The word "robot" comes pre-loaded with its own set of unique connotations. To most, robots are a science fiction concept; a flight of fancy conjured by the vivid imaginations of Isaac Asimov, Arthur C Clarke and the like. In fact, robotics is a vibrant emerging field that is steadily building credibility as a method of making our lives safer and more convenient. From living rooms and factories to battlefields and operating theatres, robots are increasingly wheeling their way out of our imaginations and into our daily lives.
With busy medical professionals increasingly under pressure to make the best-possible use of their time, hospitals often play host to the latest innovations in advanced robotics. From remotely operated surgical devices to simple drug dispensers, here we present some of the most significant developments in medical robotics and their potential for improving patient care and simplifying the daily tasks of hospital staff.
Robot-assisted surgery – da Vinci and the neuroArm
One area in which the automated precision of robots has huge potential is surgery. While it may be some time before the technology is refined (and inexpensive) enough to become a part of surgeons' day-to-day lives, several new innovations have emerged in recent years that are bringing hospitals a step closer to a future where surgeons work in tandem with robotic counterparts to achieve better results.
The neuroArm, for example, was officially launched in April 2007. This robotic device was developed by Dr Garnette Sutherland at the University of Calgary in Canada. It is designed to perform remotely controlled neurosurgery in conjunction with an MRI. The surgeon controls the device's robotic appendages from a nearby workstation, which projects a 3D display of the surgical site and MRI data, with superimposed virtual tools allowing full control of the system. As the neuroArm is MR-compatible, it can actually perform stereotactic surgery from inside the bore of an MRI with near real-time image guidance.
But the robot that has proved to be the most pervasive presence in operating theatres is the da Vinci Surgical System. As of December 2009, nearly 1,400 of these devices have been sold worldwide, with the majority appearing in US hospitals. The da Vinci System has been used for a wide range of laparoscopic (keyhole) surgeries, and has been seen to reduce bleeding during operations and minimise post-operative pain, scarring and recovery time. This multilimbed surgical tool might resemble a menacing instrument from George Orwell's Nineteen Eighty-Four, but the da Vinci is designed to perform complex surgery with minimal invasiveness and reduced discomfort. A surgeon controls the limbs from a console to make incisions and tracks progress with a mounted 3D endoscope.
If such robot-assisted surgery has the potential to benefit surgeons and their patients, why haven't we seen more widespread adoption of these devices? Well, there are some obvious drawbacks that are keeping hospitals from reaching for their cheque books. The first is cost.
The da Vinci system, for example, retails at approximately $1.5m, with significant annual maintenance costs. For hospitals with stretched budgets, more evidence must be presented showing that cost is justified by markedly improving results for the patient and creating financial savings from reduced recovery times.
On a practical level, the use of robots during surgery involves a steep learning curve for surgeons used to traditional surgical methods. Many practitioners have cited the lack of tactile feedback (the physical sensation of making an incision) as a major disadvantage, despite the sophistication of visual displays.
Dr Robot will see you now – InTouch's Remote Presence robot
Robots are also making an impact outside the operating theatre. InTouch Health has developed a Remote Presence robot (RP-7), which allows physicians to visit patients while in another location, communicating with them in real time through a screen mounted on a remotely operated robot.
What the RP-7 lacks in style (it bears a somewhat unfortunate resemblance to a wheelie bin) it makes up for in sophisticated technology. As well as allowing doctors to conduct remote consultations with patients, the robot can connect to medical instruments such as electronic stethoscopes and wirelessly transmit data back to the remote physician.
The device, which costs between $4,000 and $7,000 a month to lease (depending on volume of orders and time commitment from hospitals), has been primarily used in fields where the ratio between medical professionals and patients is particularly high.
Take intensive care. The round-the-clock observation required to treat critically ill patients puts a serious strain on ICU doctors. The RP-7 allows them to make rounds during off-duty hours to maintain quality of care and stay up-to-date with patients' conditions.
As the healthcare demographic continues to morph, with increasing numbers of elderly patients requiring ongoing hospital treatment, Remote Presence robots could potentially form a vital part of the solution to the problem of understaffing.
Indeed, many hospitals, primarily in the US, are seeing positive results after introducing Remote Presence robots. Since the UCLA Medical Center became the world's first hospital to introduce these devices to its neurosurgery ICU in 2005, an increasing number of large hospitals have embraced this technology, including Johns Hopkins in Baltimore, the Detroit Medical Center and St Mary's in London.
In February, InTouch announced that over 100,000 clinic sessions had been performed through its Remote Presence network, with 250 hospitals now on board. It is this success that led to US business magazine Inc. ranking InTouch 289th on its list of the 500 fastest-growing companies in the US in 2008, with a three-year sales growth rate of 958%.
Developing the future – remote surgery and nanorobotics
Scientists are also developing increasingly complex robotic devices in an effort to eventually make truly science fiction concepts a reality.
The da Vinci surgical system could theoretically allow remote surgery to take place over much larger distances than from one hospital room to another. Although this area is not currently a priority for manufacturer Intuitive Surgical, the system could theoretically facilitate remote surgery across oceans and continents. The would-be benefits of this development are clear, as it would allow patients in remote locations (or soldiers in combat zones) to receive remote surgery from half the world away.
Nanorobotics is much discussed as a potentially revolutionising force in modern medicine. While the development of nanorobots (microscopic devices measured in nanometres – one billionth of a metre) is still in the theoretical stages, researchers believe they could play a vital role in the future treatment of disease. Small enough to enter the blood stream, possible applications of nanorobots include targeted drug delivery to combat cancer (as an alternative to chemotherapy), advanced diagnostics and regenerative medicine.
Today, robots are just beginning to make their way into the wards and operating theatres of our hospitals. Advances in medical robotics are impressive but new technologies are still expensive to implement and often impractical in the current medical environment.
Last year, a pilot scheme in the US replaced manual medicine delivery with self-guiding robots. This might have been a futuristic idea but results showed that nearly 10% of mechanised deliveries failed to reach their destination and patient satisfaction declined in comparison to traditional delivery methods.
Despite the stumbling blocks along the way, it is projects like this that foster greater awareness of the benefits of medical robotics. As hospitals begin to make planning decisions that integrate robotics with conventional human expertise, we may begin to see our hospitals transform into something worthy of the best science fiction.