Robots: sci-fi to science to surgery
22nd November 2022 - Last modified 18th October 2023
20 years of Alto. 20 years of science. #14
By Olivia Hillson, Science Writer
As part of Alto Marketing’s 20 year celebrations, we’re looking back at some of the most important advances in science over this time in our blog series “20 years of Alto. 20 years of science.” Here, we go back in time to take a look at the origins of robotics and then see how this exciting technology has moved from the first commercial robot to pushing surgical boundaries in the operating theatre.
Fictional roots for real life robots
In 1920, the Czech writer Karel Čapek was the first person to publicly use the word ‘robot’ in a play about artificial people. ‘Robotics’ as a term for the science and technology of robots came much later, in the 1940s, from the famous science fiction writer Isaac Asimov. The origins of these terms paint a strange history where science fiction went on to inform science fact, creating an entirely new field of research and development. [1]
The main concept of cybernetics and practical robotics was formulated in 1948 and still forms the basis of practical robotics today. It focuses on the principles of a feedback loop. A sensor detects an input that decides what action a controller will then make in response, and the outcome of this feeds back into the sensor as input. While this sounds incredibly simple, the practicalities of creating functioning sensors and controllers are extremely complicated, so it would not be until 1961 that the first commercial robot – the Unimate – was installed [1,2].
The Unimate marked the beginnings of the now widespread use of robotics in industrial settings, and, as the use of robotics became more widely acceptable in industry, other applications for the technology began to arise.
Pushing surgical boundaries
Robots in simpler forms have been used for surgical applications since the 1980s but their complexity and sophistication has increased exponentially in recent years. The first robot in an operating theatre was used to correctly position patients’ limbs during orthopaedic surgery. Fast forward to the present, and surgeons now have access to many different robotic solutions that help increase the safety and efficiency of all kinds of procedures. Like the robotics used in other fields, surgical robots offer the opportunity to push boundaries set by human limitations [3].
Neurosurgery, a field involving the manipulation of some of the most intricate human tissues, has seen a great deal of advancement in surgical robotics. The application of robots in this field started early and, in 1985, an industrial robot was re-purposed and used to successfully perform a CT-guided stereotactic brain biopsy. However, even at this early stage, it was evident that the small structures in deeper brain tissues demanded robots with greater accuracy [4].
Very quickly, robots started to be designed specifically for neurosurgery and decades of development into more precise and accurate robots followed, opening the door to ever more complicated neurosurgical procedures [5].
In 2019, the neuromate®, a robotic system for neurosurgery – from Alto’s client Renishaw – was used to perform deep brain stimulation on a patient who, at just two years old, was the youngest patient to have ever undergone this treatment. This was made safe and possible by the use of robotics to navigate the especially small and delicate anatomy involved. As with many of the surgical robotics platforms, neuromate integrates with a specialised surgical planning software, neuroinspire®, which was an integral part of preparing a safe procedure for Viktoria. [6-8] But is planning software the limit, or can (should?) surgical robots be automated?
From robotic assistance to automation?
The United States Department of Defence certainly thought so in 2017, when they announced funding for the FORwARD Award: Foundational Research for Autonomous, Unmanned and Robotics Development of Medical Technologies. The idea was to fund research into fully autonomous medical robots which could serve, in a sense, as robotic doctors [9], though the DoD had perhaps jumped the gun on what was possible in practical robotics at the time.
Human bodies are so varied that no individual patient is exactly like the next. We vary by a multitude of factors including our sex, age, and size, not to mention changes throughout our lives such as developing scar tissue. Another problem is that people move during treatment. Creating a robot that is able to respond to patient movements would require highly complex programming, and returning to that fundamental aspect of cybernetics – the feedback loop – we can see that the quantity of sensory inputs needed for an automated robot to respond adequately to a human patient would be astronomical.
However, despite these major obstacles, half a decade later in 2022, we are making real inroads towards automated surgical robots. In January, the Smart Tissue Autonomous Robot (STAR) successfully reconnected two ends of an intestine – considered to be one of the most delicate tasks in abdominal surgery. The STAR, designed by a team from Johns Hopkins University, produced significantly better results than humans performing the same surgery [10].
Patient safety. The no.1 priority
Creating a functioning robot is not the only barrier to it’s use. To gain regulatory approval, researchers need to explain how and why the robot makes its decisions to prove its safety. This is largely impossible with the use of artificially intelligent programs that make their own decisions in real time. Driverless cars have also been faced with this issue – the question of ‘what if it goes wrong’ seems to be impossible for artificially intelligent systems to shake off. As a result, surgical robots will likely remain under close human supervision for the foreseeable future, regardless of their capabilities [3].
This is not necessarily a bad thing. Safety in surgery needs to remain priority number one and advancements in technology can still be used by doctors to push boundaries and improve surgical outcomes. So, while the approval for completely autonomous surgical robots may lag behind the technology, the field will continue to strive to get the best possible tools to doctors and surgeons so they can provide the best possible care.
References
(1) Wikipedia. Robotics. 2022; Available from: https://en.wikipedia.org/wiki/Robotics.
(2) Wikipedia. Cybernetics. 2022; Available from: https://en.wikipedia.org/wiki/Cybernetics.
(3) James Gaines The Past, Present and Future of Robotic Surgery. 2022.
(4) Y. S. Kwoh, et al., A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery. IEEE Transactions on Biomedical Engineering, 1988. 35(2): p. 153-160.
(5) J. Shah, A. Vyas, and D. Vyas, The History of Robotics in Surgical Specialties. (2374-0612 (Print)).
(6) Renishaw plc. Renishaw’s neuromate® robot helps deliver deep brain stimulation (DBS) to world’s youngest patient. 2019.
(7) Renishaw plc. neuroinspire™ neurosurgical planning software. 2021-2022; Available from: https://www.renishaw.com/en/neuroinspire-neurosurgical-planning-software–8244.
(8) Renishaw plc. neuromate® robotic system for stereotactic neurosurgery. 2021-2022; Available from: https://www.renishaw.com/en/neuromate-robotic-system-for-stereotactic-neurosurgery–10712.
(9) Federal Grants. DoD Medical Simulation and Information Sciences, Toward A Next-Generation Trauma Care Capability: Foundational Research for Autonomous, Unmanned, and Robotics Development of Medical Technologies (FORwARD) Award. 2007-2022; Available from: https://www.federalgrants.com/DoD-Medical-Simulation-and-Information-Sciences-Toward-A-Next-Generation-Trauma-Care-Capability-Foundational-Research-for-Autonomous-Unmanned-and-Robotics-Development-of-Medical-Technologies-FORwARD-Award-67832.html.
(10) Catherine Graham Robot performs first laparoscopic surgery without human help 2022.
