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Robotics in Medicine Applications

Shripad Shashikant Chopade¹, Sagar Pradip Kauthalkar², Chaitanya

Bhalchandra Bhandari³

Shripad Shashikant Chopade, M Tech (Machine Design & Robotics), Research Scholar, India

Sagar Pradip Kauthalkar, M Tech (Machine Design & Robotics), Research Scholar, India

Chaitanya Bhalchandra Bhandari, Research Scholar, India

Abstract

Robotics for medical applications started fifteen years ago while for biological applications it is rather new

(about five years old). Robotic surgery can accomplish what doctors cannot because of precision and

repeatability of robotic systems. Besides, robots are able to operate in a contained space inside the human body.

All these make robots especially suitable for non-invasive or minimally invasive surgery and for better

outcomes of surgery. Today, robots have been demonstrated or routinely used for heart, brain, and spinal cord,

throat, and knee surgeries at many hospitals in the United States (International Journal of Emerging Medical

Technologies, 2005).

Robots in medicine deserve enhanced attention, being a field where their instrumental ids enable

exacting options. The availability of oriented effectors, capable to get into the human body with no or negligible

impact, is challenge, evolving while micro-mechanics aims at nanotechnology. The survey addresses sets of

known achievements, singling out noteworthy autonomous in body devices, either co-robotic surgical aids, in

view of recognizing shared benefits or hindrances, to explore how to conceive effective tools, tailored to answer

given demands, while remaining within established technologies.

Nanorobotics is the still largely hypothetical technology of creating machines or robots at or close to

the scale of a nanometer (10

-9

meters). Also known as nanobots or nanites, they would be constructed from

nanoscale or molecular components. So far, researchers have only been able to produce some parts of such a

machine, such as bearings, sensors, and synthetic molecular motors, but they hope to be able to create entire

robots as small as viruses or bacteria, which could perform tasks on a tiny scale. Possible applications include

micro surgery (on the level of individual cells), utility fog, manufacturing, weaponry and cleaning. This

presentation provides a survey of current developments, in the spirit of focusing the trends toward the said turn.

Keywords :Bearings, Robot Machinery, Sensors, Synthetic molecular motors, Telesurgery techniques.

I. Introduction

Robotics is a field that has many exciting

potential applications. It is also a field in which

expectations of the public often do not match current

realities. Truly incredible capabilities are being sought

and demonstrated in research laboratories around the

world. However, it is very difficult to build a

mechanical device (e.g. a robotic arm) that has

dexterity comparable to a human‟s limbs. It is even

more difficult to build a computer system that can

perceive its environment, reason about the

environment and the task at hand, and control a robotic

arm with anything remotely approaching the

capabilities of a human being.

II. History of robotics

The word robot (from the Czech word robota

meaning compulsory labor) was defined by the

Robotic Institute of America as “a machine in the form

of a human being that performs the mechanical

functions of a human being but lacks sensitivity.” One

of the first robots developed was by Leonardo da

Vinci in 1495; a mechanical armored knight that was

used to amuse royalty. This was then followed by

creation of the first operational robot by Joseph Marie

Jacquard in 1801, in which an automated loom,

controlled by punch cards, created a reproducible

pattern woven into cloth. Issac Asimov further

elucidated the role of robotics in 1940 through short

stories; however, it was his three laws of robotics that

received popular acclaim. The three laws states are,

1) A robot may not injure a human being, or through

inaction allow a human being to come to harm

2) A robot must obey the orders given it by human

beings except where such orders would conflict with

First Law.

3) A robot must protect its own existence as long as

such protection does not conflict with the First or

Second Law.

RESEARCH ARTICLE OPEN ACCESS

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III. Applications in Medicine

Robots are filling an increasingly important

role of enhancing patient safety in the hurried pace of

clinics and hospitals where attention to details and

where reliability are essential. In recent years, robots

are moving closer to patient care, compared with their

previous role as providing services in the

infrastructure of medicine. Examples of past use are in

repetitive activities of cleaning floors and washing

equipment and carrying hot meals to patients‟ bedside.

What is new is finding them in clinical laboratories

identifying and measuring blood and other specimen

for testing, and in pharmacies counting pills and

delivering them to nurses on „med-surg-units‟ or

ICU‟s. Or bringing banked blood from the laboratory

to the ED, surgery or ICU for transfusions. Robots are

being used as very accurate „go-fors‟!

An early active robot, „Robodoc‟ was designed to mill

perfectly round lumens in the shafts of fractured

bones, to improve the bonding of metal replacements

such as for femur heads and knee joints. The future of

this system remains uncertain because of questions

about the ultimate beneficial outcomes.

The reasons behind the interest in the

adoption of medical robots are multitudinous. Robots

provide industry with something that is, to them, more

valuable than even the most dedicated and hard-

working employee - namely speed, accuracy,

repeatability, reliability and cost-efficiency. A robotic

aid, for example, one that holds a viewing instrument

for a surgeon, will not become fatigued, for however

long it is used. It will position the instrument

accurately with no tremor and it will be able to

perform just as well on the 100

occasion as it did

on the first.

IV. Robotic surgery

Robotic surgery is the process whereby a robot

actually carries out a surgical procedure under the

control of nothing other than its computer program.

Although a surgeon almost certainly will be involved

in the planning of the procedure to be performed and

will also observe the implementation of that plan, the

execution of the plan will not be accomplished by

them - but by the robot.

In order to look at the different issues involved in the

robotic fulfillment of an operation, the separate

sections of a typical robotic surgery (although robotic

surgery is far from typical) are explained below.

Surgical planning

Surgical planning consists of three main

parts. These are imaging the patient, creating a

satisfactory three-dimensional (3D) model of the

imaging data, and planning/rehearsing the operation.

The imaging of the patient may be accomplished via

various means. The main method is that of computer

tomography (CT). CT is the process whereby a stack

Of cross-sectional views of the patient are taken using

magnetic-resonance-imaging or x-ray methods. This

kind of imaging is necessary for all types of operative

procedure and, as such, does not differ from traditional

surgical techniques.

Fig 1: A patient having a brain scan

This two-dimensional (2D) data must then be

converted into a 3D model of the patient (or, more

usually, of the area of interest). The reasons for this

transformation are twofold. Firstly, the 2D data, by its

very nature, is lacking in information. The patient is,

obviously, a 3D object and as such, occupies a spatial

volume. Secondly, it is more accurate and intuitive for

a surgeon, when planning a procedure, to view the

data in the form that it actually exists. It should be

noted, however, that the speed of said hardware is

increasing all the time and the price will decrease too,

as the technology involved becomes more

commonplace. This means that the process will be

more cost-efficient and increasingly routine in the

future.

The third phase of the planning is the actual

development of the plan itself. This involves

determining the movements and forces of the robot in

a process called „path planning‟ - literally planning the

paths that the robot will follow.

Fig 2: A surgery simulation to aid planning

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It is here that the 3D patient model comes

into play, as it is where all the measurements and paths

are taken from. This emphasizes the importance of the

accuracy of the model, as any errors will be interpreted

as absolute fact by the surgeons (and hence the robot)

in their determination of the plan.

V. Registration of robot to patient

The registration of the robot and the patient is the

correlation of the robot‟s data about the patient with

the actual patient, in terms of positioning. There are

two important stages in the registration procedure -

fixation of the patient and the robot, and intra-surgical

registration itself. Fixation is an essential ingredient

of a successful robotic operation. Robots act upon pre-

programmed paths , these programs are much more

complex if they must take into account the fact that

the patient‟s position may be different to the inputted

data and, in fact, continually changing. For this reason

it is imperative that the robot can act in, at least, a

semi-ordered environment.

Fixation of the patient that is fixing the

patient in position (i.e. on the operating table), is

achieved through strapping and clamping of the areas

pertinent to the surgery. This is common in traditional

surgery, too. For example, the head is fixed in position

during neurosurgery through the application of a head-

fixation device known as a „stereo tactic unit‟.

Fixation of the robot is achieved through analogous

methods.

Fig 3: Patient held in fixed position for neurosurgery

The intra-surgical registration itself is the

process of establishing a common reference frame

between the pre-surgical data (3D model and

associated surgical plan) and the corresponding patient

anatomy. There are two primary techniques of

achieving this common frame of reference.

The first, and most usual, method is to attach

fiducial to the underlying patient structures pre-

operatively. These fiducial are then sensed, and

compared to the pre-operative data, to precisely align

the two data sets. Furthermore, these fiducial are

invasive and cause added trauma to the patient in sites

physically far from the primary field of surgical focus.

The alternative to fiducially-based registration is that

of „surface- based‟ registration. This technique uses

surfaces that are intrinsic to the data itself. The benefit

of this method is that it does not require the use of

expensive and traumatically invasive markers. The

illustration of the implementation of this concept is

shown below. On the Left (a) is a brain with extracted

curves shown in red. On the right (b) is the final 3D

model gained from these curves:

(a) Extracted curves (red) (b) Model produced from curves

Fig 4: Curves

The success of surface-registration is highly

dependent upon the realism and accuracy of the 3D

models gained pre-operatively and upon the sensing

accuracy of intra-surgical data acquisition. Geometric

surface model validation is complicated since errors

can be introduced at several stages of model creation:

during imaging, „segmentation‟ and surface creation.

Prior to the emergence of surface-based techniques for

surgery, 3D modeling medical data has been primarily

used as a teaching aid in the study of anatomy (e.g.

VOXEL-MAN). These models have very different

accuracy requirements to those used for surface-based

registration.

VI. Execution of robotic procedure

Once all of the preparation is complete, it is

time to pass control to the robot for the actual

implementation of the surgery. The robots used for

automated surgery tend, at the present time, to be

adapted industrial robots; for example, the PUMA

robot arm having brought up the fact that the surgeon

is reliant upon the engineering behind the tools that

they are using, it is clear that companies would not

wish to risk possible legal proceedings should one of

their products fail. Once the robotic procedure is

initiated, sensors collect real-time data from the

operating site and pass this to a display, via which the

surgeon observes the operation.

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Vol. 3, Issue 5, Sep-Oct 2013, pp.247-251

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Fig 5: The operating theatre in a robotic surgery

VII. Robots in Telesurgery

While, in robotic surgery, the robot is given

some initial data information and allowed to proceed

on its own, there are some other applications of

robotics in surgery where the robot is actually guided

by a human throughout the process. The actions of the

robot are not predetermined, but rather controlled in

real-time by the surgeon. The remote location can be

as far away as the other side of the world, or as near as

the next room. Since there is distance separating the

surgeon and the patient, it is evident that the surgeon

cannot operate using his own hands. A robot, local to

the patient, becomes the surgeon‟s hands, while an

intricate interface conveys the robot‟s senses to the

surgeon (making use of while an intricate interface

conveys the robot‟s senses to the surgeon (making use

of visual, aural, force and tactile feedback).

Fig 6: Surgeon in Telesurgery console

In the sense that the robot is the one

performing the surgery, telesurgery is a part of robotic

surgery. Furthermore, as in robotic surgery, the patient

is usually imaged before the operation starts and the

information sent to the surgeon. In telesurgery the

surgeon cannot rely on anything but the sensor data,

which is transmitted from the remote location. The

sensor data, therefore, must be absolutely correct. For

this purpose, a host of different schemes are used.

Telesurgery is mainly used as a form of

minimally invasive surgery. In traditional surgery, the

physical hand size has always been a limiting factor

when it comes to delicate surgery in hard-to-reach

places. Since the robot can theoretically be as small as

is desired, it can enter through a small opening,

navigate through the body and finally reach and

operate in places that would otherwise be inaccessible

without a large incision made specifically to facilitate

entry. Recent experiments even involve the robot

being inserted through a small puncture in the thigh

and guided all the way to the brain through blood

vessels as narrow as 1.5mm in diameter.

Fig 7: Endoscopy using telesurgery techniques

Over the next ten years, breakthroughs in

nanotechnology may help us build better and

smaller machines.

A nanometer is just one-millionth of a

millimetre in length and nanotechnology involves

studying and working with materials on an ultra-small

scale. Using nanotechnology, scientists have created

tiny walking nanobot, using only the building blocks

of life: DNA.

Fig 8: DNA

The microscopic walker, which is only 10

nanometers long, uses its legs to move along a

footpath. Nanotechnology could also lead to a range

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Vol. 3, Issue 5, Sep-Oct 2013, pp.247-251

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of materials with new qualities such as stay-clean glass

and magnetic liquids. There may also be

breakthroughs from scientists trying to implant

computer programs into living creatures - known as

wetware. This technology could help people with

false arms or legs to move them just by thinking about

it.

VIII. Conclusions

Medical robotics, and particularly

autonomous surgical robotics, is still in an embryonic

stage. To conclude, there are several steps that must be

taken in order to further the use and development of

robots in surgery (and in medicine in general). These

are:

The development and international adoption,

of safety standards the aim of task-specific, as opposed

to general-purpose, robots the education of the medical

community in the acceptance and integration of

Robots.

The economic and social advantages to be

gained from the mass-use of robotics in medicine (and

particularly surgery), as already expounded, are

enormous. If all of the above steps are taken, then the

full potential of robotics can be exploited in the

medical sector, as it has been in industrial applications,

for the improved welfare of society everywhere.

References

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Medical Technology “Medical Robotics‟‟,

Lara Crawford, Robotics Lab, University of

Berkeley, California

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