"The future of surgery is not about blood and guts; the future of surgery is about bits and bytes.”
/Dr. Richard Satava/

Thursday, July 28, 2011

Origins of surgical robotics

I was always wondering who had first the idea to use robots for surgery. Many of the famous people started their work towards their robotic surgery system in the late '80s, early '90s, inspired by some physicians. But apparently, the idea dates back a lot earlier. 
Arthur D. Alexander III, from NASA Ames Research Centerpublished a few articles in 1972-73 around the topic "Impacts of Telemation on Modern Society". What is really impressive that he had already had a clear concept how a master-slave teleoperational robot system should look like, and also envisioned dedicated medical-purpose comm stellites. (See the figure on the right.) Below, excerpts from the 1973 publication. Should you have any furher information, please, let us know!

"A 90-day study was made of teleoperators, robotics, and remote systems technology in the United States. The purpose of the study was to survey state-of-the-art technology in this field, determine major user needs in medicine, mining, and oceanography, and suggest initiatives where federal research and development funding would most significantly impact the application of this technology to the alleviation of explicit national social problems. Following a review of the findings of this study commencing with user needs, speculation is made on impending developments in the application of telemation to remote emergency medical care and remote mining systems. " Source: CSA

"Use of Manipulators for Remote Medical Emergency Care Recent advances in the technology of human extension by remote manipulation, concepts derived largely from the U.S. space program, make possible professional medical care, including surgery, in situ at the emergency site and remote from an environmenrspecializing in acute care (such hs a hospital emergency facility or Clinic). Figure 2 illustrates such a remote surgical system. A proposal, currently under consideration, suggests the use of human extension through remote manipulation to upgrade the quality of medical care at both remote and accessible areas and to make the most effective use of scarce skilled medical practitioners
throughout this nation and the world for the relief of human suffering. This proposal is directed specifically to a pilot study of the use of human extension by remote manipulation for extended medical care at the emergency site. It includes a survey of on-site remote medical care capability, the
design of an emergency care package, and a pilot research demonstration of remote surgery for one or
more procedures.
Initially assuming a modular concept, a proven minimum requirement for remote patient treatment is
a two-way color TV/voice communication system (Massachusetts General Hospital's Logan Airport Emergency Room) that enables skilled doctor/patient interfacing. Next, in order of importance, basic diagnostic equipment is required at the emergency site: 
  • respirometer, 
  • sphygmomanometer, 
  • remote stethoscoper,
  • fluoroscope, 
  • image intensifier radiography, 
  • EKG machine,
  • possibly EEG capability. 
All such equipment must be remotely operable through reliable telemetry, which state-of-the-art technology presently permits. The ultimate modular design would provide remote treatment capability, thus eliminating the need for trained paramedical personnel to be in attendance at the remote emergency site. Envisioned for this purpose would be a pair of master/slave manipulator arms remotely extending the doctor's manipulative, tactile (touch), visual (stereo TV or fiberoptic telemetry at terminal "hands"), and listening (stereosonic) capability. Adjunct treatment equipment would provide for remote maintenance of life-support functions and might include respirator, heart stimulator, blood flow control apparatus,anaesthesia equipment, and skeletal support systems.
In summary, an idealized modular remote care system must provide the attending physician with reliable two-way communication, diagnostic and treatment capability in that order. Each of the preceding concepts represents a distinct and measurable improvement over existing emergency care procedures.
As remote emergency care is demonstrated to be feasible, and as the concept becomes accepted domestic medical practice, a number of international implications will become evident. As emerging
nations place greater emphasis on developing technology (greater use of machinery, cars, etc.), they
will encounter an increasing accident frequency--a frequency they may be unable to deal with effectively unless they are able to educate and develop concurrently a medical staff adequate for their needs. A practical interim solution would be to draw upon medical staffs in the developed nations to provide that care using remotely operable facilities linked by dedicated medical communication satellites.
Further, these remotely operable emergency care facilities, when not in direct use, could be used for
medical education purposes, linking the outstanding medical centers of the world to the most remote
regions, providing access to the most advanced medical techniques and procedures available."

So thus surgical robotics was born...

A couple of the early patents citing this: SRI1, SRI2, SRI3, SRI4, SRI5, SRI6, Intuitive, Intuitive1 , Intuitive2, Intuitive3.

Update:
Learn more about in-space surgery capabilities from this old but very detailed NASA report.

Source: Alexander AD, "Impacts of telemation on modern society," Proc. of the 1st CISM-ITOMM Symposium. New York: Springer, Wein, 1972; pp.121–36.
~ in Proc. of the Annual Meeting of Human Factors and Ergonomics Society, vol. 17, no. 2, Santa Monica, CA, 1973, pp. 299–304.
~  Human Factors Society, 17th Annual Meeting, Washington D.C.; 16-18 Oct. 1973. pp.299-304. 1973

2 comments:

ted said...

Great article. Would you know where I can find a full text copy of the above source?

T. said...

Yeah, it's weird they removed it. Drop me an email and I send it!