In use for nearly 20 years, robotic surgery utilizing the da Vinci Surgical System has become a standard technique by hospitals in the United States and Europe when performing minimally invasive procedures. And while the elements of precision, flexibility, and control associated with robot-assisted surgery has made it popular within the surgical suite, technological advances now in development may soon take its application to the battlefield, natural disasters, and even space.

Dr. Gianluca De Novi.

In disasters or war zones, patients are generally triaged and transported to treatment centers where doctors are available to perform surgery. Those first few hours post injury are critical, with patients often receiving the most minimal level of care.

Current robotic surgical solutions cannot be applied to the operational field for multiple reasons. Their size and weight are not usable due to bulk; they require fixed installation and a sterile, controlled temperature environment; incapability to perform any open surgery procedure; and require surgeons to operate within feet of the wounded. Remote telerobotic procedures have been performed but they remain still rare occasions due the many technical difficulties such as the communication delays. It stands to reason that onsite containers with surgical robots and real emergency rooms can provide the best immediate care as the environment is safer than transporting an unstable patient.

Advancements are now under way to bring surgical robotic solutions as close as the firing line, shortening the vital time lapse between wound and heal. The methodology — one that has received strong reviews from key experts in the military and the U.S. Department of Defense — would allow surgical robots to perform both minimally invasive and open surgery, guided by surgeons from remote locations. This solution brings together components of technologies already CE marked with a native design for field operations.

The remote methodology is composed of a plurality of surgical units; each unit maintains a base with 1° of freedom (DoF), an anthropomorphous robotic arm with seven DoFs; an end-effector, mounted at the arm wrist, carrying three actuators that drive the surgical tool, and a three DoFs surgical tool. Moreover, the first six DoFs of the arm are provided with torque sensing. Its weight is limited to less than 300 lb in order for the parts to be deployed in the operational theater and the size is deployable with normal military vehicles. Each surgical tool is comprised of a distal component, a rod and an interface component.

Remotely guided surgical robot.

The digital component is the actual surgical tool: i.e., grasper, scissors, dissector. It has two rotational joints in order to orient the tool's tip around two perpendicular axes and to open and close its jaws.

This work in progress is being developed with artificial intelligence (AI) to make the technology fully autonomous. It will have many capabilities well suited to environments outside the surgical suite in terms of sensitivity, flexibility, size, and cost efficiencies. Movement scaling is expected to exceed 10 times the accuracy of standard surgical robots, it provides enhanced vision and navigation and high dexterity (10 DoF) allows for ease to learn and operate.

In terms of flexibility, the advanced surgical robot soon headed to market is modular in design for easy and swift setup; makes multi-quadrant procedures possible; can execute both laparoscopic and open procedures with microsurgery precision; contains sensors and software to simplify coordination of movements; is compact and light enough for movement to another operating site within minutes.

Coming in at a cost of 50 percent less per procedure than the standard da Vinci method, the remote technology can perform 5–10 times higher the number of procedures per tool and can be used in virtually in any procedure.

Changes in today's battlefields and air space have made it challenging to evacuate patients to different locations for treatment, making surgical robotics technology particularly promising to expeditionary medical and theater hospital environments. The fully autonomous surgical robot seems to be even more appealing, cutting out any need for external communication.

Designing technology for tomorrow may not be the easiest task. The integration of artificial intelligence combined with a stringent certification protocol can be daunting, but the benefits of deploying life-saving procedures to battlefield conditions, disaster recovery, and eventually to space will make this in-development iteration of robotic surgery one for the ages.

This article was submitted by Gianluca De Novi of XSurgical.


Medical Design Briefs Magazine

This article first appeared in the July, 2019 issue of Medical Design Briefs Magazine.

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