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1 Informative paper Syed Irvin 301475527 Email: sai3@sfu.ca ENSC 105W, Design Lab LA27 Psi 10/27/2022 Do Robots Belong in the Medical industry? Acknowledgments Thanks to Nahid Qaderi and my fellow design lab members for their valuable feedback.

2 Introduction Have you ever thought about a Cardiac Surgeon operating on a beating heart without even opening the patient’s chest? Or a flexible robot that could maneuver and navigate through the complex branching of blood vessels or bronchi in the lungs and perform surgery at its tips? Surprisingly enough, these types of technology exist today, and many are coming up. Medical robots are improving daily; as each day passes, we engineers learn new facts and try to implement that to make the future of the medical industry brighter [1]. Robots in the medical industry are capable of supporting and staying by our side, giving us the advantage of better outcomes so that surgeons can operate more confidently. There are both pros and cons of robot use in the medical and there are many upcoming technologies about to arrive in the healthcare field. There’s always been considerable controversy about whether medical robots should be used or not. Yes, medical robots do have some downsides to it but it also has a lot of potentials that they can provide shortly. Robots are used in many medical industry sectors, including Neurology, Orthopedics, General Laparoscopy, Steerable Catheters, and Radiosurgery; these are just a few technologies that are making a difference already. The robots are a guidance tool that provides information to the surgeons while keeping them engaged and on target [2]. The robotic medical industry has just been growing; from only a few initial brain surgeries, orthopedics, endoscopic surgery, and other areas, the field has expanded exponentially, with them being used in almost every hospital. The physical design for medical robots will keep improving while dropping the expense

3 by a hefty bit, leading to more hospitals using these technologies [2][3]. Medical robotics is changing the way surgeons perform surgeries; thanks to the advancement of technology, medical instruments are now more than capable of imitating and enhancing surgeons while having outcomes with minimal errors. In the early stages of medical robotics, the rigid structural models did not succeed in having a hundred percent outcome but that gave the robot developers a good platform. Those early robot designs navigated engineers toward better advancements, which led the industry toward flexible robots, making the machine more fluent and trustable. By using these high-tech machineries, robotic systems could decrease invasive procedures for patients [4][5]. Area of controversy All technologies have some limitations; in this case, the surgeon must have a good grasp on operating on patients using this type of machine since the patient’s life are at stake; also, the developing companies have a responsibility to make the technologies with little to no errors. There are many improvements to make, and if we get too stuck on only the adverse events, moving forward will become a massive obstacle for the medical industry and robot developers. The controversy lies in whether medical robotics should be a permanent part of the health industry or not. Different people have their own opinion on it, and most of them are against it because they believe that robots cannot be more accurate than Humans, which is not, in fact, accurate. Questions about robotics revolve around unresolved questions about autonomy, responsibility, empathy, trust, moral agency, and medical robots' social and economic impacts [6]. People should study more about robotic technology and then decide whether they appreciate it or not; rather than just having a stereotypical view.

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4 History of Medical robots The history of medical robots has come a long way; in the early 1980s, medical robots were introduced. Since then, this industry has been growing to this day and has made extreme improvements and is improving daily [7]. Today, medical robots are well known for carrying out surgeries, specifically using robots, computers, and software to precisely manage surgical equipment and assist surgeons with more complicated procedures [8]. Medical robots are computerized consoles that include single or multiple arms being operated on the patient. All the information is pre-programmed into the robot before the beginning of the surgery, which then facilitates the medical robots to traverse the human body correctly [7]. Robotic minimally invasive surgeries (MIS) have transformed for over 35 years. They had three stages: Stage 1: Industrial robots for surgery applications, Stage 2: Minimal invasive surgery (MIS), and Stage 3: Next generation. The first surgical robot, the PUMA 560, was introduced and designed in connection with computed tomography (CT) guidance for obtaining neurosurgical biopsies. Then for the next few years, many other technologies made their way toward the medical industry, and the designs got better and better until the middle of stage 2 came along. By the end of the stage 2 era, around the early 2000s, types of machinery like DaVinci and Zeus Surgical system were formed, which was the start of an age where Intra body robots and other Hi-Tech machinery started to come along [9][10]. Robotics is constantly evolving even after that; the applications of this field only go back to the last three decades.

5 There are many uses for AI systems in today’s society, as it was back in the first generation of medical robots. As days go by, the need for this technology will keep increasing, and developers must adapt and make new advancements to keep up with the present time [11]. The pros and cons of medical robots Robotic-assisted surgery comes with high risks and benefits. Let’s talk about the benefits that this technology brings to the table. There are countless benefits of using medical robots; the robots can also be more accurate and precise in carrying out surgeries that could be complicated for surgeons to operate. 3D magnified vision, Increased range of motion, improved accessibility during operation, and efficiency of surgeons went up, which improved surgeon comfort [13]. The traditional industrial robot was basically like a robotic arm leading surgery. Even though that design was effective, it was missing diversity. A new type of robot enters the medical industry: Continuum robots. These robots were a big turning point for the medical industry as they still had the same efficiency as the robotic arm. Still, the joints on the robotic arm were now much more flexible, which caused the arm to get into the tiny and complex parts of the interior of the patients [1] The most benefits from robot-associated surgery are the ones with laparoscopic surgeries. Surgeons benefit from improved ergonomics and less fatigue compared to traditional laparoscopy. Laparoscopic surgeries operate by smaller incisions, reduced blood loss, and faster recovery. Every good in the world has some bad tied to it. The same is valid for medical robots. One of the most significant issues with medical robots is their affordability, as they can get very pricy. In August 2021, the US Food and Drug Administration (FDA) released a safety communication

6 telling patients that the procedures of robotic-assisted surgeries haven’t been established. Patients’ harm can result from surgeon errors or a machine malfunction which could be very risky for the patient’s health. Collaborating with Pennsylvania Patient Safety Authority in analyzing hospitals over ten years showed quite a few adverse events, of which 544 were robot-assisted surgeries [13]. An ABC News broadcast talks about how there have been some issues with using robots inside the operating room. Complications took place for about eleven robot-assisted surgeries. In one instance, the aorta of a kidney patient was torn as a cause of either a machine malfunction or an error by the surgeon while operating [17]. Present-Day Medical-robotics & Future ambitions Many well-known technologies/robots exist in the medical industry and are changing people’s perspectives of how they view medical robots. An article by “Donavan Alexander” talks about fifteen medical robots changing the world. DaVinci system: this is the Concentric Tube robot, made famous by the name DaVinci system. DaVinci was one of the record-breaking inventions for the medical robot industry. This system is prevalent in most hospitals around the globe, saving people’s lives. Endoscopy-bot: Another brilliant invention by which endoscopy can be performed without inserting the camera into the body using a natural opening. The traditional procedure can be very irritating and uncomfortable, and the invention of this kind of technology made a difference. The use of “capsule endoscopies,” where the procedure boils down to swallowing a pill-sized robot that could travel inside the digestive system and gather information and take pictures. Clinical Training Bots: A brilliant invention that is a dummy on which treatment

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7 can be done. Most surgeon learns as they practice on the human body, so having a training bot will significantly decrease the risk of a mistake by a surgeon. Making the training robot compulsory for med schools will lead to a bright future for medical surgeons. The article discusses a few more robots, like companion robots, disinfectant robots, etc. [12]. For many years Davinci system ruled the robotic surgery industry. Still, more new technologies are showing their presence on the market and spreading more and more. Studies have shown that “In 2019, ¼ of US Hospitals use at least one surgical robot” [13]. For further improvement of medical robots, modeling methodology could be a brilliant way of testing and designing robotic models that could minimize the chances of errors occurring. Models that represent physical properties of arterial tissue with no more than 5% error; robots could be used to operate on machines that can be used as practice runs [14]. The good news is that many new technologies are coming up, which could excite and encourage people who are uncertain about medical robots and make them realize the power of technology in our lives. Technologies such as Computer-Aided Detection (CADe) and Computer-Aided Diagnosis (CADx) are one of the most awaited technologies for the future. CADx and CADe are technologies that will detect and diagnose lung cancer. Both CADe and CADx have some faults; hence their use of them is still not as available. CADe systems are still unable to present the characteristics of tumors, and CADx systems cannot detect the growth of tumors and do not have good levels of automation [15]. Both technologies are under development and hopefully, show their presence in the market soon. Soft robots are also making a come-up in the medical scene; as endoscopy may lack some stability, surgical tools are being developed to provide the surgeon with maximum flexibility and comfort to operate comfort, unlike traditional manipulators, manipulators such as Stiff-flop manipulators

8 [16]. A lot of planning and research is behind building these technologies, and it’s safe to say that the future ambitions of medical robotics are strong. Conclusion For the last three decades, engineering has been leaving its mark on the medical industry while showing us what technologies are capable of. Many robots have been invented and operating while other new technologies are on the verge of coming up. From the early models of robots which were much more rigid, they were hard to work with. That introduced the soft robots and robots with more joints, meaning, the structure was much more flexible. Medical robots have both bad and good sides. Medical robots could be extremely expensive and there have been many cases of malfunctions during surgeries. But introducing technologies such as the CADe and CADx could be game changers in coming years. With the rise of many variants of diseases and flu, having these technologies alongside doctors would benefit human societies. References [1] J. Shaw, “The Medical-Robotics Revolution,” Harvard Magazine , Apr. 06, 2022. https://www.harvardmagazine.com/2022/05/features-medical-robotics-revolution (accessed Oct. 28, 2022).

9 [2] R. A. Beasley, “Medical Robots: Current Systems and Research Directions,” Journal of Robotics , Aug. 12, 2012. https://www.hindawi.com/journals/jr/2012/401613/ [3] R. H. Taylor, A. Menciassi, G. Fichtinger, P. Fiorini, and P. Dario, “Medical Robotics and Computer-Integrated Surgery,” Springer Handbook of Robotics , pp. 1657–1684, 2016, doi: 10.1007/978-3-319-32552-1_63. [4] “Medical Robot: What Is It and How Does It Work?,” Koombea , Feb. 17, 2022. https://www.koombea.com/blog/medical-robot/ [5] Y. Zhong, L. Hu, and Y. Xu, “Recent Advances in Design and Actuation of Continuum Robots for Medical Applications,” Actuators , vol. 9, no. 4, p. 142, Dec. 2020, doi: 10.3390/act9040142. [6] A. S. Weber, “Emerging Medical Ethical Issues in Healthcare and Medical Robotics,” International Journal of Mechanical Engineering and Robotics Research , pp. 604–607, 2018, doi: 10.18178/ijmerr.7.6.604-607. [7]

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10 “Robotics in the Medical Field,” www.brighthubengineering.com , Nov. 17, 2010. https://www.brighthubengineering.com/robotics/95856-use-of-robotics-in-the- medical- field/#:~:text=Medical%20robotics%20was%20introduced%20in%20the%20science% 20of (accessed Oct. 28, 2022). [8] C. Gyles, “Robots in medicine,” The Canadian Veterinary Journal , vol. 60, no. 8, pp. 819–820, Aug. 2019, [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625162/ [9] O. Boubaker, “Chapter 7 - Medical robotics,” ScienceDirect , Jan. 01, 2020. https://www.sciencedirect.com/science/article/pii/B978012821350600007X [10] J. H. Lonner and J. F. Fraser, “A Brief History of Robotics in Surgery,” Robotics in Knee and Hip Arthroplasty , pp. 3–12, 2019, doi: 10.1007/978-3-030-16593-2_1. [11] T. Ginoya, Y. Maddahi, and K. Zareinia, “A Historical Review of Medical Robotic Platforms,” Journal of Robotics , Jan. 30, 2021. https://www.hindawi.com/journals/jr/2021/6640031/

11 [12] D. Alexander, “15 Medical Robots That Are Changing the World,” interestingengineering.com , Nov. 03, 2020. https://interestingengineering.com/health/15-medical-robots-that-are-changing- the-world [13] ZaggoCare, “The Dangers of Robotic-Assisted Surgery,” ZaggoCare , Aug. 31, 2020. https://zaggocare.org/dangers-robotic-assisted- surgery/#:~:text=In%20addition%20to%2010%20tragic%20patient%20deaths%2C%2 0they [14] S. Ikeda et al. , “In vitro patient-tailored anatomical model of the cerebral artery for evaluating medical robots and systems for intravascular neurosurgery,” IEEE Xplore , Aug. 01, 2005. https://ieeexplore.ieee.org/abstract/document/1545554 (accessed Oct. 28, 2022). [15] M. Firmino, G. Angelo, H. Morais, M. R. Dantas, and R. Valentim, “Computer-aided detection (CADe) and diagnosis (CADx) system for lung cancer with likelihood of malignancy,” BioMedical Engineering OnLine , vol. 15, no. 1, Jan. 2016, doi: 10.1186/s12938-015-0120-7.

12 [16] M. Cianchetti and A. Menciassi, “Soft Robots in Surgery,” Soft Robotics: Trends, Applications and Challenges , pp. 75–85, Sep. 2016, doi: 10.1007/978-3-319-46460- 2_10. [17] A. B. C. News, “Video Robot Doctors in the Operating Room,” ABC News . https://abcnews.go.com/WNT/video/robot-doctors-operating-room-18944557

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