by Hallie Trial, a sophomore majoring in chemistry at Rice University, Houston (29.7° N, 95.3° W)
Physicist Richard Feynman once quipped, “it would be interesting in surgery if you could swallow the surgeon.” It sounds like science fiction, but with advances in medical robotics, it may become reality within the next few decades. While microrobots like those envisioned by Feynman have not yet emerged in mainstream healthcare, researchers have begun to build and study these tiny machines.
Robots already have many applications in healthcare, including performing ancillary tasks like fetching linens and lab results, assisting with surgery, replacing missing limbs or augmenting existing ones, and facilitating long-distance medicine. Many of the robots in the medical workforce currently conduct simple routine maintenance and caretaking tasks. In several US hospitals, robotic carts transport meals, bedding, medicine, and lab results around the building. Bestic, a robotic arm that users can control with their knees, feet, chins, or other body parts empowers patients with impaired arm or hand movements to eat meals on their own.
Other robots work under much more precise, demanding conditions. Surgical robots like the da Vinci surgical system and ZEUS Robotic Surgical System assist human surgeons at numerous US hospitals in performing minimally invasive surgeries and can even allow doctors to perform operations on patients thousands of miles away. These systems have tiny surgical arms with cameras that can fit through small slits in a patient’s skin, unlike the larger openings that are often necessary in a fully human-conducted surgery. The surgeon sits in front of a magnified 3D image of the inside of the patient’s body and manipulates the controls just as if she were performing the surgery herself; the robotic instrument copies her movements inside the actual patient. The robotic surgical arms can operate with even greater accuracy than human hands because they detect and do not copy hand tremors. The surgeon can also instruct the machine to move, for example, one inch for every three inches she moves, allowing for incredibly tiny motions and precise tissue manipulation.
These surgical tools, while useful in telesurgery, find use more often in on-site minimally invasive surgeries. Researchers have engineered other robots specifically to facilitate telemedicine. Remote Presence Virtual + Independent Telemedicine Assistant (RP-VITA), for instance, is a robot of approximately human height with a screen where its “head” would be. It shows a live video feed of a doctor on its screen and can navigate independently around rooms. This allows doctors to serve patients across the country or globe from their laptops or tablets in a way that feels more natural to the patient than talking to a disembodied screen. Telemedicine helps connect medical specialists and experts concentrated in certain parts of the country to underserved, often rural, communities.
Besides assisting with treatment, sometimes robots can serve as treatment. Robotic limbs have restored mobility to many individuals with birth defects and amputations. Scientists have constructed limbs that respond to impulses from severed nerves or even directly to signals from a patient’s motor cortex so that the patient can control the robotic replacement just like a natural limb. Robotic “exoskeletons” that wrap around existing limbs can also enable individuals with paralysis or other motor disorders to stand up and walk away from their wheelchairs—to move their own bodies again. Physical therapists can employ assistive exoskeletons as part of programs that help train people to move under their own power again.
Perhaps the most thrilling advancement in medical robotics is the field of microrobotics. Someday, these machines may perform surgeries from the inside without any external incisions. Researchers at MIT constructed an elegantly simple, biocompatible device from a piece of magnet attached to a film made from pig intestinal tissue. In a simulated silicon digestive system, the scientists were able to guide the robot into the stomach using magnets and have it remove a battery from the stomach lining. Numerous research groups have taken different engineering approaches to the same problem, building everything from hydrogel “origami” robots to cyborg sperm cells with nanotube helmets full of medication.
Given the incredible strides that the field of medical robotics has already made, it is easy to imagine a future world in which machines revolutionize medical care much the way they have revolutionized manufacturing, making it better and cheaper. There are, however, substantial barriers to such a future. Right now, medical robots tend to be prohibitively expensive; only the largest hospitals with the most resources can afford to invest in such mechanical solutions. It also takes time and training to teach doctors how to use medical robots like the da Vinci surgical system. Public policy has yet to catch up with rapidly-evolving technical innovations. For example, although telemedicine has become technologically possible, doctors still receive licensing by individual states, which can inhibit their ability to treat patients in other parts of the nation. While microrobots controlled by external magnetic field have incredible applications, the full realization of microrobotics’ potential will not occur until scientists develop self-navigating microdevices. In an interview for Proceedings of the National Academy of Sciences, Sylvain Martel of Polytechnique Montréal in Canada pointed out, “You can’t control the robot because you cannot see the road.”
Innovators in a wide variety of fields will need to address these problems so that robotics can continue to change healthcare for the better. Researchers in both academia and industry with backgrounds in disciplines like mechanical engineering, electrical engineering, bioengineering, materials science, computer science, and physics will need to engineer cheaper, more effective, and more broadly applicable devices. These researchers will need to collaborate with forward-thinking medical doctors, surgeons, and hospital administrators to ensure that these devices are practical for healthcare settings. Government and public policy officials will have to adapt the law to evolving technological realities and carefully consider the outcomes and ethics of changes in medical robotics. These interdisciplinary innovators of our generation will push medical care into the future to the benefit of us all.
Further reading:
Providing a summary of robotics in healthcare, this serves as a good introduction to the subject: https://www.rn.com/nursing-news/robots-in-healthcare-whats-in-store-for-the-future/
The following is an article from Proceedings of the National Academy of Sciences describing recent breakthroughs in microrobotics: https://www.pnas.org/content/114/47/12356.
This source describes a telemedicine robotic system for caretaking of the elderly: https://www.mdpi.com/1424-8220/19/4/834/htm.
This article from MedTech Boston discusses RP-VITA in more detail: https://medtechboston.medstro.com/blog/2014/08/26/rp-vita-robot-extends-specialized-medical-care/.
The following webpage provides further information about robotically assisted surgery: https://www.mayoclinic.org/tests-procedures/robotic-surgery/about/pac-20394974.
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