling them, the doctor makes a biopsy or cauterization of the wound. Another example is capsule endoscopy, where the device is swallowed like a pill and follows the GI tract to collect data and take diagnostic pictures5.

    Rehabilitation robots

    These are robots designed for the rehabilitation of patients after surgery or the active phase of the disease3. The first truly robotic devices for rehabilitation worked on the principle of continuous passive movement: to keep a part of the patient’s body moving even during rest3. Modern rehabilitation robots use the concept of neuroplasticity of the brain aiming at maintaining it7. They support performing exercises that restore the mobility of the arms and legs by keeping them in motion, which allows to create neurological pathways for active muscles.

    Modern rehabilitation robotics are divided into two types: a therapeutic robot that helps patients perform exercises (for example, an exoskeleton), and an auxiliary prosthesis robot that replaces lost limbs7. It is also worth mentioning intelligent wheelchairs that allow to control the center of gravity when descending and ascending stairs.

    Exoskeletons

    A mechanical structure that is connected to a person to partially restore mobility or speed up recovery from injuries and operations. It resembles a robot suit.

    Exoskeletons are used in rehabilitation after spinal cord injuries and strokes3. For example, the sensors of the Hybrid Assistive Limb (HAL) exoskeleton, located on the skin, register small electrical signals in the patient’s body, and the suit responds by moving a joint3.

    Robotic prosthetics

    Prostheses with robotic capabilities are designed to restore the function of lost limbs. They are intended to be permanently held by people with limited mobility, which have lost arms, legs or hands3.

    Neuromuscular-skeletal prostheses are attached to bone and controlled by bi-directional interfaces connected to the human neuromuscular system via electrodes implanted in nerves and muscles8. As a result, the robotic limb is set in motion by the power of thought.

    Assistant and consultant robots

    On average, a doctor spends around 9 hours a week on administrative task ― practically full working day9. Several of these tasks can be automated with the help of appropriate robots – virtual assistants and humanoid consultant robots. The former are synchronized with the HIS and upload data there, take care of paperwork, call patients, allowing the clinic to reduce information processing costs and increase customer loyalty. The second help patients make an appointment and are engaged in their routing in the lobby of the clinic without the involvement of employees. Such humanoid robots are able to communicate, answer questions, and are able to recognize faces and emotions of people10.

    Companion robots

    Robots are able to play the role of companions and even pets. Analysts predict that emotional support robots will be in demand in the future11.

    In hospital settings, robots assist patients, especially the elderly and children, by encouraging them and demonstrating how to perform certain movements3, such as sitting and getting up from bed. They remind them to take medication or talk to those who are deprived of regular human contact (which is especially relevant in the context of a shortage of nurses and caregivers)4. Such robots are often designed to look like other people or animals. For example, the Paro robot, a robotic baby harp seal covered in soft white fur, exhibits many of the behaviors of a real pet4. Its task is to evoke a positive emotional response in patients and speed up recovery4.

    There are currently very few care and support robots, primarily because of their high cost. However, their number is expected to increase significantly over the next decade4.

    Training robots

    This type of robot is used in the training of doctors and medical staff12. They help to work out common clinical scenarios or act as patient simulators (robotic patients, robot mannequins), simulating a complete or partial human body, related to the topic of training. For example, it can be a simulator of a woman in labor or a premature baby. Sometimes such robots behave like real patients: they breathe, sweat, bleed, move their limbs, and their pupils can react to light.

    Delivery robots

    A robot trolley for serving patients or a courier robot – these could be classified as one of the subtypes of nursing robots. They are used to deliver medicines, lab samples, glassware, food, and sort medicines, facilitating the work of medical staff in hospitals and nursing homes4.

    Such robots are able to navigate the terrain using a built-in map, a variety of on-board sensors and computer vision. Wi-Fi provides communication with elevators, automatic doors and fire alarms 13.

    Radiation therapy robots

    In the 1990s, robotics was introduced into the field of radiotherapy and radiosurgery3. The first such solution included an X-ray source mounted on a robotic arm that precisely treated a tumor site3. Modern robots are now able to deliver precise doses of radiation directly to tumors while minimizing exposure to other parts of the body16.

    Nanorobots and microrobots

    The purpose of using micro- or nanorobots is to deliver therapeutic substances directly to target organs16. They can enter the body intravenously or orally16. Nanorobots are too small to contain elements of autonomous control, so they are controlled manually through a remote.

    Scientists are trying to ensure that nanorobots can carry out full-fledged non-invasive procedures in hard-to-reach parts of the body: for example, dissolve blood clots and inject microdoses of medicine16. Future nanorobots could even be able to penetrate through the blood-brain barrier16.

    Benefits of using robots in medicine

    The use of robotics in medicine has proven to increase the efficiency and speed of processes in the course of diagnostic and therapeutic measures, and help accelerate rehabilitation17. At the current level of development, artificial intelligence devices are able to perform partial patient care. Robots have proven successful in maintaining a safe hospital environment.

    Medical robots take on minimally invasive procedures, can regularly monitor patients with chronic diseases, work as active elements of rehabilitation therapy, and help support the social activity of elderly patients17.

    By delegating routine tasks to robots, it is possible to reduce the burden on doctors and nursery staff17. This leaves with more time and energy to focus on patient-centered work.

    Work during the pandemic has demonstrated the high efficiency of medical robots in situations where there is a shortage of medical staff to perform routine tasks in a pathogenic environment17. In hospitals, the use of robots to transport consumables and bed sheets, for cleaning and disinfection, limits exposure to pathogens, helping to fight hospital-acquired infections.

    Can a robot replace a human specialist?

    Technology should have a supporting role, making doctors and medical robots work together as well as possible. The computing power of robots is combined with human problem-solving skills and creativity9.

    The effectiveness of collaboration between doctors and robots has been proven in a number of studies, for example in the field of using artificial intelligence to detect metastatic breast cancer. When the results of the AI system were combined with the findings of the pathologist, the accuracy of tumor localization and image classification improved significantly. The error rate has been reduced by 85%15.

    During a robot-assisted operation, the robotic mechanism does not perform all the actions on its own – the doctor sits at the console and moves precisely the robotic “hands”, or manipulators. This way the best result is achievable.

    Advances in the field of robotics are also not able to cancel the personal contact, human experience and professionalism of the practitioner. There will always be duties and responsibilities that technology cannot perform. It will be much faster, more reliable, and cheaper to entrust them to people9.

    History of healthcare robotization in Russia

    The robotization program in Russia started in 2007 with the installation of 25 American daVinci robotic assistants to perform operations in cardiac surgery, urology, gynecology, endocrinology, general surgery and other areas18. Since 2007, they have performed around 25,000 surgeries in Russia19. Over the past four years, there have been 4,500 operations in Moscow alone20.

    The process took on a planned shape when the government approved the HealthNet roadmap, including plans to promote innovation in medicine as part of the National Technology Initiative20. It is divided into three stages and is valid until 2035. The plan is built taking into account the key trends in the development of medicine technologies, including21:

    • Application of virtual and augmented reality methods.

    • Development of organ-on-a-chip (OOC) technology.

    • 3D printing of organs and creation of biofactories (growing organs from own and animal cells).

    • Production of nanorobots for health correction (including targeted drug delivery).

    • Robotization of surgical interventions – it is planned that by the end of the second phase of the plan (2025), most operations will be performed using robots.

    The roadmap provides for the implementation of pilot projects in priority areas20.

    Another priority task is the formation of the necessary conditions and infrastructure, including legal regulation, for the introduction of new technologies20.

    Experts note that in terms of service robotics, Russia is five years ahead of the rest of the world, but in terms of sales, it is still lagging behind22. However, in the face of sanctions pressure that limits the supply of technology from other countries to the Russian market, domestic companies open up broad prospects for the development and expansion of the production of Russian medical robots23. After all, demand is the driver of growth.

    Prospects for telemedicine

    The concept of telemedicine includes text messages, phone calls, image transfer, doctor-patient video chats and remote monitoring. It is in the latter case that the possibilities of artificial intelligence are used: for faster diagnostics and optimization of routine services2.

    For example, the InTouch Vici telemedicine robot enables clinicians to communicate remotely with a patient undergoing isolated treatment2. In addition to the camera, screen and keyboard that provide communication between doctors and the patient, the robot is equipped with medical equipment for measuring vital signs and transferring data to a digital archive. Advanced AI-powered cameras help monitor fever and other bodily signals.

    Through telemedicine applications, patients in remote areas can receive high-quality emergency consultations on a wide range of problems2. The patient logs in via a tablet or personal computer, and doctors can use the type of device that best suits the situation. Such assistance is indispensable in cases where an urgent consultation is required, but medical workers cannot arrive at the patient on time.

    Conclusion

    The introduction of robotics into medicine has led to radical changes and greatly increases long-term survivability of patients. Developments in the field of robotics are moving forwards, and the answer to the question “Can a robot perform medical operations?” is unequivocal “yes!”, even though complicated cases still require human control and intervention. Nevertheless, medical industry may soon reach a completely different level, which until recently was considered something out of science fiction.

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