"We have been given an ambitious task"
How a robot surgeon was created in Russia
"News 1R1", Tatiana Pichugina
A new Russian robot surgeon capable of performing complex operations on blood vessels, heart and even brain has successfully passed tests and will soon enter the world market of medical equipment. "Novosti 1R1" tells what an assisting surgical complex of domestic development is capable of, why patients will not have to pay for it and in what it surpasses the American competitor "da Vinci" – a machine of the previous generation.
The first robots for surgery were created in the USA in the mid-1980s. The electric manipulator, guided by the computed tomography data, performed a brain biopsy. In 1990, the startup Computer Motion, commissioned by NASA, produced a robotic arm "AESOP" (AESOP), armed with an endoscope. It could be controlled by voice commands. The Space Agency intended to equip orbital shuttles with this manipulator, and when the program was closed, Aesop came in handy in civilian medicine.
In the 2000s, he was replaced by a more advanced robot surgeon "da Vinci". The doctor is sitting at the console, watching the operating field in a 3D monitor. With the help of joysticks and pedals, he controls manipulators and instruments inserted into the patient located on the trolley.
The era of "da Vinci"
Initially, da Vinci was developed for heart surgery, coronary artery bypass grafting. Then the scope of application was expanded, and now the most popular operations with its help are prostatectomy and hysterectomy.
Da Vinci has revolutionized surgery through the introduction of robotic technology. But it has drawbacks. The fact is that on average one robot performs one operation in two days. That is, a device worth more than two million dollars is actually idle. This is explained, firstly, by the price of the operation with his participation, which does not fit into the insurance: the patient or the clinic are forced to pay extra. Secondly, it has limited functionality," Sergey Sheptunov, Doctor of Technical Sciences, Director of the Institute of Design and Technological Informatics of the Russian Academy of Sciences, tells Novosti 1R1.
The manufacturer "da Vinci" actually monopolized the market. Several thousand such complexes have been sold in the world. About 30 operate in Russia. However, in practice, "da Vinci" was not as effective as doctors expected. Among the difficulties associated with it, the large dimensions and weight of the complex are noted, the need to specially prepare an operating room for him, a narrow viewing angle for the surgeon. In addition, one mechanism is used for different movements of the manipulator. Maintenance of the robot is also expensive: one set of tools for manipulators costs about three thousand dollars. It is possible to train surgeons for its use only abroad.
"We won't repeat it"
Russian doctors have performed more than one thousand operations with the help of da Vinci and know all its problems. A few years ago, Dmitry Pushkar, head of the Department of Urology of the Moscow State Medical University and chief urologist of the Ministry of Health, proposed to create a more advanced robot that takes into account all the wishes of surgeons.
Sergey Sheptunov and a team of young engineers took up the project.
"To make such a robot, you need to be completely untethered. You can't attract the old experience here," the scientist says.
The Institute of Design and Technological Informatics of the Russian Academy of Sciences was founded in 1990, during perestroika. Its specialists were engaged in automation of machine tool construction, and then applied their achievements in a variety of fields: from education to medicine. We designed automated parking lots, educational engineering stands, created medical implants with nanostructured surfaces, composite nanoparticles that inhibit cancer cells.
"Having studied what technologies surgeons need, we realized that it makes no sense to improve da Vinci. We have developed a fundamentally different architecture. We made a layout that is seven and a half times larger than what turned out in the end. We proved that our approach works and started implementing it. If da Vinci is a standard robot, then ours is focused on surgery," says Sheptunov.
Surgeons needed a compact robot with high precision of actions and wide functionality. An important technical condition is that the manipulators must be attached to the operating table. And, of course, the operation cannot be as expensive as with "da Vinci" – it is necessary to fit into the CHI.
Engineers have radically changed the configuration of the system, methods of fixing tools, cameras, significantly reducing the dimensions of the installation, increasing its mobility and expanding functionality.
Can I touch it
An operation using a domestic robot surgeon, or, as the developers call it, an assisting surgical complex, looks similar to how "da Vinci" operates. The surgeon sits at the console, using the controller handles for manipulation and pedals to enable various functions. He looks at the monitor in 3D glasses, where the operating field is shown with a given magnification. You can change the scale: for example, zoom in on a blood vessel to cauterize with a coagulator or put a clip. The movements of the surgeon are transmitted by controllers to manipulators on a microscale.
Russian scientists have achieved an order of magnitude greater manipulation accuracy: 50 microns instead of half a millimeter at da Vinci. It may not always be necessary in urology, but it is very important in cardiac surgery, in operations on vessels, spine or brain. High precision expands the scope of the robot surgeon.
"Da Vinci", in order to achieve such accuracy, must be several times larger. With the current architecture, they will not be able to overcome the barrier of one hundred microns," Sergey Alexandrovich is sure. Unlike da Vinci, the Russian robot was immediately created on a digital platform, which, combined with the rejection of the cable mechanism, made it possible to implement feedback when the surgical operator physically feels the pressure of the instrument on the tissue. That is, the installation conveys tactile sensations that are so important in surgery. Of course, scientists do not disclose the principle of feedback implementation: this is know-how with great commercial potential.
"We have developed universal fasteners to the operating table that position the manipulators relative to the body with the right accuracy, at the right angles," the scientists add. Another "trick" is that the operating field can be set simply by outlining it on the monitor. The manipulator tool will not go beyond this contour and will not touch, for example, the bones of the pelvis, which is fraught with inflammation.
And, of course, the brain of the whole system is a computer. All the movements of the surgeon on the controllers are recorded in his memory – they are calculated and transmitted to the manipulators. This will allow in the future to connect elements of artificial intelligence to facilitate the work of a person.
A surgeon – and a surgeon in the Arctic
Completely domestic development has recently passed a "battle" baptism. With her help, a pig was operated on, removing uterine fibroids. Now the robot is being upgraded and will soon be promoted to the market.
The plans are to implement a mobile version of the robot surgeon, which fits in a suitcase and is suitable for field conditions. The batteries are enough for three hours of battery life. A doctor at a hard–to-reach point will have time to perform the operation - independently or under the supervision of an experienced surgeon watching the process on a monitor from another region. To do this, you only need mobile Internet. Fully remote control of the robot is not yet possible due to the physical limitation of the speed of communication lines. The longer the cable, the longer the signal goes. And a delay of even five milliseconds is critical for a surgeon.
The developers are trying to expand the robot's capabilities by making the tip of the tool rotate 180 degrees. In addition, they want to equip the complex with another tool – a laser. Then a lot of surgical techniques and technologies will be added, including operations on areas of ten microns in size, that is, at the cellular level. No robot surgeon is capable of such a thing yet.
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