Precise assistants in the operating room

Robot technologies are increasingly finding their way into modern medicine. They are improving the quality of diagnosis, therapy and care.

Whether it is rising life expectancy, the growing shortage of skilled labor or exploding costs – the healthcare system is facing great challenges. The key to mastering these problems is the rapid advance of medical technology. What sounded like science fiction just a few years ago is today a reality: from diagnostics to treatment, robotic components provide doctors with support in a manner that is safe, precise and consistent. In the future, robots will be able to perform an increasing number of tasks in the field of healthcare – for example, as reliable assistants to surgeons in operation rooms or as mechatronic helpers in rehabilitation and nursing care.

In many areas of the healthcare system, robots are already being tested and used successfully. This includes robot-based systems for X-ray imaging, for radiotherapy and for patient positioning. The major advantage of using robots is that the machines work untiringly and offer maximum precision around the clock – even for emergency services – and are safe helpers for medical specialists.

But robot technology is not just on the march in diagnosis and therapy. Robots are also already being used for medical and nursing logistics, where they are helping personnel with simple tasks such as the transport of laundry in hospitals and retirement homes. Scientists from the Fraunhofer Institute for Household and Assistive Robots in Stuttgart are currently testing a robot to assist elderly care workers. Among other things, the prototype can serve as a waiter and play Pairs. The development of robotic assistants for nursing care is one option for handling the growing number of nursing care patients and the simultaneous shortage of skilled labor. The German Federal Statistical Office estimates that the number of those requiring nursing care in Germany will increase from the current 2.6 million cases to around 4.5 million by 2050.

Robot technology improves X-ray imaging

Robot-based systems for X-ray imaging are one example of the existing use of robotic components in the field of medicine. With these systems, a robot with six rotational axes enables the physician to move the so-called C-arm – a C-shaped X-ray device – flexibly around the patient. This allows angiography to be applied even during the operation without moving the patient. The elementary advantage of the robot-guided C-arm is the precise rotation of the C-arm around the patient, thereby enabling the generation of high-quality 3D X-ray images directly in the operating room.  There is no need to transfer the patient to an imaging department (CT) in a different part of the hospital.  Much valuable time is thus saved. The surgeon obtains, in near-real time, three-dimensional images of the position of the blood vessels, the instruments being used or the stents that are to be implanted during vascular surgery. This combination of operating room and 3D imaging is therefore referred to as the “hybrid operating room”. It increases the safety of operations, particularly for complex interventions such as catheter-supported heart valve replacement. Thanks to flexible and precise robot-based X-ray imaging, it is possible to carry out such an intervention through the groin with minimal access. An open-chest operation is then no longer required. Beyond this, the doctor can carry out complex movements using the C-arm that are not possible with conventional C-arm systems – for example, for peripheral images of the patient when the patient is in an inclined position.

These robot-assisted angiography systems are also coupled with the controller of the robotic patient table so that the C-arm automatically tracks changes in position of the table. This feature is also of major benefit to physicians for ergonomic reasons, as they often have to work bent over the patient for hours on end. This is a particular advantage during lengthy interventions in which the surgeon has to wear a heavy lead apron. If the system is not needed, it can be parked off to the side to take up a minimum of space or the C-arm can be positioned upwards so that it is no longer in the way. This is of particular importance in rooms that are used for minimally invasive surgery and operating procedures in which 3D imaging is not required.

Robot-based oncology increases precision

Robotic components are also being used to improve cancer treatment therapies, for example, with robot-controlled radiosurgery systems for the treatment of tumors. Instead of a scalpel, a bundled, high-energy X-ray beam is repeatedly aimed precisely at the patient’s tumor by a robot arm from a very large number of different directions. In this way, the system maximizes the dosage in the tumor itself, while minimizing the impact on the surrounding healthy tissue. During the therapy, the patient lies freely on the treatment table, which is also controlled by a robot.

One special characteristic of robot-controlled radiosurgery systems is their ability to precisely follow tumors that move with the motions of breathing. After all, inhalation and exhalation can cause lung, liver and kidney tumors to move several centimeters, making precision irradiation difficult. Conventional radiation procedures require that the patient’s lungs be artificially stopped. Or the breathing is limited using special restraints and a larger “safety area” receives beams of radiation; though this also hits healthy tissue. A robot-based radiosurgery system, on the other hand, is able to “breathe with the patient”. During treatment, the outward breathing motion is captured by a 3D camera and compared with the internal position of the tumor. The robot head follows the breathing in a low-risk and careful manner and pinpoints the radiation exactly on the tumor. This results in high precision and quality of therapy. This form is therapy is particularly suited to tumors for which surgery would involve high risks. In Germany, there are now several centers for treatment with robot-based radiosurgery systems. To date, over 5,000 treatments have been carried out at the European Cyberknife Center in Munich-Grosshadern (ECZM). The treatment spectrum runs from tumors in the skull/brain area to the irradiation of cancerous growths in the eyes, along the spine and around the lungs, liver and kidneys.

Lightweight robots become “assistant doctors”

Applications based on large robots – as in the examples described above – are not the only ones that can be used in the field of medicine. In the future, lightweight robots designed to be particularly collaborative will take on an increasing number of assistance tasks in the field of healthcare. Thanks to their sensitivity, these robots are able to work “hand in hand” with medical specialists to provide support. A complex cinematic and sensor system and a sleek design make lightweight robots responsive assistants. They feel their way towards objects, allow themselves to be gently pushed away by people, and withdraw automatically when touched. As a result of these characteristics, lightweight robots will, for example, be able to assist surgeons in the operating room or carry out physiotherapeutic tasks in rehabilitation.

Cooperative research projects drive development forward

In the field of medicine, cooperation between industry and science is particularly close and important. Numerous research projects are currently working to develop new robot applications for medical technology.

For example, RWTH Aachen University and Aachen University Hospital are developing “mechatronic physiotherapists” based on the KUKA lightweight robot. Always in top form and never tiring, these can assist patients with their exercises in a manner that is constant and precise. The demand for frequent, repetitive training is a strong argument for robot-based rehabilitation. Robots can initiate the movements of the patient while taking into account the patient’s current state and individual therapy plan – without any additional therapeutic personnel being required. This enables the patient to carry out the exercises independently with help from the robot and to do so with the necessary regularity and consistency.

For years, KUKA has been a competent supplier and development partner of leading companies and research institutions in the field of medical robotics. Modified solutions based on service-proven large robot series, such as the KR QUANTEC with the KR C4 robot controller, are already being used in hospitals for various applications, including angiographies, radiotherapy, hippotherapy and patient positioning. Even the KUKA lightweight robot LBR Med is continuously being adapted to the specific requirements of the medical industry, in cooperation with various research institutions. To achieve this, KUKA began to use an open and modular system architecture for the controller very early on, thus allowing for an easy integration of external sensors as well as software from third parties.

The developments described above demonstrate that medical robotics is increasingly contributing to qualitative improvement in the healthcare industry. With help from robotic components, existing methods of diagnosis and therapy can become safer, more precise, more consistent and even more cost effective. Robots can also perform simple, routine logistical tasks in the growing field of care for the elderly so that specialist staff have more time for nursing tasks. As a result, the use of robotic components in the medical field will become an increasingly important factor in stabilizing our healthcare system.

Find out more about KUKA medical robotics at https://www.kuka.com/en-de/industries/healthcare/kuka-medical-robotics

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