Robots in Medicine 1

Robodoc. The New Era of the Medical World.

Robots in Medicine 2 Outline I Introduction 1. Historical background 2. Patients stories II Body 1. Modern misconceptions: a) why people are afraid of robots b) robots in literature and movies c) results of the survey 2. What we have to know about robots: a) very first medical robots b) the Da Vinci Surgical System c) experts opinion d) field of usage e) advantages and disadvantages III Conclusion

Robots in Medicine 3

Abstract We are living in the twenty first century, which is the century of technological development, new ideas and great inventions. Modern medicine is also developing, robotic surgery is a new chapter in it. Robot-assisted surgery has a lot advantages for patients as well as for surgeons. However, not everyone gets acquainted with it. There are still so many people who do not trust robots, and consider that robots are something evil and dreadful. The lack of information and disinformation are the main reasons of such thoughts. The purpose of this research paper is to introduce medical robots and to show all benefits and drawbacks of them.

Robots in Medicine 4 Everybody knows that the twenty first century is a century of innovation, new ideas and technology. In the twenty first century we are beginning to see that the boundaries of science are farther than we imagined. Today, people can proudly say that artificial intelligence has already been created in our life. Since ancient times, human beings have been trying to make their lives easier and more comfortable. For example, we have learned to make fire, domesticated animals, and built whole civilizations. This list can be endless, every time we discover and make something new, because the life itself is a progress. Today, we are on the threshold of the new world, because one of the best inventions that man ever made has become intelligent. Nowadays, automatic machines or robots play very significant role in different spheres of our life. At present there are many types of robots, based on their use. Modern robots are irreplaceable in military service, industry, science, entertainment and medicine. The last field of their usage is a completely new tool of the medical world. What is happening today in medicine really captures peoples attention. Scientists work on developing technology and methods to make medicine better for providers and better for patients. The twenty first century modern operating room with medical robots is not science fiction. To see and understand its reality and importance we can always refer to our past experience. Now it is even hard to imagine how people made their first operations in a Stone Age, or how they simply made cuttings without knowing if it was right or wrong. After inventing anesthesia, it gave them the possibility to experiment with human body, people got the opportunity to delve deeper in it. Using antiseptics during operation in order to prevent infection was another revolution in the history of medicine (Gerhardus, 2003). So, step by step we got to this point when it is time to accept robots. Robotic surgery is a new chapter of modern medicine that has had a huge impact on many patients lives, including, for example, Cathy Cloud, who had breast and ovarian cancer. Cathy was very surprised when her surgeon offered her robotic-assisted surgery with less pain and a faster recovery period than the

Robots in Medicine 5 traditional method. He was right, she said happily. On a pain scale of one-to-ten, I rated my pain a one. I mean, I had absolutely no pain! added Mrs. Cloud. Another breathtaking story from real life is the story of John Burpee. He is a typical seventy-five year old. When John experienced everyday difficulty breathing and pain in his chest, he thought that the reason for those symptoms was his age and lifestyle. Unfortunately, it was a tumor in his heart. Johns cardiologist recommended a robotic-surgical removal of the tumor, saying I have three jobs: one job is to save your life, the other is to take the tumor out, and the last is to do it as little invasively as possible. Finally, Johns surgery required only three small incisions without opening his chest. A week after my surgery, I was home. My recovery was much faster and easier, he concluded (Gerhardus, 2003). The fact that robotic surgery is growing worldwide can be proved not only by patients stories, but also by real statistics. The number of people undergoing robotic-assisted surgery has dramatically grown from 152 in 2004 to 803 in 2007 only in Australia and New Zealand. At present, there are more than 300 robotic systems installed worldwide. Around 800 systems are installed in US and Europe (Murphy et al., 2008, pp. 1076-1081). All the major cancer centers and major teaching hospitals have robots. Although robotic surgery is the latest evolution in surgical technology with a great value, there is still a feeling of fear to be operated on by a robot. How would you feel if you knew that your operation was going to be performed by a robot instead of a human? Would you agree to be operated on by a robot? Does robotic surgery have the future? Yes, it definitely has. Knowing more about robots, about the advantages of robotic surgery, and about unbelievable results will instill confidence in peoples hearts. Humanity will trust them completely.

Robots in Medicine 6 Modern misconceptions. Why people are afraid of robots. Almost everybody agrees with the fact that to live means to move, to go ahead, to develop. It is impossible to find a person who would say that progress is bad, however not everybody is ready to make the first step in order to change the world around us. It is a great responsibility to make this step, because it will certainly influence next generations. For people born in the twenty first century it is twice as difficult. Intellectual creations like robots were the subject of human dreams from ancient times. Even very powerful and flourishing civilizations, like Egypt, Babylon, Rome and China, could only dream about super powerful men who had the ability to do everything and never die. Todays scientists make that dream come true. Now robots take place not only in imagination, but also in reality. They are not heroes of fairy-tales any more. Humans have been dreaming about it for ages, but modern society is not in a hurry to welcome robots, especially medical robots. What is the barrier between robots and patients? In order to answer the question, why people are afraid of robots and are not ready to accept them, we have to take into consideration humans psychology and the influence of the movies, mass media, and fiction. Unfamiliar things and objects always seem dangerous and scary to people. Why humanity is afraid of a robot-assisted surgery is quite clear. Because, people simply do not have enough information to trust them. We are afraid of changes, developments, and strangers. And robots are like strangers for us, because they were invented not so long ago. We are afraid of darkness. It is our nature, because when there is no light, we cannot see anything, we do not know what to do and how to behave ourselves. The same thing is happening when new inventions and creations enter our life. In case of robots, they just were not introduced correctly.

Robots in Medicine 7 Robots in literature and movies. The word robot comes from Czechoslovakian language. Forced labor is the meaning of the Czechoslovakian word robata. This word was invented by Karel Capek. He was a writer and used the word in his plays (Gerhardus, 2003). Nowadays, it has many definitions. Dictionaries and encyclopedias explain it as any automatically operated machine that replaces human effort (Rosen at el., 2004, pp. 985-986). The first person who tried to find an association between robot and man was Professor Lee Dai Gil. He claimed that human beings are also direct-drive robots. We (people) have muscles instead of motors (Gerhardus, 2003). The creative writings of Isaac Asimov also involve robots. His science-fiction stories were about robotics and their laws. Later, Isaac Asimov was considered as the best imagination of the world. His writings were very popular and brought him great success (Rosen et al., 2004). It is obvious that, nowadays, movies, cartoons and fiction have more power and influence than scientific projects, researches, different programs. Nobody will read tons of special literature dedicated, for example, to medical robots, because instead of this boring occupation, they can entertain themselves by watching TV or reading something. Unfortunately, society became acquainted with robots through Hollywood. It is hard to find someone who does not watch I am robot, Terminator, Transformers, and Robocop. Robots in these movies are bad heroes, a lot of people suffer because of them, they are even ready to fight against people and destroy the Earth. What viewers remember is, of course, that robots are evil, they have bad reputation. For people they will be associated with negative meaning. People will not pay attention to the fact that medical robots are not those dreadful monsters from the TV. Thus, humans attitude toward robots is simply based on movies and stories.

Robots in Medicine 8 Results of the survey. Unfortunately, the result of the survey, which was conducted among KIMEP students during four days from 5th March 2012 to 12th March 2012, confirms this fact once again. One hundred students from different faculties with different age and gender took part in that survey. The purpose of the survey was to discover the level of the knowledge about new medical equipment and surgeries among students and to reveal if they are ready to trust them. The survey was conducted with the help of a questionnaire that was given to the students to fill out. The list of questions consisted of three parts with five questions in each of them. The first part was connected with the general information about human inventions. The second section was dedicated to robot-assisted surgery, the last one to media influence on peoples opinions. According to the first sections questions, 88% of the students are sure that some human inventions are dangerous for people in their usage, 63% answered that they are afraid of robots, moreover 52% claimed that someday people would lose control over them. In the second section there is 95% no answer to the question Would you agree to be operated on by a robot. 100% of all students prefer ordinary surgery rather than robot-assisted one. On the open question about advantages of medical robots only 19% gave the answer, like less number of scars and less invasive. In the last section, not surprisingly, 100% watched films like Terminator, Blade Runner, and Transformers, I am robot. 48% like science fiction. If we start analyzing this survey, we will come to the following conclusion. KIMEP students are not enough informed about the latest medical technologies, most of them have Frankenstein complex that is fear of artificial human beings. Their knowledge about robots in general is based on films and movies. Also nobody of the students will choose robot-assisted surgery in case they need it. According to the survey there is one other

Robots in Medicine 9 conclusion: society, nowadays, knows very little about medical robots, they cannot even imagine the number of advantages and positive consequences, and Hollywood really has a very big influence. What we have to know about robots. In order to get acquainted with robots closer, it is better to start with origins. Why did that technology appear in our life? When was the first robot invented? What are the basic advantages and disadvantages of robots? The fact that man does not have perfect abilities to see, to hear, and to feel makes human beings not satisfied with their skills. Necessity is the mother of invention, because of this, the XX century was the period when people tried to create a lot of tools in order to compensate those limits. Using robotic technologies was an evolutional step of the medical world, which could offer a high amount of new options for patients and doctors. Very first medical robots. The field of robotic usage is endless. However, medicine takes a very serious position in this list. 1980 was the year when surgical robots first appeared in hospitals. Such robots were used in neurosurgery and orthopedic surgery. Impressive results of using robots in these two spheres encouraged other surgeons, thus robots became common in urology and otolaryngology. The first medical robots, PUMA 560 and PROBOT, were used during brain biopsy and prostatic surgery. The Da Vinci Surgical System. Farther history of robots in medicine was directly connected with the Da Vinci Surgical System. One of the most advanced robots used today in operating rooms is the Da Vinci Surgical System (Cepolina et al., 2004, pp. 21-23). This system consists of three main elements, four robotic arms, camera with 3D vision system, a surgeons console. The name of the system is connected with the Italian painter and sculptor, Leonardo da Vinci, because he

Robots in Medicine 10 was also a bright engineer of his century. He created several different flying machines, some of which had great success. Moreover, he studied human body and was interested in anatomy. The first pictures of the human skeleton belong to him. Da Vinci system is very valuable because of its accuracy. The direct link between surgeon and patient provides the best interaction between them (Cepolina et al., 2004). Experts opinion. Health is the most valuable thing in our life. People are equal in terms of health. Yesterday we were born, today we live, and tomorrow we will die. But everyone wish to live happy and healthy life. Information that is taken from producers creations cannot be considered as credible. We cannot rely on them when we face problems with our health. Robots in medicine and their acceptance is a big issue that requires professional view. In order not to have an error of judgment, it will be better to take into consideration an experts opinion. Special interview with the representative of the medical world gives us such a great opportunity. According to the cardiologist of #12 Almaty Hospital, it is not a secret that our (Kazakhstani) medicine is not perfect and is not on the first place. There are a lot of things to improve. For example, our city needs more hospitals and doctors, our patients need more care, the equipment and tools that we have are not in the best conditions. The whole world also tries to improve medical service and possibilities. The world medicine is developing. Today, robots are used in different surgical procedures. Modern surgical systems are really advanced technology, operations made with the help of them are non-invasive. Patients with serious illnesses could only dream about this. While working with patients and seeing their fear and pain, you are starting to understand the worth of life and the difficulties that are connected with the decision making process. It is so hard to make a decision, especially when you deal with something new and unfamiliar for you. But if you are terribly ill, you have no choice, you will do everything in

Robots in Medicine 11 order just to stay alive. It is so scary to face such situation and to overcome it. However, people are starting to understand that the thing you offer to them is right and good, as they get more acquainted with it. The more information they have, the more they trust you and your methods. It is directly connected with time and knowledge. Filed of usage. There are two types of robots used in medicine, active and passive. Passive robots are controlled by the physician, active ones by the computer. The field of their usage is very huge and impressive. Medical robots proudly find their places in general surgery, cardiology and electrophysiology, gastrointestinal surgery also gynecology and urology. Nowadays, it is hard to imagine how surgeons would make, for example, gastrointestinal laparoscopic operations without medical robots. The most widespread system for general surgery is Da Vinci system. Cardiac surgeons also use Da Vinci system. Using robots during such operations increases the chances of success and decreases the morbidity. Robotic technologys 3D cameras show the whole picture of the heart. Robotic surgery in gynecology also is becoming more and more popular. Using the robotic system, gynecologist can perform hysterectomies, myomectomies, and lymph node biopsies (Dharia et al., 2005, p. 7). Several robots are currently used in neurosurgery. Operations on the brain demand a lot of accuracy, because brain tissue is very sensitive. Surgeons in the United States of America especially appreciate medical robots in urology, because of the difficulties in anatomic access to organs. In addition, there are almost no cases when robot-assisted surgery in urology has negative consequences or results. Medical robots are very important in orthopedic surgery, because it is hard to make operation on bones (Horgan et al., 2001). Modern medical robots have other different applications. One of them is training. Medical robots can be used instead of real patients. It is a good simulator for surgeons, who have just graduated and do not have enough experience. So, they can practice and develop

Robots in Medicine 12 their skills. Medical robots also are a good decision for disabled people who want to stay independent or who do not have family and relatives. For example, robots are really irreplaceable for deaf and blind people. There are also good solutions for children with mental deficiency, for example, educational robots. The last type of application is telerobotic echography (Horgan et al., 2001). Advantages and disadvantages. Surgeons all over the world always try to minimize the pain of their patients during the surgery. Minimally invasive operations become real with medical robots appearance, because it is the most important advantage of robot-assisted surgery. The reason is that robotic cutting instruments and camera are very small, that is why the surgeon, who performs the operation, does not need to make large-size incisions. Moreover, the problem of shaky hands is also solved, because robots make very accurate cuttings. Surgeon with a help of robots arms moves in the direction that he needs and does not touch other organs, that is does not make additional trauma. There is a good example with heart bypass surgery. Traditional method requires sternotomy, which involves opening the chest and stopping the heart beating. Unfortunately, it is very dangerous and can lead to morbidity. In the case of robot-assisted surgery, surgeon does not open the chest that is he does not make eight-inch to ten-inch incision. Instead of this, he simply cuts three one-centimeter incisions in between the ribs to insert the two robotic arms and an endoscopic video camera (Rogozea et al., 2009, pp. 2324). Less invasive operation leads to positive consequences like reducing patient s death as well as fewer and smaller scars, because patients often care about them and their look. Moreover, it is not the only advantage of robots in medicine. The small risk of infection, blood transfusion and other complications are the greatest benefits of such operations. Another advantage is connected with the time, because robot-assisted surgery makes recovery period faster. Patients leave the hospital approximately after one week, when

Robots in Medicine 13 patients who choose usual operation spend half a month in the hospitals. Because of faster recovery period patients return to their normal life, job and other activities sooner (Preising et al., 2008). Robot-assisted surgery is also very beneficial for pediatric patients. Sometimes little children or even babies may have serious health problems and need difficult operations. But there another problem appears. Because of their bodies size, some operations are extremely dangerous or even impossible. However, this problem is easily solved with a help of medical robots. Robot-assisted surgery gives the opportunity for developing of telesurgery. As a result, surgeons from different countries will work together, will share with their knowledge and experience. It is a good chance for working at distance (Rogozea et al., 2009). For physicians it is also better to use robots because robots allow the surgeon to have the full view with a help of 3D displays. Camera gives the opportunity to see places that is impossible to see. Finally, surgeons have the full control over their robot assistant. Also control board is very sensitive, so the robot repeats all the movements after the surgeon. From financial point, robots are very beneficial for hospitals. Patients with fast recovery period and little scarfs do not need additional nursing care. Medical robots replace different assistants, thus, they reduce the number of medical staff. Also hospitals will be able to help more people with diseases, and they will not wait their turn until they become worse (Lobontiu et al., 2007). Unfortunately, with all the advantages there are also some disadvantages. The first one is connected with the procedure of learning the working mechanism of such a machine. It must require additional time for surgeons to get acquainted with these surgical systems. Forty hours of training sometimes is not enough for the surgeon, because practice makes perfect.

Robots in Medicine 14 There is no guarantee that during this short time they will be completely ready for operations. It is really risky, because it is connected with someones life and health. Another drawback that the physician faced is losing sense of touch. Control panel cannot replace humans arms. During ordinary operation surgeon can feel what he is doing, he can measure and count the pressure and power of his movements. Although 3D monitors are so accurate and advanced, sometimes it is hard for surgeons to look at his patient through all these systems and mechanisms. Robot-assisted surgery sometimes looks like unreal, and surgeon always has to keep in his mind that six feet away there is a person, whose life completely depends on him. One more drawback is connected with the fact that such systems are very expensive, around $750,000 to over $1 million, not all countries can afford such robots and not all patients can pay for such operations, because the price of the surgery is also extremely high. However, a lot of people believe that soon the prices will become lower (Rahbar et al., 2007). Conclusion. When we talk about peoples health and life, there is no place for faults and errors, because even the smallest of them may cost someones life. No one in this world has the power to turn time back in order to correct mistakes that is why it is better not to make them at all. But here a logical question appears: who is that person with perfect abilities, like super vision, no shaky hands and accurate cutting instruments? It is not a secret that people are always dissatisfied with their skills, because they are sure that their abilities to see, hear and feel are limited by their nature. It is unfair to claim that doctors have no rights to go amiss, because they are human beings too, but it is also wrong not to pay attention to medical errors. Maybe it is time to think about an alternative way of solving this problem? Maybe it is time to accept something new?

Robots in Medicine 15 Medical development means not only the improvement of existing methods and tools, but implementation of absolutely new technology. Now we can answer the question above about that perfect creation. The answer is simple: it is a robot. However, robots were not invented and created yesterday, they have been with us for a long time, so why are they not so widespread, why are there still so many doubts about their usage? Robots in general do not have a good reputation, because they were not introduced correctly. People know them through films and movies; robots become bad heroes very often. People believe that robots can capture our earth and destroy our life, however they forget that the most powerful thing is an idea, the power of believing in something. Unfortunately, this power stops progress and does not allow our life to develop. This simple unconfirmed idea deprives so many patients of successful surgical results. Nowadays, doctors and surgeons use robots for diagnostics, assisted surgery and rehabilitation. Medical robots return people their hope to continue living after difficult operations. They help patients with disabilities to be independent, and they allow doctors to find exact reasons of the diseases. Huge iron machine becomes a fragile link between surgeons arms and patients life. People all over the world have the right to know about the latest medical advances, as well as the right to live and to get the best medical service. Their knowledge must not be based on unbelievable film producers imaginations and fantastic stories. People have to know everything about the advantages and disadvantages of such technologies, because they are directly connected with their health. They can make decisions and choose the best option, only when they are completely acquainted with robots in medicine. People will have an opportunity to weigh all the pros and cons of modern surgery and choose the type of operation, ordinary or robot-assisted, with no doubts.

Robots in Medicine 16 The lack of information generates fear. We are afraid to go to unknown places, we are afraid to trust strangers, the darkness frightens us. On the question what you will feel if your operation is going to be performed by a robot instead of a human, everybody will answer that they will be afraid. It is a normal human reaction, a common biological instinct. Disinformation is also a problem, because it makes people think in the wrong way. It is even worse than the lack of information, because when you do not know anything, you have no ideas. When you have incorrect information, all your thoughts will be based on it, and it will be twice as difficult to change your opinion. Knowing more about robots, about the advantages and disadvantages of robotic surgery will create confidence in peoples hearts. The future of robots in medicine depends on people, however people have already made their choices when they used robots for the first time. Medical robots have a long history, from the moment when they were just the subjects of dreams till the point when they were installed in operating rooms. Maybe it is hard to believe, but their future has already started. Robots hold strong positions in the medical world, because they are really helpful and irreplaceable. In addition, robot-assisted surgery is not the final destination of modern medicine; voice-controlled equipment is the next step.

Robots in Medicine 17 Reference

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Robots in Medicine 18 Rosen, J. & Speich, J. E. (2004). Medical robotics. In Encyclopedia of Biomaterials and Biomedical Engineering, 983-993. doi: 10.1081/E-EBBE 120024154