Autonomy for surgical robots

A great editorial appeared in Science Robotics this week, presenting the expected 6 levels of autonomy for surgical robots, or robot surgeons on higher level. This is very much in line with the brand new IEC 60601-4-1 Technical report on Medical electrical equipment and medical electrical systems employing a degree of autonomy. The envisioned levels include:
  • "Level 0: No autonomy. This level includes tele-operated robots or prosthetic devices that respond to and follow the user's command. A surgical robot with motion scaling also fits this category because the output represents the surgeon’s desired motion.
  • Level 1: Robot assistance. The robot provides some mechanical guidance or assistance during a task while the human has continuous control of the system. Examples include surgical robots with virtual fixtures (or active constraints) (2) and lower-limb devices with balance control.
  • Level 2: Task autonomy. The robot is autonomous for specific tasks initiated by a human. The difference from Level 1 is that the operator has discrete, rather than continuous, control of the system. An example is surgical suturing (3) the surgeon indicates where a running suture should be placed, and the robot performs the task autonomously while the surgeon monitors and intervenes as needed.
  • Level 3: Conditional autonomy. A system generates task strategies but relies on the human to select from among different strategies or to approve an autonomously selected strategy. This type of surgical robot can perform a task without close oversight. An active lower-limb prosthetic device can sense the wearer’s desire to move and adjusts automatically without any direct attention from the wearer. 
  • Level 4: High autonomy. The robot can make medical decisions but under the supervision of a qualified doctor. A surgical analogy would be a robotic resident,who performs the surgery under the supervision of an attending surgeon. 
  • Level 5: Full autonomy (no human needed). This is a “robotic surgeon” that can perform an entire surgery. This can be construed broadly as a system capable of all procedures performed by, say, a general surgeon. A robotic surgeon is currently in the realm of science fiction."


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