The rise of Robodoc: They can operate on everything from your heart to creaky knees – but would you put your life into the hands of a robot surgeon
00:31 GMT, 7 August 2012
Doctors are increasingly using robots to treat disease and injury
Having an operation
Don’t be surprised if the surgeon performs it from the room next door.
Indeed, he could even operate from halfway across the world — because these doctors are increasingly using robots to treat disease and injury.
‘These are incredibly exciting times,’ says Brian Davies, emeritus professor of medical robotics at Imperial College London and inventor of the surgical robot, which in April 1991 became the first in the world to remove tissue from a living human.
‘Robots can work much more accurately
than human hands, which is fantastic now that we are seeking minimally
invasive surgery through a tiny incision where precision is key,’ says
course, the surgeon still performs the operation, but uses the robot to
see inside the body, or operates it using a joystick or console so it’s
like a spare arm — but without the human hand’s natural shake.
‘Medical robots are not like the sci-fi images of autonomous humanoids; they are sophisticated computer-assisted instruments that remain always under the surgeon’s control,’ says Dr Patrick Finlay, founder of medical robotics firm MediMaton.
Robots are still only in a handful of centres as we await long-term evidence comparing their accuracy with traditional methods. But many surgeons believe they could transform treatment for a range of health problems.
Here, we look at some of the most exciting developments.
The Sculptor robot is being used for hip and knee replacements, with claims that it provides a more accurate fit.
First, CT scans are taken of the patient’s body and a tailor-made implant is designed to their exact dimensions.
Then the surgeon enters data from the scans into the robot, which is pre-programmed to perform the operation exactly according to the patient’s dimensions.
Sculptor has two arms — one holds a high-speed burr which cuts into the bone and shapes it to fit the dimensions of the implant, while the other is fixed to the patient’s bone with pins.
The Sculptor robot is being used for hip and knee replacements, with claims that it provides a more accurate fit
This means if the surgeon needs to move the patient’s leg around to get at the bone, the robot can track the patient during surgery so that if the surgeon then tries to stray into tissue he hasn’t planned to touch, the robot stops working, preventing damage to healthy tissue.
‘This is very exciting because we can sculpt a limb more accurately to give the best joint replacements possible,’ says Professor Justin Cobb, orthopaedic surgeon at Imperial College London, who developed the robot.
A 2004 study showed that 100 per cent of joints were positioned accurately, compared to 40 per cent without Sculptor.
Another benefit is that the operation can be performed with a smaller incision.
Sculptor is being used at several UK centres including Charing Cross Hospital, London.
A million Britons have atrial fibrillation, in which cells in the heart send out a faulty electrical signal causing the heart to beat at an irregular, rapid rate.
The condition can be treated by catheter ablation, where a catheter or flexible tube is inserted through a vein in the groin and then used to burn away the faulty cells with radio-frequency energy.
The Amigo Remote Catheter Manipulation System is a 3ft-long robotic arm which is guaranteed not to shake
But the target areas are just 5mm across — and in one in every 100 procedures, a slight tremor in the surgeon’s arm causes the wrong cells to be burned, meaning the procedure needs to be done again or even that the patient needs a pacemaker fitted.
The Amigo Remote Catheter Manipulation System is a 3ft-long robotic arm which is guaranteed not to shake.
‘The robot simply reproduces my movements, but takes out any slight tremor so it’s safer,’ says Dr Andre Ng, cardiologist at Glenfield Hospital, Leicester, who was the first in the world to perform the procedure in April 2010.
He sits about two metres from the patient, controlling the robot from behind a screen, but says in the future it could be programmed to work semi-automatically: ‘One day a skilled cardiologist could even control the robot from half way across the world.’
The Amigo is currently being used only at Glenfield Hospital.
The da Vinci robot, used to treat cancer and other prostate problems, features a tiny telescope which is placed inside an incision in the patient’s body.
The telescope takes images from two points, which are relayed back to a console so the surgeon has a 3D image on-screen while he operates.
The da Vinci also has four spider‑like arms, controlled by the surgeon, which hold cutting instruments to make tiny incisions and remove the prostate or the cancerous part using images from the telescope to guide the surgeon.
‘Da Vinci gives wonderful 3D vision, rather like having your eyes inside a patient,’ says Justin Vale, urological surgeon at Imperial College Healthcare Trust.
Evidence shows that using these robots mean significantly less blood loss, reduced risk of blood transfusion and probably a shorter overall recovery time.
A 2002 study in the journal European Urology found prostate cancer surgery done by da Vinci robots had better outcomes for continence and cancer control than keyhole approaches done by the human hand.
The robot is also now used for heart bypass surgery, heart valve repair and hysterectomy.
A new robot that could be used in the UK within five years offers hope for treating conditions including epilepsy, Parkinson’s and brain tumours.
Surgery is used as a last resort if epilepsy can’t be managed with medication — electrodes are placed inside the brain to burn off the nerves that are causing electrical disturbance and, in turn, seizures.
The Active robot has two thin arms with tools for positioning electrodes at the end of them.
First, MRI or CT scans are used to create a detailed map of the brain, then the electrodes are inserted (the surgeon either programmes the robot to do this, or controls it himself using joysticks).
With the standard operation, the surgeon has to insert a tube 10-15mm in diameter in the brain to place the electrodes; the Active uses a tube that’s just 3mm.
‘The scans mean we can identify where the misbehaving nerves are much more accurately, and the robot’s arms are much smaller than human hands so they don’t need as big a tube,’ says Dr Finlay.
‘Previously, if we found the target area was close to a vital structure in the brain, we simply couldn’t operate because the risks were too great. Now we can treat these patients, too.’
surgeons often rely on an assistant who holds an endoscope — a small camera on a tube — inside the patient’s abdomen which displays the view on a screen.
Freehand is a robot arm which does this job. The advantage is that it’s directed by infra-red signals from a sensor the surgeon wears on his head.
The surgeon moves his head to make the robot go sideways or up and down; a quick tap on a foot pedal tells it to zoom in or out.
‘Even a skilled assistant suffers from hand shake after 30 minutes of holding the camera, while the robot produces a consistent shake-free image.
And mistakes in communication are eliminated: sometimes left and right can be confusing if the surgeon and assistant are on other sides of the table,’ says Dr Finlay.
‘Surgeons have reported typical savings of 40 minutes operating time in prostate surgery, while the risk of harmful side-effects including impotency and incontinence may also be reduced.'
The robot costs just 15,000, compared to over 1.5 million for da Vinci, and is being used at 40 British hospitals for a range of operations, from hysterectomies to prostate cancer surgery.
Scientists at Imperial College London are working on iSnake, which will work round the body’s organs using bendable joints and sensing mechanisms.
‘Sting’, also in development at Imperial, is a steerable robot for brain surgery which can insert a needle along a curved path (instead of only in a straight line) to target a tumour deep inside the brain with no damage to healthy tissue.
Scientists in Italy and Germany are conducting animal trials with tiny robots, or microbots, which crawl through arteries cleaning them up.
The microbot can also examine intestines with no need for a colonoscopy (putting a tiny camera into the body via a tube).
Meanwhile, a robot the size of a sesame seed and controlled by magnets is about to begin animal trials in Zurich — it’s hoped it could treat diabetic retinopathy, a complication of diabetes that damages the retina and can lead to blindness.
The robot can move through the eye, targeting bleeding blood vessels far more accurately than a surgeon could.
And finally, scientists are also working on robots which will assemble themselves inside the body, clicking together once they are put through narrow apertures.
Incredibly, one could remove a gall bladder without the need for an incision — the robot would assemble in the stomach, remove the organ, repair the stomach wall and exit via the mouth.