Not so long ago, a prostate cancer operation would cost the patient 1.5 litres of blood and entail a two-week stay in hospital. Now the average patient loses just 20 millilitres of blood, and three days in hospital are usually sufficient. This drastic change is thanks to the rise in use of robot-assisted surgery, which has replaced long incision operations in many areas of medicine. In addition, 84 percent of the man’s sexual potency can be preserved by robot-assisted surgery, because the instruments can be manoeuvred highly accurately to avoid all major vessels and nerves.
One of many junior participants of the Skolkovo Robotics Forum interacting with Sberbank's talking Promobot. Photo: Sk.ru.
Robot surgeons and other medicine and rehabilitation-related robots were just some of the stars of the annual Skolkovo Robotics Forum that took place at the Skolkovo Technopark on Tuesday.
“Robot-assisted surgery has made new forms of surgery possible: it has created a technological revolution in surgery,” said Sergei Sheptunov, founder of the Biomedical Technologies research and development centre, who cited the progress made in prostate operations.
It doesn’t just improve things for the patient: it also makes life easier for surgeons, said Sheptunov, while emphasizing that it is still the doctor who performs the surgery, and not the robot. But the surgeon can now sit at a terminal and control the instruments instead of having to stand over the patient for hours, which enables them to stay better focused and be more accurate, he said.
Sergei Sheptunov's team has created a rival to the U.S.-made Da Vinci surgical system. Photo: Sk.ru.
Pavel Rasner, a professor of the urology department at Moscow State University of Medicine and Dentistry, agreed.
The 3D cameras used in robot-assisted surgery enable surgeons to get a better picture of the tissue they are working on than they ever could using their eyes or a microscope, and the joystick used to control the instruments is more precise than the human hand, said Rasner, speaking at the forum’s plenary session, titled “Robotics. Global Challenges.”
Assistive technology also drastically increases the number of patients who can be operated on each year. It’s a market that is due to reach a value of $14 billion in the U.S. alone by 2024, said Sheptunov, whose team has developed a rival to the U.S.-made Da Vinci surgical system.
Amir Shapiro, a professor at Israel's Ben Gurion University. Photo: Sk.ru.
The aim of the rival project was to create a robot that could be brought to any ordinary clinic and used in an operation, said Sheptunov. The Russian system, which was successfully used to operate on a pig named Roza last month, is cheaper and far more compact and portable than the Da Vinci, he said.
Robot-assisted surgery is, however, only the tip of the iceberg of medical robotics.
“Technology and medicine have always gone hand in hand,” said Amir Shapiro, a professor at Israel’s Ben Gurion University, during a talk at the forum devoted to the past, present and future of medical robots. The first hospital opened in London just as the industrial revolution was beginning there, he pointed out. Now computers are used to plan operations, people have robotic limbs, eye implants are used to improve vision, and cochlea implants enable deaf people to hear.
A robotic hand made by Skolkovo resident startup Kleiber Bionics on show at the exhibition. Photo: Sk.ru.
Robots are also widely used in rehabilitation, such as exoskeletons that help people regain the use of their hands or arms after a stroke, or even to walk again after spinal injuries. ExoAtlet, a Skolkovo resident startup that makes medical exoskeletons that help disabled people to walk again, unveiled the latest version of its robotic suit at the Skolkovo Robotics Forum.
Another Skolkovo startup, Eidos-Medicine, also presented its medical robotics technology at the event. Eidos makes simulators and training machines that can be used both to train medical students and by experienced surgeons to practise complex operations. At the exhibition section of the forum, the company displayed Adam, a simulator for teaching resuscitation skills. Children at the forum (which also offered a range of masterclasses aimed at younger robot enthusiasts) took turns in pumping Adam’s chest and squeezing air into a ventilation mask while keenly watching a monitor for signs of a pulse. The monitor also showed users whether or not they were pressing down on the dummy’s chest hard enough.
Eidos-Medicine's simulator for teaching resuscitation skills was a big hit with visitors of all ages. Photo: Sk.ru.
Eidos’ machines enable doctors and medical students to practise a range of procedures, from a laparoscopy and endoscopy to neurosurgery, gastroenterology and dental operations, as well as surgery on newborn babies. The company’s software allows users to write the scenario for the operation themselves, enabling them to recreate the precise conditions of the operation they are preparing for. Like Adam, the other simulators also give feedback on the virtual patient’s condition, such as their blood pressure and pulse. The machines also help doctors to practise using equipment safely, since real equipment such as defibrillators are used during the simulations. Eidos’ simulators are already in use in Asia, including Japan, and Europe, including the Netherlands, as well as around the former Soviet Union, and this year, Eidos plans to enter the U.S. market.
Back at the conference part of the event, Professor Shapiro argued that medical robotics is simply part of evolution.
“It’s part of the same process that caused us first to have tools, and then more technology that affects humans,” said Shapiro, who presented Medrobotics’ robotic snake, which can be inserted into patients to perform minimally invasive surgery.
Pavel Rasner, a professor of the urology department at Moscow State University of Medicine and Dentistry. Photo: Sk.ru.
At the same time, there are ethical issues regarding assistive medical technology that still need to be resolved, he acknowledged.
“Where is the boundary between the machine and the person? How much of the body can be changed or replaced for it to still be human?” said Shapiro.
Dr. Rasner pointed out that robots are used in various aspects of human life to meet very different requirements, depending on the field. The task of driverless vehicle technology, for example, is to come up with a complete set of rules for the cars to follow, Emilio Frazzoli, co-founder and CTO of nuTonomy, which develops software for self-driving cars, said during the plenary session.
“In the case of cars, we don’t necessarily want to have robots that behave like humans. We may want to exploit the things robots are good at, and develop products that are very useful to humans, even though it is not something that behaves like a human,” said Frazzoli.
A driverless KAMAZ truck on display at the entrance to the giant Skolkovo Technopark. Photo: Sk.ru.
“One of the most stupid things I’ve heard in my career is people talking about a Turing test for autonomous cars, meaning that they want autonomous cars to drive or behave in a way that is indistinguishable from human-driven cars. Why would you want that?” he asked the conference.
“What I’d like to have is not autonomous cars that drive like a human, with all their limitations, but a robotic car that drives like a robot, meaning in a very predictable, very reliable, very consistent way,” he said.
In surgery, however, there is no highway code with fixed rules, and standard situations are rare: it’s a very individual process, so the task of robotics in this field is quite different, said Rasner.
“Every surgical procedure is unique; it’s difficult to trust a machine to do the right thing [without human control],” he said.
Skoltech rector Alexander Kuleshov (left) shakes hands on an agreement signed with Sberbank. Photo: Sk.ru.
The army of robots on show in and around the Skolkovo Technopark was far from limited to medical robots. They also included a driverless KAMAZ truck outside the Technopark, the result of a joint project between VIST Group (the parent company of Skolkovo resident VIST Robotics), truckmaker KamAZ and the Nazarbayev University.
Other robots doing the rounds were talking androids made by Skolkovo resident Promobot. One of their robots at the forum was there to represent Sberbank, the event’s general partner. The state banking giant also signed an agreement with the Skolkovo Institute of Science and Technology (Skoltech) at the forum.