In addition to safety, the large-scale application of medical robots must meet the doctor's clinical needs and usage habits, improve the treatment effect, and consider whether to increase the patient's expenses.
"After a long operation time, doctors will inevitably shake hands. The surgical robot can filter the jitter and avoid the threat to the patient." Zhu Gang, a doctor at Beijing Hejia Hospital, sat at the computer and played back the surgery he had done with the Da Vinci robot: Two micro-mechanical arms enter the abdominal cavity of the patient from the abdomen hole and the tumor is removed.
Unlike fully automated industrial robots, Da Vinci still needs a doctor to operate. The patient is lying on the operating table. Zhu Gang is sitting on the robot console and staring at the imaging system. This system can clearly magnify the surgical site several times. The left and right hands respectively manipulate the two handles on the console, supplemented by the foot. The control pedal, commanding the robotic arm to complete the operation.
Since its inception in 1996, Da Vinci has been synonymous with medical robots for generations in the past 20 years. Nowadays, more types of robots are beginning to appear, helping medical staff to get the job done better in each medical session.
In the current medical robot market, European and American companies occupy a major market share. China's medical robots are still in the stage of research and development or clinical trials. The scale of medical robots has not yet been realized, and the penetration rate in medical institutions is also low, but efforts are being made to catch up.
Surgical robot first
As early as 1985, doctors at the Los Angeles Hospital completed a neurosurgical brain biopsy with the assistance of the Puma560 industrial robot. This is the first time that robotics has been used in surgery.
Since then, medical robots have developed many types. The team of the Academician Wang Tianmiao of the Institute of Robotics, Beijing University of Aeronautics and Astronautics has written an article describing the medical robots that have been marketed into several categories according to their functions and uses, including neurosurgical robots, orthopedic robots, laparoscopic robots, vascular interventional robots, prosthetic and exoskeleton robots. , assisted rehabilitation robots, hospital service robots and capsule robots.
Da Vinci is one of the most successful medical robots in commercialization. It is mainly used for minimally invasive laparoscopic surgery in cardiac surgery, urology, thoracic surgery, hepatobiliary surgery, gastrointestinal surgery, and gynecology. Li Bijing, CEO of Hejia Medical, participated in the introduction of Da Vinci into China. She told reporters that as of the second quarter of 2016, more than 3,700 Da Vinci have been deployed worldwide, of which 2,474 are in the United States, followed by Europe and Asia, completing millions of operations.
The Da Vinci robot consists of three parts, a bedside robotic system consisting of a doctor's operating system, three instrument arms and a lens arm, and a three-dimensional video imaging system. During the operation, Zhu Gang only needs to operate the handle to control the robot arm into the abdominal cavity for surgery. The imaging system provides a high-definition three-dimensional surgical field of view with open direct vision to help him judge.
Zhu Gang and many surgeons can cite a series of advantages of Da Vinci. With the aid of the robot, the doctor can sit and perform the operation. The comfortable sitting is conducive to long and complicated surgery, and it is the liberation of the doctor's body. Li Haoyuan, Ph.D., of the Institute of Intelligent Robotics, Beijing Institute of Technology, said that the operation accuracy of the robot is controlled by the computer, which filters the hand shake caused by the fatigue and reduces the risk of surgery.
With the help of the robot, Zhu Gang alone can complete most of the work of the previous TV laparoscopic surgery team, which can save more manpower.
In addition, the doctor uses the mechanical arm to enter the abdominal cavity for surgery, avoiding direct contact with the patient and reducing the risk of infection; and the surgical incision is small, and the recovery time of the patient is naturally faster.
Up to now, China has deployed about 60 Da Vinci robots, mainly in first-tier cities and large hospitals. Due to the liberalization of procurement of large-scale equipment, some provincial-level and provincial-level top three hospitals in coastal developed areas are also planning to purchase surgical robots.
Zhu Gang himself experienced the replacement of open surgery by laparoscopic surgery, which is quite optimistic about robotic surgery. In his opinion, as long as the robot is skilled, more surgery can be given to the robot to complete, and the doctor can continuously improve the speed and accuracy of the operation. “We are now using robots for prostate cancer surgery, which takes less time than open surgery,†he said.
Li Haoyuan pointed out that the laparoscopic surgery robot has its own uniqueness. The physiological and anatomical knowledge of the internal organs of the abdominal cavity is accumulated more, the relative activity space inside the abdominal cavity is increased, and the external intervention of the robot is larger, and the risk is relatively small.
The neurosurgical robots that target the brain are in stark contrast. Wang Tianmiao pointed out that "mostly the neurosurgical robots currently on the market use the pre-medical image navigation method to guide and position the robot. The brain tissue will be deformed and displaced due to intracranial pressure changes during the operation, which will inevitably cause positioning. Error." The brain tissue is too fragile to withstand excessive external intrusion, and error means risk. Therefore, the neurosurgical robot needs to be repeatedly adjusted by the doctor in combination with the medical image during the operation of the auxiliary surgery, which becomes a bottleneck that needs to be broken.
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