Robots are poised to revolutionize the practice of medicine. Artificial intelligence, miniaturization, and computer power are contributing to the rise in design and use of robots in medicine.
Medical robots had their start about 34 years ago when an industrial robot and computed tomography navigation were used to insert a probe into the brain to obtain a biopsy specimen (1). This was followed by a number of robots that were capable of certain urological procedures and total hip arthroplasty. These fully autonomous robots, however, did not find favor with surgeons and subsequent robots were designed to be slaves to surgeon masters (1).
Today, medical robots are well known for their roles in surgery, specifically the use of robots, computers and software to accurately manipulate surgical instruments through one or more small incisions for various surgical procedures (2). A 3-D high-definition magnified view of the surgical field enables the surgeon to operate with high precision and control. One instrument, da Vinci, approved by the FDA in 2000, is said to have been used to perform over 6 million surgeries, worldwide. Patient benefits from robot-assisted surgery are largely those associated with the laparoscopic approach — smaller incisions, reduced blood loss, and faster recovery. Long-term surgical outcomes don’t appear to be different from those of traditional surgery and the system has occasional malfunction. Surgeons benefit from improved ergonomics and dexterity in comparison with traditional laparoscopy. Major drawbacks are high cost and the need for training of surgeons and the surgical team. The base price of a da Vinci system is upwards of $1 million.
Various companies are developing surgical robots designed for a single specific procedure such as knee or hip replacement. Other companies are seeking to build systems that incorporate artificial intelligence to assist surgical decision-making (1). In neurosurgery, Modus V is an automated robotic arm and digital microscope built by a Toronto company and based on the space shuttle Canadarm technology (3). The arm tracks surgical instruments, automatically moves to the appropriate area in which the surgeon is working, and projects a magnified, high resolution image on a screen.
Prostheses are benefitting considerably from new structures and control systems (2). Robotic limbs with bionic skin and neural system are allowing a remarkable degree of user control. Robotic exoskeletons (orthoses) are finding use in rehabilitation, assisting paralyzed people to walk and to correct for malformations (2). Robots are also finding a place in keeping hospitals clean as hospital rooms are being disinfected with the use of high intensity UV light applied by a robot (2).
Traditional endoscopy may soon be replaced by small robots that can be driven to specific locations to carry out various tasks such as taking a biopsy or cauterizing a bleeding blood vessel. Microrobots may be employed to travel through blood vessels and deliver therapy such as radiation or medication to a specific site. Robotic endoscopic capsules can be swallowed to patrol the digestive system, gather information, and send diagnostic information back to the operator. Then there are robotic nurses designed to assist or replace overworked nurses with tasks such as digital entries, monitoring patients, drawing blood, and moving carts. A really exciting area of medical robotics is in replacement of antibiotics. The concept is that nanorobots with receptors to which bacteria adhere can be used to attract bacteria in the blood stream or in sites of local infection.
Do any of these grand developments have a place in veterinary medicine? Robots are currently being used in simulations for training veterinarians and can be used for tasks such as lifting animals. Until robot-assisted surgical equipment becomes far less expensive and proves to add value to current laparoscopic procedures it seems unlikely to become incorporated into veterinary practice. However, robot assistants, robotic prostheses, hospital disinfectant machines, and microrobots that conduct endoscopic examinations or treat patients are distinct possibilities for the veterinary practice of the future. Indeed, it may not be long before there are robotics veterinarians who provide care for animals with prosthetic limbs or implanted chips or for robotic animals that are used in a variety of settings.
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