Image by Thomas Meier from Pixabay 

Article Writer-   Sudipta Biswas, Int. MSc., School of Biological Sciences, NISER, Odisha(India)

Robots and Robotics:

Robots are the machines/devices that are made by humans and controlled using several programs, allowing them to perform many tasks automatically. Whereas robotics is the branch that deals with the construction, research, applications, and the operations of the robots [1]. They have shown to possess several degrees of movement, programmability, and flexibility; all of which have allowed them to be the backbone workers in many industries. Taking that into account, the robots have also taken over the healthcare and medical industry [2]. It helps in automation of various processes and procedures in the area and immensely helping the healthcare community. Nowadays, robotics and automation are just a mere addition to the healthcare system. But when the years will roll by, it is predicted that at the end of the 2040s, one-fourth of the world population will be over 65 years of age. In addition to that, the number of pandemics/epidemics and chronic illnesses may also rise [3]. Hence, at that time, the robotics in healthcare will be needed more than anything to cope with the increasing flow of patients and manage the automation of the healthcare system. So, its better to get acquainted with all the developments that have been done in the field of robotics and understand them. Therefore, we have pieced together some crucial bits of things that the robots are up to in the healthcare system.

Robotics in surgery:

With more complicated procedures being used to operate patients, it’s becoming quite stressful for the surgeons to perform these tasks meticulously all the time. Therefore, surgical robots are being produced to help surgeons. These robots can work on patients quite precisely; once given a set of instructions by the surgeons, they will complete a lot of tasks without getting tired. They can manage to operate without making more significant scars. Hence less blood loss happens during the operation [3]. There are many other reasons why these robots are used for accompanying the surgeons. Here, we will look at some of the surgical robots used nowadays and the advantages while having them.

da Vinci robotics:

You might have heard about this robot on various social media platforms like the one who can operate on grapes and other fruits [4]. Even if it is made as an infotainment video, it shows how precisely a robotic arm can be used to operate on humans. Leaving that aside, the da Vinci is a robotic system that can be used by surgeons with the help of certain consoles to carry on operations. This was developed by an American company called Intuitive Surgical and approved by FDA way back in 2000 [5]. The robotic system consists of two parts: The surgeon console and four robotic arms. The consoles help the surgeon control and maneuver all robotic arms, which are there to operate on the patient. The robotic arms can hold objects such as scalpels, scissors, or bovies, whereas some of them have 3-D cameras, hence making it a robot with seven degrees of freedom. It’s being used to help the surgeons in various procedures like general-laparoscopic surgical procedures, gynecologic-laparoscopic surgical procedures, general non-cardiovascular thoracoscopic surgical procedures, abdominal surgical procedures, prostate cancer surgery, and urologic surgical procedures [6]. The system allows surgeons to perform these complex minimally invasive procedures with utmost precision and accuracy. To date about there are more than 1,700 da Vinci Systems in hospitals worldwide, with more than 775,000 patients have had a da Vinci procedure [7]. It is becoming way more popular in the healthcare systems in the laparoscopic area. In India, several centers provide these services like the Apollo Hospitals, Manipal Hospitals, Asian Heart Institutes, and others [8].

ZEUS robotics:

It is another robot helping the doctors to operate on patients. Made by the American company Computer Motion and being approved by the FDA in 2001. Unlike the da Vinci system, ZEUS has three robotic arms, which are again controlled by the surgeons. The first arm is AESOP (Automated Endoscopic System for Optimal Positioning), a voice-activated endoscope that allows the surgeon to look inside the patient’s body. Simultaneously, the other two arms try to mimic the surgeon’s movements to make precise incisions during the surgery [9]. These arms can correct the tremors in the surgeon’s hands. This type of tremor can occur during the procedures, which are usually several hours long. Here, the ZEUS system can trace, decrease, and cancel the tremors while still responding to the movements of the surgeon’s hands. It can scale down the actions of the surgeon’s movements, too. Hence it was preferred for several minimally invasive surgeries like beating heart surgery, mitral valve surgery, and endoscopic coronary artery bypass grafting (E-CABGTM) [10]. However, after the company merged with its rival Intuitive Surgicals, the robotic system was discontinued, and da Vinci was used hence after. The predecessor to this was the AESOP robotic system, which was approved by FDA in 1994, and hencebecoming the first ever surgical robot. AESOP’s function was to direct an endoscope inside the patient’s body during the operation. The camera moves based on voice commands given by the surgeon [10]. Later on, it became integrated into the ZEUS system as one of its robotic arms.

PUMA560 CT:

The PUMA short for Programmable Universal Machine for Assembly, or Programmable Universal Manipulation Arm, is one of the first industrial robotic arm developed for surgical procedures at a robotic company called Unimation, back in 1977. It again had the same components as all of the above robots: a controlling system and a robotic arm. For a small amount of time, it was used to place a needle for a brain biopsy using CT guidance [11].

Robotics in Intelligent Prosthetics:

Prosthetics are the range of devices that replaces lost/missing body parts, which may have been lost for various reasons [12]. The scientists are trying to find new ways to improve the models of these devices and make them more realistic in terms of any human body’s needs. The robotic prosthetics allows the person to control his prosthetic parts, in the same manner, he would use to control his lost body parts. The system here consists of biosensors, controllers, and actuators. The biosensors detect signals from a person’s neural or muscular networks, which previously controlled muscles on an amputated limb. Biosensors are of a different variety; they include the electrodes placed on the skin or implanted into the muscles, which detects electrical activity on the skin/muscles. Whereas, others are like solid-state electrode arrays with nerves growing through them. These sensors relay on the signals from the skin/muscle/nerves to another device on the prosthetic limbs called the controllers. These controllers are like the processing devices, which helps in processing the biosensors’ input and giving back the output to the other device called actuators. After receiving the signals, the actuators present in the limbs produce force and movements in the prosthetic part as per the biosensors’ instruction [13]. The techniques like Targeted muscle reinnervation (TMR) and Targeted sensory reinnervation (TSR) depends on these principles and have helped provide the much-needed services to the patients. Several robotic arms and limbs are being used all around the world. Some research is going on in DARPA, the Pentagon’s research division, to improve these robotic limbs system so that the sensors will be able to take in command from the human brain itself [13].

Robotics in Treatment and Therapy:

Just like all the other sectors of healthcare, the robots were able to get into the medicine department too. Robots are being used for drug delivery, treatment(pre/post-operative), therapy, and rehabilitation purposes [14]. For example, targeted therapy microrobots are used to deliver/localize a drug or other treatments to a specific target site within the body(like delivering radiation to a tumor). Recently, a microrobot was designed with a burr-like porous spherical structure that is used for carrying and delivering targeted cells in vivo under a magnetic gradient field-driven mechanism needed for tissue regeneration [15].

Coming to rehabilitation, robotics in this area is tailored for assisting various sensorimotor functions, and assessing the sensorimotor performance of a patient post-operation. It helps the patients perform active-assisted exercises, active-constrained exercises, active resistive exercises, passive exercises, and adaptive exercise, which will help them go through the clinical rehabilitation phase [16]. Under this treatment, new robot exoskeletons are being made, allowing the patients with either paralysis or having had a stroke to walk again. The exoskeleton provides weak muscles with the extra help they need to perform movements [17].

Therapy robots are a kind of device that uses sensors to monitor human movements and positionings and then uses these inputs to interact with them. These robots are beneficial for rehabilitation purposes and help interact with patients with severely deficient motor skills [18]. Children with autism are being encouraged to learn social skills from these robots, as face to face interaction with another human can be quite overwhelming for them. The robots interact with these children, helping them gain confidence and learn social skills. A study performed by researchers at the University of Luxemburg on the ASD children showed that many repetitive behaviors(like hand flapping) which are indicative of being uncomfortable and anxious occurred about three times as often in the patients during sessions with the human therapists, compared with the therapy robots [19].

Robotics in the maintenance of the clinics:

Robotics are used in clinics in some countries to automate many of the works performed by humans. According to a study, about more than thirty percent of the work in clinics can be automated using robots. They are capable of playing almost any predictable human interaction and then allowing these patients to make appointments, log in to applications, fill in forms [20]. They can help store the patient information more efficiently every day. Hence, it can be said that robots can take the place of the hospital receptionist. It’s not the receptionist only; there are some nurse robots too, which are going on the surface to help the patients. However, the robots cannot fully replace the nurses, but they can still take vital signs, deliver medicine, and communicate with doctors and patients [21].

Other types of robots can be found in clinics like the disinfectant bots. These disinfecting robots tend to move to patients’ rooms when they are not there, and then using high-powered UV rays for several minutes helping to clean the room [22]. Many hospital corridors and rooms are being disinfected and cleaned by these robots nowadays due to the ongoing coronavirus outbreak.

Robotics in supporting the Elderly population:

With the population of young people busier than ever, it’s becoming harder for them to take care of the older people for a longer period of time. A similar situation is with the old age nursing homes, with the substantial incoming number of patients, sometimes the workers in these places are not able to keep up with the demands. Hence robotics can be the right solution to this problem. Specific robots are made to take care of the elderly population. They can perform an outrageous number of tasks. These robots can autonomously navigate and interact with the older people living in various households, old-age homes, and hospitals, hence helping them live either semi-independently or fully independently. They can measure the vitals(like heart rate, blood sugar levels, blood pressure levels) of these people regularly and help report to the medical authorities if any abnormality occurs [3]. They can also provide them with on-time medicines and make them feel less lonely by just being with them, enhancing the mindset of older people [23].

Conclusion:

Robotics and automation promise a sustainable and promising future for the healthcare sector. However, they have raised a few pressing questions regarding their use in the area. The use of robots in healthcare is much costlier than having to pay humans to do the same work. Buying and maintaining robots is a severe issue, which is limiting their use [24]. Also, many ethical issues are making rounds. Like, several surgical robots are said to give out some stray electric currents while operating, which can severely affect the health and operation of the patient [5]. Similarly, there is a bit of a problem when it comes to distributing these machines to several developing countries.

Even when they have some cons, the robotics industry is becoming more prominent in the medical and healthcare systems because of the massive range of possibilities they provide. Also, because, there’s always a scope to rectify all the single problems faced by the persons while using them. The research and development of robots are going on at a fast pace to improve their quality and lower their price. And if this progress goes on in the future with the similar speed then one day will come when a lot of the healthcare works will be automated and done more precisely.

References:

1.https://en.wikipedia.org/wiki/Robot
2.https://online-engineering.case.edu/blog/medical-robots-making-a-difference
3.https://www.slideshare.net/paras97/robotics-in-healthcare
4.https://www.uchicagomedicine.org/forefront/surgery-articles/they-did-surgery-on-a-grape-and-we-did-a-q-and-a-with-a-surgeon-about-it
5.https://en.wikipedia.org/wiki/Da_Vinci_Surgical_System
6.https://www.slideshare.net/srutipn/robotic-surgery-29427247
7.https://www.uchealth.com/services/robotic-surgery/patient-information/davinci-surgical-system/
8.https://www.apollohospitals.com/departments/robotics-surgery/da-vinci-robotic-surgery
9.https://www.vision-systems.com/factory/robotics/article/16741225/surgeon-uses-zeus-robotic-surgical-system
10.https://en.wikipedia.org/wiki/ZEUS_robotic_surgical_system
11.https://twcroboticsurgery.weebly.com/past.html
12.https://www.britannica.com/science/prosthesis
13.https://en.wikipedia.org/wiki/Prosthesis
14.https://interestingengineering.com/15-medical-robots-that-are-changing-the-world
15.https://www.researchgate.net/publication/326027347_Development_of_a_magnetic_microrobot_for_carrying_and_delivering_targeted_cells
16.https://en.wikipedia.org/wiki/Rehabilitation_robotics
17.https://en.wikipedia.org/wiki/Powered_exoskeleton
18.https://www.mentalfloss.com/article/71987/10-therapy-robots-designed-help-humans
19.https://spectrum.ieee.org/the-human-os/biomedical/devices/robot-therapy-for-autism
20.https://healthtechmagazine.net/article/2020/01/what-does-robotic-process-automation-look-healthcare-perfcon
21.https://cs.stanford.edu/people/eroberts/cs201/projects/2010-11/ComputersMakingDecisions/robotic-nurses/index.html#:~:text=Today%2C%20robotic%20nurses%20are%20robots,distances%20to%20communicate%20with%20patients.
22.0https://www.servo.com.sg/product-categories/disinfectant-robot
23.https://www.independent.co.uk/life-style/gadgets-and-tech/features/robot-carer-elderly-people-loneliness-ageing-population-care-homes-a8659801.html
24.https://www.healthline.com/health-news/is-da-vinci-robotic-surgery-revolution-or-ripoff021215#:~:text=A%20single%20robot%20costs%20about,more%20than%20traditional%20laparoscopic%20surgery.