How emerging medical robotics is changing surgical medicine.
As appeared in Jan/Feb's issue of Wired
The emergence of medical robotics has changed the way surgical medicine is performed and perceived today. These intelligent machines enable surgeons to perform complex operations with unprecedented precision and in the process, reduce surgical risks, speed up patients' recovery times, and improve cost-efficiencies for healthcare providers. In this round of the Singapore Sessions, we sit with a diverse group of experts to find out how the use of robotics in surgery is opening up a new era of medical innovation and how else can we harness technology to complement the skills of human doctors in the future.
The Session
Click on the sessionists to find out more about their perspectives or read the full session.
Christopher Cheng — Dollars, Circuits, and Sense
The initial cost outlay for a medical robot may seem at first prohibitive. Yet, as Dr. Christopher Cheng, Head and Senior Consultant to Singapore General Hospital's Department of Urology, points out, "so is most advanced technology in medicine. The cost of each procedure comes down with more procedures done per year, thus diluting the capital and maintenance cost." An important consideration, he says, is that "from the institution's standpoint, there is also the early adaptor benefit of staff retention, enhanced research potential and building of advanced technology reputation."
However, he warns, this should be subject to careful oversight: "Patients may be attracted to inappropriate treatment. Ultimately it is up to the ethos of the institution and physicians to practice appropriate, patient-oriented medicine" he said. "Technology is neutral."
Yes
NoAbout the sessionist
Christopher Cheng
Head, Department of Urology
Singapore General Hospital
View profile
Jacob Rosen — Gaining Ground
Jacob Rosen, robotics expert and Associate Professor of Computer Engineering at the University of Santa Cruz, is working on one of the biggest challenges facing medical robotics: the human machine interface. With his wearable "exoskeleton" robot prototype, he is developing its application for rehabilitation and physical therapy, particularly for stroke patients who typically experience one-sided loss of movement and for anyone recovering from surgery who needs to regain muscle strength and coordination. Rosen describes how, in conjunction with neuroscience's theories of symmetric movement, his exoskeleton "allows the patient's healthy side to tele-operate the non-healthy side." This is accomplished through the use of surface electromyography (EMG), where electrodes placed on the healthy side of the patient's body transmit predications based on neuro-muscular impulses to the exoskeleton on the side damaged by stroke or injury and subsequent surgery. The exoskeleton then conducts exact, mirrored movements of the damaged side in concert with the healthy side. These exercises rely on the plasticity of the brain to simultaneously teach and relearn movement-based impulses. And the bonus is, as Rosen points out, "therapy that was once limited by the therapist's time, is now only constrained by the patient's ability to learn." And, as we're discovering, that potential is nearly endless.
About the sessionist
Jacob Rosen
Associate Professor,
Department of Computer Engineering
University of California - Santa Cruz (UCSC)
View profile
Dr. Thomas Lendvay — Accelerating Change
The learning curve for robot-assisted surgery is reportedly shorter than traditional surgical techniques, though there is a valid concern that with the uptake of robotic techniques comes the scarcity of traditional surgical methods. However, Dr. Thomas Lendvay, Assistant Professor of Pediatric Urology at Seattle Children's Hospital, notes that virtual reality technology enables faster training because it is not dependent on the use of the robot itself. To this end he has developed a virtual reality curriculum in which trainees practice different tasks, exercising camera movements, clutching movements, instrument transferring of materials, and some needle and suturing work. Then, says Dr. Lendvay, "When subjects go from the simulator to the robot, they are much more comfortable learning the robot's movements."
Someday, Dr. Lendvay believes, "virtual reality training will be used f or patient-specific simulations. Pre-operative imaging will recreate a 3D simulation of a patient's specific anatomy for practice performance before the actual live surgery, allowing the surgeon to become familiar with structural details like vasculature or tumor location."
Mapping the Future
The use of virtual reality in surgical robotics is already proving helpful. But the possibilities don't end with training: in the future, the combination of pre-operative imaging and 3D modeling could be mapped in real-time to the patient, allowing the surgeon to see labels and marked areas of important tissue structures overlaid on what is directly visualized by the robot's camera.
Further, Dr. Lendvay envisions improvements to the sensors on the robotic instruments themselves, "such that we can get more information about the tissues as we're handling them." For example, biophotonics, light sensors that can determine tissue oxygenation and blood supply to the tissue as it is being grasped, would display to the surgeon in real-time, providing valuable statistics on how the procedure is affecting the patient on a moment-to-moment basis.
About the sessionist
Dr. Thomas Lendvay
Assistant Professor, Department of Urology
University of Washington
View profile
Roger Kamm — Living Machines
Generally when we think of robots, we picture machines of metal or plastic, wires and motors, running on electricity and complicated software. However, in medicine, another kind of robot entirely is emerging: a living machine, or biological robot, comprised of real cells or tissues which themselves carry out specified tasks via chemical or genetically coded instructions. Research partnerships like the Singapore-MIT Alliance for Research & Technology are focused on bridging the gaps between engineering and molecular cell biology. Future applications for this technology may include drug monitoring, reporting, and adjustments in the bloodstream, or identification and remediation of unhealthy bodily intruders such as cancer cells. Will these "bio-bots" soon be taking over the OR? "It's probably more likely that biotechnologies will help make surgery obsolete, or at least unnecessary in many cases," says Roger Kamm, Singapore Research Professor of Biological and Mechanical Engineering at Massachusetts Institute of Technology. "'Smart' implants might know where to go, how to connect with the resident tissue, and what to do to treat the medical condition." Cells could be engineered to perform specific functions such as generating new tissue in an infarcted heart, or injected into the liver to reverse the destruction of fibrosis. "This may seem far-fetched, Kamm says, but in fact, "it may not be that far off."
About the sessionist
Roger Kamm
Research Professor of Biological and
Mechanical Engineering
Massachusetts Institute of Technology
View profile
Comments
0 Comments have been posted
0 People have recommended this
Entry comments
Post your comment
Note: A selection of your comments may be published, displaying your name and location.