You are here: Robotics/Chapter 1/Robot Applications

Robots in Healthcare

Robots are playing an increasingly pivotal role in the healthcare industry.  The most well-known application is likely the da Vinci Surgical System.  This was approved by the FDA in 2000, and is basically an advanced robot manipulator for performing non-invasive surgeries.  Some of the benefits that the site lists are that it is minimally invasive, and offers superior precision and control compared to a surgeon.  It is important to note that the surgeon is still in control of the robot, and makes all of the decisions and operates the robot.  But the robot performs the surgery.  It is equipped with a magnified 3D HD vision system (able to magnify the view up to 10X), and it’s ‘wrists’ are tiny and able to bend and rotate more than a human’s wrist.  The premise is that it takes the surgeon’s hand movements and translates them down into smaller and more precise movements.  Imagine moving your hand one foot, and the robot is able to perform the same movement except it only moves 1mm (this is exaggerated).  This scaled down approach allows for precision that may not be possible by human surgeons.  The system also can reduce the effect of any tremors in the surgeon’s hand.  Now, I’ll list the additional benefits that the da Vinci Surgery System claims to offer.  It is able to reduce the size of the incision that surgeons would make for the same surgery, and so is deemed to be less invasive.  This results in a number of benefits: a shorter hospital stay, less bleeding, the potential for less complications, fewer pain medications post-surgery for recovery, a faster recovery, and less scarring.  The benefits certainly do sound astonishing.  Obviously, it is not the choice for all surgeries.  But it is now widely used for hysterectomies (removal of the uterus, and additional the cervix, ovaries, and fallopian tubes) and prostatectomies (removal of part of or all of the prostate gland).    Other surgeries include gynaecological, Urologic, Cardiac, Thoracic, Neck and Head, and General surgeries.  Da Vinci states on their website that for surgeries to remove the prostate (in the case of prostate cancer), the da Vinci system is currently used 4 out of 5 times, which is an incredible number, and that the system has assisted in 1.5 million surgeries worldwide (and counting).  How much does this robot cost?  About $2 million.

However, you can imagine that this robot has some drawbacks and there are many that do not believe that it can offer all of the benefits that it promises.  One of the drawbacks is that humans (to a varying degree) are uncomfortable with a robot performing a delicate and potentially life-threatening task such as surgery, instead of a highly skilled surgeon.  Of course, the surgeon is still in control, but it may look more like they are playing a video game as oppose to performing a surgery.  This is similar to the debate about autonomous aircraft – would you rather a pilot fly the plane or replace the pilot altogether by autonomous hardware and software?  Even if the stats showed that autonomous aircraft are safer, it would probably still make many passengers uncomfortable if there was no pilot at all.  What if the robot malfunctions?  Of course, a surgeon could also make a mistake – and they do.  Critics say that the da Vinci’s benefits are difficult to prove, and that it may be a solution in search of a problem.  This means that because the company, Intuitive Surgical, was able to design and build the robot, and then went out and looked for ways to implement it.  Which is fine – sometimes the best inventions come about this way – but it can be a valid point, especially in the field of robotics.  Just because we can design and build a robot to perform a task, doesn’t automatically mean that we should.  For instance, a robotic barbecue cleaner – is that really necessary?  Of course, if it works and customers are willing to pay for it, then so be it.  But many robots will fail to gain traction for this reason: just because you are able to build a robot to perform a task does not necessarily mean that there is a market for it.

Back to the da Vinci robot.  Originally, it was designed for cardiovascular surgeries, but failed to gain traction is this type of surgery, and instead began to perform gynaecological surgeries.  But in 2013, the American College of Obstetricians and Gynaecologists (ACOG) declared that, in their opinion, the robot wasn’t the best option for non-cancerous gynaecological surgeries.  In the post on the ACOG website, the article lays out a few claims: first, that due to extensive and clever marketing, many women may be misinformed about the benefits of robotic surgeries for a hysterectomy.  They state that the reality is that it is not always the best solution for non-invasive surgeries – but it is often the most expensive.  They go on to say that there is no good data that proves it performs better than existing and far less costly minimally invasive procedures.  The article raises a very good point: the surgeons performing these surgeries are highly trained and specialized in their field.  But many of them would not have years of training with a robotic surgery system.  They state that studies have shown there to be a learning curve when using the robot, which is understandable since it is not the traditional way of performing surgeries.  The issue is that during this learning curve, complications increase.  They also state that the quality of surgery you will get with these devices varies – expertise with robot systems is varied and limited.

So, apart from criticism from varying doctors and medical societies, are there actually problems with the robot itself? In many cases, yes. Forget about the cost for a minute. Because if the da Vinci system does indeed deliver on the many promises it offers, then maybe a higher cost per surgery could be justified. You can easily google ‘da Vinci lawsuits’ or ‘da Vinci injuries/deaths’ and receive many hits. There are articles available, alleging that problems range from cut blood vessels to the patient being hit in the face by the robot itself. A particularly scary incident was report where the robot was physically unable to let go of a patient’s tissue during a surgery. Other research shows that robots may sometimes break and leave small parts of themselves inside the patient. The articles (some links to these articles are posted at the bottom of this paragraph) reiterate the point that many doctors feel that clever and widespread marketing have led to it’s widespread use, generating billions in revenue. Now, in another industry, I would feel less sympathetic for the complaining customers – buyer beware, to some extent. But when lives are on the line, and patients have put their trust in doctors, and doctors have put their trust in these robots, then it becomes a moral and ethical issue if the robots pose any danger to the patient for the sake of revenue. If a surgeon makes a human error, that is expected and in most cases, would not be driven by financial reasons (unless the surgery was unnecessary, for instance). According to reports, there have been over one hundred deaths link to the da Vinci surgical system in the last 13 years. Over one hundred cases of the robot breaking and pieces falling into the patient. Nearly two hundred reports of the robots emitting sparks, sometimes burning doctors and patients. And dozens of cases where the robot simply malfunctions, or the doctor loses control, and causes severe damage. These incidents have been fairly consistently spread out since the robot was introduced, perhaps indicating that the doctors are still learning, or issues with the robot have not been fully resolved.

Now after reading that, you are probably horrified – and at your next surgery, you will insist that a human surgeon and not the da Vinci open you up. But also consider that there are hundreds of thousands of people who die every year due to medical mistakes. Surgeons have been known countless times to leave objects inside of patients and sewing them up. The rate of death and injury with the da Vinci systems, then, doesn’t look so bad in that light. Especially as it is a fairly new technology, and as mentioned earlier, doctors themselves are just getting use to the machine and it’s learning curve. Maybe robotic surgery could be the way of the future, as these machines are improved upon and become more advanced. In that case, we may have the opportunity to truly reduce the mortalities due to medical errors. In my opinion, it is certainly not something to give up on yet. It is easy to present both sides of the issue, as both proponents and opponents of the surgical system have valid points that should be considered. As engineers, we need to aware of these moral and ethical issues when it comes to robots, and do our best to protect the public and keep them informed. Money should not be the driving factor (but most often is) – and we need to be especially with robots who’s intended use could have serious repercussions on human lives.

Now, the da Vinci robot is somewhat of an extreme case, since it is attempting to perform and extremely difficult task where human lives are on the line. But there are many other applications of robots in the healthcare industry, such as prosthetics, drug-deliver, and general care for patients. Let’s review a few examples.

Robot prosthetics for people who have lost limbs is an important applications of robotics in healthcare. Unfortunately, we have not yet developed the ability to regrow limbs – maybe one day. Until then, engineers can attempt to help these people by allowing them to walk again, or allowing them to do something as simple (and that most people take for granted) as picking up a cup of coffee. It used to be that prosthetics had no robotic component at all – they were simple prosthetics that may have helped patients walk, but not come close to regaining full function. They were crude, wooden prosthetics. Today, some prosthetics are incredibly advanced, such as interfacing the robot with human nerves so that the prosthetics can be controlled by the human nervous system. And not all of the advances are just in the field of robotics. Materials such as carbon fibre and titanium are vastly superior to wood and are now widely used, providing greater comfort, strength, and providing more life-like feeling. Enabling the prosthetics with microprocessors gives them the ability to ‘think’ – for instance, varying joint resistance in a prosthetic knee, based on the pressure placed on the prosthetic, preventing the knee from buckling.

A recent article published by the New York Times (highly recommended reading/viewing) describes in detail the advances scientists and engineers have made at the John Hopkins University Applied Physics Lab. This particular robot arm has 26 joints and can curl 45 pounds, which is more than most humans would be able to do. The prosthetic aims to give patients back full functionality of their arm, and then build on that to make them even better than the original arm (which opens up a whole other moral discussion, which I will briefly delve into below). The article describes how the truly remarkable aspect of this prosthetic is that it the nerves.

Robots are used for saving lives, but they can also be used for killing people who’s lives we’d rather end. The use of military robots is a rising concern. Now, this isn’t to say that all robots used by the military are armed, equipped to drop enemy combatants. In fact the majority of military robots may be used for other purposes such equipment transport and bomb diffusing robots. But anytime robots are used in a battlefield setting, the ethics must be considered. This can also be difficult because the U.S military has the ability to provide so many funds to advance robotic research – look at the Defence Advanced Research Projects Agency (DARPA), for instance. It would be unfair to say that DARPA is focused on the offensive (defence is in their name after all), and they fund many more projects and research than just battlefield applications. If you look at the topics they list on their website, they range from algorithms to autonomy to chemistry to imagery and language, to medical devices and microsystems. The have their hands in many pots. So while militaries may provide untold amounts of money to fund important research, the applications must be closely monitored and understood.

But there is definitely a moral dilemma with using robots and autonomous vehicles in wartime. Probably the most well know issues in the last ten years in the use of drones, which has been written on extensively. Drones – autonomous aircraft – have killed thousands of people in the wars in the Middle East, and often innocent civilians and children. Drones are still operated by a ‘pilot’ – but this pilot sits many thousands of miles away, sitting in a comfortable chair somewhere in the middle of the United States, while the drone seeks and destroys it’s targets. One of the main concerns is that this removes the human aspects, and makes it easier for the drone operators to pull the trigger – resulting in innocent people being killed. Laws are in place that require human operators to be involved. The Geneva Conventions laid out legal groundwork to ensure that fully autonomous weapons are illegal – human intervention is necessary at certain steps to ensure that the human is picking the target, and that the target is correct – the robot would not make these decisions. But with the advance of artificial intelligence, who knows how these laws will change in the future? Maybe wars will be decided on who has the most advanced robotics weaponry, and robots kill each other and not humans – although somehow that seems highly unlikely.

Here, we’ll look at some of the specific robots employed by militaries around the world. You’ll notice that none of these robots are able to make the decision to kill (not yet anyway) – humans must be consulted first and make that ultimate decision.

BigDog was created in 2005 by well-known robotics firm Boston Dynamics, based out of Massachusetts (which has since been purchased by Google – or Alphabet now). Partners also included NASA’s JPL (Jet Propulsion Laboratory) and the Harvard University Concord Field Station. It is a remarkable machine, and quite eerie to watch in action. The name describes it well; it looks like a black, headless dog, that stands 2.5 feet high and is about 3 feet long. It’s movements are natural to the point that it looks unnatural – many people find watching the robot walk unnerving, especially when it reacts as you’d expect a real dog (or even human) to react in situations such as slipping on ice. It weighs about 240 pounds, and is capable of running 4 miles per hour – jogging pace. The payload that it is able to carry is impressive – 340 pounds, nearly 1.5 times its bodyweight. It is able to walk on an incline of 35 degrees. These are all impressive in their own right, but it would be decidedly less impressive if this was simply a wheeled device – like an autonomous modified golf cart. But the thing The most impressive of all is how advanced the controls systems must be in order to keep it balanced and upright – walking, which again we talk for granted, is an extremely complex motion. The idea was that since it is capable of walking, it would be able to haul heavy loads over difficult terrain that would hamstring typical ground vehicles. The premise makes sense. A dog, or a wolf, would be able to climb steep inclines, rough terrain, muddy regions better than any wheeled vehicle, or even a human. The project was funded by DARPA.

Boston Dynamics has other legged robots apart from BigDog that are truly at the forefront of robotic technology which mimics animal walking. The LS3 is similar to BigDog but offers additional carrying capacity. The Cheetah is the fastest legged robot that has ever been built, maxing out at a top speed of 30 mph or 50 km/h. Currently, the Cheetah is externally powered, as so it can only reach these speeds on a treadmill, and needs an external boom to keep it on the treadmill. But Boston Dynamics plans on overcoming these technical challenges with it’s next version of the Cheetah, called the WildCat. The WildCat will be able to roam untethered – it is unknown how fast it will be able to sprint. The Sand Flea is like a remote-controlled car but with a unique ability: it is able to jump up to 30 feet in the air. It is able to drive flipped on either side. Planned uses include breaching high walls for intelligence gathering. It ‘jumps’ by raising itself to a certain launch angle by an level-like device which pushes against the ground, raising its front wheels in the air; it then propels itself by punching against the ground with a piston-like device, propelling it into the air. Once in the air, control systems and gyro sensors keep it level, so that the video it feeds back to its operators remains level and clear, and so that it lands on all four wheels when it lands, spreading out the impact and limiting the possibility of damage to the device. It is fascinating to watch, and I recommend visiting the Boston Dynamic website (or visiting YouTube and searching for these robots).

Now the question some of you may be asking: are these robots useful? Wouldn’t a small drone be able to do the same job as the Sand Flea by flying over walls? While the sound a drone makes may be an issue, the landing of the Sand Flea isn’t exactly silent. As for the legged robots, is it practical to have a large robot carry heavy gear over terrain? Wouldn’t air support be able to drop in these items, flying over the rough terrain? And how often are soldiers clambering over rocks and the like which typical ground vehicles are unable to cover? It seems unlikely that on a mission, soldiers would be sent miles through extremely rough terrain. But whatever the usefulness of these robots, or if they will see frequent field use, or the concern over the potential weaponizing of these robots, one thing is certain: they are remarkable machines, at the forefront of robotics technology of this type. Experts in several different fields work to make and design these robots, and they are advancing the state of robotics technology. It is likely that the technologies they are developing will find use elsewhere (hopefully in an application other than for military use!).

Now to move over to the applications of robots in the field of medicine and clinical engineering. We’ve discussed the da Vinci system at length, partly because it is the most well-known surgical system currently being used. But there are others. And while robotic surgery may be the most often though of and glamorous application of robotics in the healthcare system, there are many other ways that robots could be beneficial for humans. I’ll discuss a few here, but the list is by no means exhaustive. It is simply meant to get prospective students and engineers of the field thinking about the endless possibilities of robotics.

Robots are doing more and more ‘dirty’ work in hospitals. The type of work that is crucial to the operation of a hospital, but that is low-skill work, such as doing laundry, fetching items for patients, delivering clean sheets, delivering food, taking away dirty laundry, etc. These robots could potentially eliminate the running around, unskilled work that nurses have to do as part of their daily job – and let them focus on patient care. A great example of this type of robot is TUG, built by Aethon. TUGs are able to work around the clock – 24/7, if needed. They are completely autonomous, navigating the hospital themselves, equipped with sensors to prevent from bumping into objects – but more importantly, so they don’t smash into patients, doctors, nurses – humans in the hospital. But smash is a strong word, since the TUG moves no faster than a casual walking pace. Apart from the improved productivity, they allow nurses and hospital workers to focus on more important work such as providing increased care – spending more time with patients. The TUG machine is able to carry heavy loads, limiting fatigue and injuries in hospital workers – increasing job satisfaction (which in turn could increase the level of care that patients receive, if the workers themselves are happier with their jobs). There are two buttons – one to turn off the robot, one to turn it one. The robot works by having a touch screen interface so that the operators can specify where to make deliveries or pick up materials and equipment. The TUG robot will also calculate the most efficient path if there are multiple drop-offs/pickups scheduled. For navigation, the robot contains overlapping sensors for redundancy to ensure that it travels in a safe an effective manner. It employs laser sensors for high accuracy. Obviously, the sensing system is extremely important. It would be a complete failure if the robot posed any threat to humans in the hospital at all, or could possible damage equipment. It also employs sonar and infrared sensors near ground level to detect any low-lying objects in it’s path. Now, the robot does not rely on sensors alone. How would you go about giving it effective information?

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