Doctor Robot

Computerized robot assistants are needed for surgeons today and may already be available in the near future. The latest generation of medical robots can already do a lot even without human control. Such a doctor robot takes control of part of the work in operating rooms.

Martina Bortolani

“Star” is one of the emerging technologies in the field of medical service robotization. A robot recently introduced in the United States stitches soft tissues such as intestines. What distinguishes it from others is its smart program. The autonomous robot (Star) is not only a doctor’s assistant, but after being programmed, it is able to fully independently perform the assigned program. He sewed so well that his stitches were no worse than those performed by surgeons. The developers of the robot are convinced that it has a great future.

“Robots will increasingly take over such tasks in the future,” says Hans-Florian Seilhofer, director of maxillofacial surgery at the University Hospital Basel. For example, “Carlo,” one of the models of surgical robots that he developed with colleagues from the University Hospital Basel and the University of Basel, was used for the first time in an operation on a small child who was suffering from a skull deformation just a few months after development.

Carlo can cut bones with laser beam with exceptional precision. “It is much more sophisticated than a human,” says Seilhofer. The machine works independently and checks everything with sensors. Carlo can even cut an S-shaped bone. It was unthinkable just a few years ago. It is not surprising that the project won the Swiss MedTech Award 2015 for this last year.

The advancement of high-tech equipment is already unstoppable. “The advantages of this robot are absolutely impressive,” says Dr. Stefan Bauer of the Urology Center at Hirslanden Clinic in Zurich. The hospital worked as one of the first clinics in Switzerland with “Da Vinci” and now uses the third generation in its operating rooms. The “Da Vinci” technology has been around for over 10 years.

The four-armed telemanipulator is currently used in urological tumor surgery, in almost 90% of all prostate operations, as well as in operations on the kidneys and bladder. We all appreciated the benefits of this technology. Compared to the conventional method (laparoscopy) and “open” surgery, the computer robot technique is revolutionary, says urologist Bauer. The video of the organ being operated on can be seen thanks to a high-resolution display with a 10-fold magnification. The surgeon sits at a console next to the patient. He controls the camera with his feet and moves the joystick with his hands, which transmits the direction of movement to the robot’s arms. The robot rotates over the patient, like a spider. As a result, incredibly precise and safe operations are obtained.

“We used the advantages of the Gameboy generation when operations are performed with a joystick,” says the urologist. A young surgeon who is familiar enough with the mechanics of the console operator must perform at least 50 interventions before becoming a confident user and having good skills. “Robot” courses should be introduced in all medical schools and many major continuing education centers, so a clear curriculum needs to be developed. Robot-assisted operations clearly have a positive effect on the patient, as the work is softer and less painful.

Patient’s feedback

“I was operated on with the Da Vinci surgical robot on May 26, 2010. The removal of the prostate and lymph nodes is indeed accompanied by great pain, and the more cuts during the operation, the more they hurt. The Da Vinci robot made small incisions. The urinary sphincter worked well again immediately after the catheter was removed, and the bladder is now completely emptied. I recommend that every patient choose the method of working with the Da Vinci system.”

Today, 3,200 Da Vinci machines are used worldwide, 27 of them in Switzerland. About 5,000 operations have been performed since 2004.

The development of other computer-assisted surgery systems operating in Switzerland is in full swing. The start-up company KB in Lausanne has developed a spinal manipulator that will be used in high-risk interventions.

At the ETH Zurich Multiscale Robotics Lab, they are currently researching a micro-robot that is to be inserted into the body and controlled from the outside by a magnetic field (MBO).

Philippe Morel, chief physician of visceral surgery at the Hospital Universitaire de Genève (HUG), has performed nearly 2,000 surgeries with the Da Vinci in the nine years since its acquisition. "The future belongs to Da Vinci," he says, "without alternative." Just as you now read newspapers on a tablet, during operations we will rely on a robot that can realize the surgeon's hands with precise movements. Of course, the cost of such robots is high, around 2 million Swiss francs, due to the monopoly of the American manufacturer. In general, health insurance companies are in favor of a progressive approach in surgery. The additional costs are covered by the hospital.

Dr. Robot is precise, reliable and sometimes more accurate than a doctor. Does that mean robots are better than a surgeon? No. Even if the large three-dimensional image facilitates many interventions, the whole matter is complicated by the lack of touch. Only a doctor can feel the living flesh and make decisions as the operation progresses. It can also happen that the robot fails and then one-step doctor can go straight to traditional laparoscopy.

And this will not change in the future, "real" surgeons are irreplaceable. Despite the fact that in the future, due to the highest precision of the robot, it may happen so that a person will only manage and the robot will do all the main work.