Article | REF: S7789 V1

Medical robotics – Constraints, specificities and challenges

Authors: Florent NAGEOTTE, Salih ABDELAZIZ

Publication date: January 10, 2022

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ABSTRACT

Medical robotics consists in using motorized positioning systems for performing medical procedures onto patients. The medical robots have entered many medical fields under different appearances: from conventional robotic arms to miniature systems mounted onto the patient. In all cases, the environment of the operating room and the interactions with the patients make these systems specific and different from industrial robots. This article discusses three issues linked to the development of these systems: the design of robots compatible with MRI, the use of pre-operative images for guiding gestures, and the automatization of procedures allowing to handle motions and contacts.

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AUTHORS

  • Florent NAGEOTTE: Senior lecturer - ICube, University of Strasbourg, CNRS, Strasbourg, France

  • Salih ABDELAZIZ: Senior lecturer - LIRMM, University of Montpellier, CNRS, Montpellier, France

 INTRODUCTION

The medical robots discussed in this article are systems used to assist doctors and surgeons in performing medical procedures on patients. They generally consist of a motorized mechanical structure located in the operating room, next to the patient at the time of surgery, which in some cases is similar in appearance to an industrial robotic arm. Added to this is a human/machine interface enabling a medical user to control the positioning or movements of the robotic arm. This interface can take a wide variety of forms, from a simple set of conventional computer peripherals (screen, keyboard, mouse) to advanced mechatronic systems known as haptic interfaces. The human/machine interface also enables the user to access medical decision-making tools, in particular medical images. The whole system is controlled by a software and electronic system linking the human/machine interface to the motorized structure, and ensuring that the user's commands are carried out.

The first medical robots were introduced in the mid-1980s for neurosurgical applications. An industrial robot of the PUMA-260 type was used on 22 patients at Long Beach Hospital in California. In France, the Speedy robot developed at the TIMC laboratory in Grenoble was also introduced in 1989 for neurosurgery. The first commercial robot was the Robodoc system for orthopedic hip surgery, available from 1992. The development of medical robots accelerated sharply in the late 1990s and early 2000s in the field of minimally invasive laparoscopic surgery, in particular with the Da Vinci system.

Robots have now taken over a large part of the medical field due to the following main advantages:

  • precision and predictability: these characteristics are of particular interest in orthopaedics and neurosurgery;

  • dexterity: in minimally invasive surgery, robots make it possible to control movements inside the patient's body intuitively, thanks to the principles of telemanipulation;

  • simultaneous control of multiple degrees of freedom (DDL) and multiple instruments: telemanipulation also makes it possible for a single person to control more than two instruments. This makes it possible to perform minimally invasive surgery alone, without an assistant during the medical phases;

  • stabilization and filtering of tremors: in microsurgery (eye surgery, neurosurgery), the robot's mechanical structure or control modes can be used to eliminate involuntary user movements;

  • work in difficult-to-access environments: robots enable access to the center of medical imagers. They also protect the practitioner in the case of ionizing imagers by remote control. These features are particularly...

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KEYWORDS

interventional radiology   |   Medical robotics   |   MRI compatibility   |   registration   |   control based on medical images


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