Robots in surgery: where and how are they used

Last Thursday, the world’s first baby born in a uterus, which was completely transplanted using robot-assisted surgery, was born at the clinic of the Swedish University of Gothenburg. The creation of robotic surgical systems is one of the most promising and rapidly developing areas in medical equipment. By 2030, this market will exceed $30 billion. Already, there are robots that perform a variety of operations, however, so far this is more of a smart tool for a surgeon than an independent system.

Rapid market growth

In recent years, the use of robots in surgery has been actively developing. By forecasts Analytical company GlobalData, the number of surgical operations using robotic systems will grow in the period up to 2030 by an average of 10.5% per year. The global market for surgical robots and components for them, which in 2020, according to some countingwas estimated at $4.6 billion, will reach by this time $30.7 billion that is, it will grow almost six times.

GlobalData analysts note that the popularity of operations using robots has grown significantly over the past five years. They are used, for example, in the field of general surgery, as well as in cardiovascular, gynecological, cosmetic and other operations. According to forecasts, by 2030, 87% of surgical operations will be performed by a robot. At the same time, systems for orthopedic and neurosurgical operations are the fastest growing segments.

Robotic surgery also has its own limiting factors: it requires more financial investments than other medical areas, and therefore is more vulnerable in the event of an economic crisis. It is for this reason that the number of such systems acquired by American medical institutions decreased by 27% last year.

“During the economic downturn, it is much more difficult for healthcare companies to get funding for robotic surgical systems. Purchasing such systems is a significant capital investment for medical institutions,” said Tina Deng, chief medical equipment analyst at GlobalData. According to her, the average cost of such a system is $ 1 million plus maintenance fees. At the same time, in the long term, according to Ms. Deng, even economic difficulties can increase the demand for surgical robots due to “greater efficiency and cost savings compared to traditional surgical methods.”

Subtle, however, work

First surgical robot approved by US authorities back in 2000 – it was the device of the American company Intuitive Surgical called da Vinci. Since then, more than 7,500 such robots have been delivered to hospitals around the world, designed for various operations.

Two and a half decades later, significant changes have taken place in this area. The use of robotic systems allows for less invasive and more precise operations.

Robots make smaller incisions, which makes operations less painful, faster recovery after them, etc. It has become possible to insert a camera and a robotic arm with instruments into the patient’s body through small or even pinpoint incisions.

Last Thursday at the clinic of the Swedish University of Gothenburg for the first time in the world was born a baby born in a uterus transplanted using a robotic surgical system. This made it possible to carry out this operation with minimal blood loss. The uterus was transplanted at the university clinic in October 2021. “With minimal intervention robotic surgery, we can perform ultra-precise surgeries. This is the surgery of the future,” said Pernilla Dam-Köhler, lecturer at the Sahlgreni Academy of the University of Gothenburg, who performed the operation.

In 2019 at the same clinic of the University of Gothenburg was born the world’s first womb baby to be transplanted by a robot. But then the robot was only involved in extracting the uterus from the donor. The Gothenburg surgeons did not then implant the uterus with the help of a robot, and the future woman in labor underwent the usual large abdominal operation. Now, doctors have used the robot in both extraction and uterine implantation.

The Israeli company Tamar Robotics recently introduced robotic system for neurosurgery. As described in the company, this is the smallest and most accurate system for brain surgery. Its main part is a tube with a diameter of 10 mm, equipped with a camera and robotic “arms” with the necessary tools. It is primarily designed to remove tumors and blood clots in the brain. The practical application of the robot should begin in the US already in 2026.

Usually, neurosurgeons have to make larger holes to reach the areas of the brain that are being operated on, which means more healthy areas are affected. “In the brain, everything is so subtle and sensitive that if you move in the wrong direction, you can remove the tumor, but the patient will not be able to speak or move for the rest of his life. Therefore, reducing the corridor through the brain tissue to the tumor is of great importance,” says Aaron Feldman, vice president of business development at Tamar Robotics.

According to experts, a promising direction is the creation of more flexible and “softer” robots, the possibilities of which will be wider than those of the current ones. “These flexible, hingeless robots will be able to sink even deeper into the body, and therefore they will be able to solve problems that cannot currently be solved,” says Bernd Vogel, founder of Endosmart. It is developing components for such robots, made from nitinol, a titanium-nickel compound.

The creation of advanced surgical robots can be significantly accelerated through the use of artificial intelligence, cloud computing and other cutting-edge technologies.

At the same time, the robot is still more of a smart tool led by a doctor than an independent system. This is due, among other things, to the fact that the size and exact location of the organs differ in each person.

To some extent, cameras, sensors and software that track the smallest movements of the tissue and the scalpel allow to solve this problem. Last year, scientists from the American Johns Hopkins University tested Smart Tissue Autonomous Robot. He sewed together two parts of a torn intestine from a pig. Both parts were coated with a fluorescent gel, which was tracked by the robot’s sensors. At the same time, the cameras created a three-dimensional model of the tissue, also transferring it to the system. However, although 83% of all stitches were performed by the system itself, in 17% of cases a human had to intervene.

Even with a significant increase in accuracy, the issue of safety and decision making remains – the same problem that completely unmanned vehicles still do not drive on ordinary roads en masse. According to Alex Attanasio, a researcher at the Japanese company Konica Minolta, who studies surgical robots among other things, regulators and hospitals want to be explained to them how the robot makes certain decisions. Namely, this is where problems arise – modern robots using machine learning technologies make decisions based on large amounts of data, so that people are not able to explain each of their specific decisions and actions.

Yana Rozhdestvenskaya