ROBOTICS IN HEALTH CARE PRACTICE

INTRODUCTION

The use of robots in healthcare is a new concept. What is a robot? It is a

re-programmable, multifunctional manipulator designed to move material,
parts, tools, or specialized devices through various programmed motions for the
performance of a variety of tasks.

There has been a great deal of controversy within the medical profession
concerning the reliability, cost effectiveness and relevance of robotic surgery. To
some medical professionals, it represents nothing more than the Emperors new
clothes syndrome taken to extreme lengths. Or to put it more bluntly, the critics
say that progress is made simply for the sake of making progress and that
something new is automatically associated as being better. Others argue that
the usage of robotic surgery may still have some teething problems that need to
be resolved but ultimately, the technology has a lot of potential and which could
radically improve the efficiency and productivity of the profession as a whole.

DISCUSSION

Since 1921 when Czech playwright Karel Capek introduced the notion
and coined the term robot in his play Rossoms Universal Robots, robots have
taken on increasingly more importance both in imagination and reality. Robot,
taken from the Czech robota, meaning forced labor, has evolved in meaning from
dumb machines that perform menial, repetitive tasks to the highly intelligent
anthropomorphic robots of popular culture. Although todays robots are still
unintelligent machines, great strides have been made in expanding their utility.
Today robots are used to perform highly specific, highly precise, and dangerous
tasks in industry and research previously not possible with a human work force.
Robots are routinely used to manufacture microprocessors used in computers,
explore the deep sea, and work in hazardous environment to name a few.
Robotics, however, has been slow to enter the field of medicine.

The lack of crossover between industrial robotics and medicine,

particularly surgery, is at an end. Surgical robots have entered the field in force.
Robotic telesurgical machines have already been used to perform
transcontinental cholecystectomy. Voice-activated robotic arms routinely
maneuver endoscopic cameras, and complex master slave robotic systems are
currently FDA approved, marketed, and used for a variety of procedures. It
remains to be seen, however, if history will look on the development of robotic
surgery as a profound paradigm shift or as a bump in the road on the way to
something even more important.

The origin of surgical robotics is rooted in the strengths and weaknesses

of its predecessors. Minimally invasive surgery began in 1987 with the first
laparoscopic cholecystectomy. Since then, the list of procedures performed
laparoscopically has grown at a pace consistent with improvements in
technology and the technical skill of surgeons. The advantages of minimally
invasive surgery are very popular among surgeons, patients, and insurance
companies. Incisions are smaller, the risk of infection is less, hospital stays are
shorter, if necessary at all, and convalescence is significantly reduced. Many
studies have shown that laparoscopic procedures result in decreased hospital
stays, a quicker return to the workforce, decreased pain, better cosmesis, and
better postoperative immune function. As attractive as minimally invasive
surgery is, there are several limitations. Some of the more prominent limitations
involve the technical and mechanical nature of the equipment. Inherent in
current laparoscopic equipment is a loss of haptic feedback (force and tactile),
natural hand-eye coordination, and dexterity. Moving the laparoscopic
instruments while watching a 2-dimensional video monitor is somewhat
counterintuitive. One must move the instrument in the opposite direction from
the desired target on the monitor to interact with the site of interest. Hand-eye
coordination is therefore compromised. Some refer to this as the fulcrum effect.9
Current instruments have restricted degrees of motion; most have 4 degrees of
motion, whereas the human wrist and hand have 7 degrees of motion. There is
also a decreased sense of touch that makes tissue manipulation more heavily
dependent on visualization. Finally, physiologic tremors in the surgeon are
readily transmitted through the length of rigid instruments. These limitations
make more delicate dissections and anastomoses difficult if not impossible.10
The motivation to develop surgical robots is rooted in the desire to overcome the
limitations of current laparoscopic technologies and to expand the benefits of
minimally invasive surgery.

From their inception, surgical robots have been envisioned to extend the
capabilities of human surgeons beyond the limits of conventional laparoscopy.
The history of robotics in surgery begins with the Puma 560, a robot used in
1985 by Kwoh et al to perform neurosurgical biopsies with greater precision,11
Three years later, Davies et al performed a transurethral resection of the prostate
using the Puma 560.12 This system eventually led to the development of
PROBOT, a robot designed specifically for transurethral resection of the prostate.
While PROBOT was being developed, Integrated Surgical Supplies Ltd. of
Sacramento, CA, was developing ROBODOC, a robotic system designed to
machine the femur with greater precision in hip replacement surgeries.1
ROBODOC was the first surgical robot approved by the FDA.

Also in the mid-to-late 1980s a group of researchers at the National Air and
Space Administration (NASA) Ames Research Center working on virtual reality
became interested in using this information to develop telepresence surgery. This
concept of telesurgery became one of the main driving forces behind the
development of surgical robots. In the early 1990s, several of the scientists from
the NASA-Ames team joined the Stanford Research Institute (SRI). Working with
SRIs other robotocists and virtual reality experts, these scientists developed a
dexterous telemanipulator for hand surgery. One of their main design goals was
to give the surgeon the sense of operating directly on the patient rather than
from across the room. While these robots were being developed, general surgeons
and endoscopists joined the development team and realized the potential these
systems had in ameliorating the limitations of conventional laparoscopic
surgery.

The US Army noticed the work of SRI, and it became interested in the possibility
of decreasing wartime mortality by bringing the surgeon to the wounded
soldierthrough telepresence.1 With funding from the US Army, a system was
devised whereby a wounded soldier could be loaded into a vehicle with robotic
surgical equipment and be operated on remotely by a surgeon at a nearby Mobile
Advanced Surgical Hospital (MASH). This system, it was hoped, would decrease
wartime mortality by preventing wounded soldiers from exsanguinating before
they reached the hospital. This system has been successfully demonstrated on
animal models but has not yet been tested or implemented for actual battlefield
casualty care.

Several of the surgeons and engineers working on surgical robotic systems for
the Army eventually formed commercial ventures that lead to the introduction of
robotics to the civilian surgical community.1 Notably, Computer Motion, Inc. of
Santa Barbara, CA, used seed money provided by the Army to develop the
Automated Endoscopic System for Optimal Positioning (AESOP), a robotic arm
controlled by the surgeon voice commands to manipulate an endoscopic camera.
Shortly after AESOP was marketed, Integrated Surgical Systems (now Intuitive
Surgical) of Mountain View, CA, licensed the SRI Green Telepresence Surgery
system. This system underwent extensive redesign and was reintroduced as the
Da Vinci surgical system. Within a year, Computer Motion put the Zeus system
into production
 According to Broadbent et.al (2010), investigate about the publics
perception attitudes and reactions to a health care robot. The objective of the
study explore the perceptions and emotions toward the utilization of healthcare
robots among individuals over 40 years of age, investigate factors contributing
to acceptance, and evaluate differences in blood pressure checks taken by a
robot and a medical student. Fifty-seven adults aged over 40 years and recruited
from local general practitioner or gerontology group lists participated in two
cross-sectional studies. The first was an open-ended questionnaire assessing
perceptions of robots. In the second study, participants had their blood pressure
taken by a medical student and by a robot. Patient comfort with each encounter,
perceived accuracy of each measurement, and the quality of the patient
interaction were studied in each case. As a results, the participants' perceptions
about robots were influenced by their prior exposure to robots in literature or
entertainment media. Participants saw many benefits and applications for
healthcare robots, including simple medical procedures and physical assistance,
but had some concerns about reliability, safety, and the loss of personal care.
Blood pressure readings did not differ between the medical student and robot,
but participants felt more comfortable with the medical student and saw the
robot as less accurate. Although age and sex were not significant predictors,
individuals who held more positive initial attitudes and emotions toward robots
rated the robot interaction more favorably. In conclusion, many people see robots
as having benefits and applications in healthcare but some have concerns.
Individual attitudes and emotions regarding robots in general are likely to
influence future acceptance of their introduction into healthcare processes.
ADVANTAGES

According to Lepton (2011), there are advantages in using robots in health care
setting specially in surgery.The fact that a surgeon will be able to manipulate the
robot from a centralized distance means that the surgery can be performed in a
less restrictive manner. This means that the patient can be treated and operated
on with a minimum of staff which in turn, reduces costs.

1. The fact that surgeons can perform surgery from a distance also benefits
the quality of healthcare for the patient as they are able to enjoy the
reduction in the costs, as well as a greater degree of flexibility in regard to
the areas they are can be treated.
2. Doctors will tire and become fatigued, which in turn, reduces their
concentration and ability to focus. A surgeon who has been working for
several hours without a break will find that he will struggle to hold the
scalpel steady and so this places considerable strain on the operating
surgeon. With robotic surgery this concern is reduced, even eliminated.
3. Robotic surgery will allow for a much greater degree of precision and
accuracy to be achieved whenever certain types of surgical procedures are
being used, such as orthopedic surgery, or neurological.

DISADVANTAGES

According to Biomed, robotic surgery is a new technology, so its uses and efficacy
have not been fully determined. There are not many extensive long-term studies
on the procedure to confirm or deny its effectiveness. Biomed cited some
prominent disadvantages to robotics, including time, cost, efficiency, and
compatibility with current systems.

1. Time
Biomed stated that the robotic assisted heart surgery can take nearly twice the
amount of time that a typical heart surgery takes, but this is variable depending
on the surgeon's expertise and practice with the equipment.

2. Cost

The usage of robot are very expensive. It is possible that with improvements in
technology and more experience gained by surgeons the cost will fall. People may
believe that with these developments in technology the systems will convert more
complicated and the costs will rise. Additional issue with costs is the problem
with upgrading the systems as they improve. Only when these systems gain more
widespread multidisciplinary use the costs will become more justified.

3. Efficiency and Compatibility

Another disadvantage cited by Biomed is the large size of the system in an

overcrowded-operating room. The size of robotic arms are awkward and bulky
and there are many instruments needed in the small space. For robotic-assisted
beating heart surgery, the space is even smaller because stabilizers are needed.
For surgeons, this cramped area can interfere with their skills during the
procedures. Another disadvantage is that current operating room instruments
and equipment are not necessarily compatible with the new robotic systems.
Without the correct equipment, tableside assistance is needed to perform part of
the surgery.

Conclusion

As the future is uncertain, the only thing relatively clear is that much of what
we will experience in the future will be different from the past. We must
understand it is not information or even technology that will produce this
unprecedented change, but the impact of technology on all aspects of human
life; not computers or even bits and bytes, but the ability to apply and integrate
rapid technological change
As a nurse, it is important that nurses seek opportunities to educate themselves
about this technology, assess its impact, and determine how to best care for
patients in the future. The health care sector is growing and showing different
approach with the use of robots in day to day operations in operating room. In
the near future, the robots may take away the jobs of health care professionals
and passing it on to the robots. The health care sector must invest in training,
educating and developing health care professionals in order to keep their
knowledge and skills up to date. In return, the health care professionals will be
able to work in tandem with the robots,

All of these technologies can increase efficiency and quality, reduce errors and
improve patient care. Some can reduce personnel time and thereby reduce costs,
but all require substantial personnel experience and training. Many are now
commercially available. They are certainly major innovations and will likely be
quite disruptive of how medical care is currently delivered.