In recent decades, intelligent medical technology has been a research hotspot, among which medical robots are one of the most promising intelligent technologies, with several robotic products successfully gaining clinical application both domestically and internationally. Medical robots are medical devices that integrate multiple disciplines, including medicine, mechanics, biomechanics, and computer science. From the perspective of clinical medical applications, they can be roughly divided into surgical robots, rehabilitation robots, and social assistance robots.
1. Surgical Robots
Surgical robots, as innovative intelligent medical devices, can perform precise surgical operations in areas with dense human cavities, blood vessels, and nerves. They have advantages such as accurate positioning, minimal surgical trauma, low infection risk, and fast postoperative recovery, meeting patients’ demands for high-quality medical services. Research on surgical robots in China began in the mid-1990s, achieving significant breakthroughs in fields such as orthopedics, general surgery, urology, and neurosurgery.
(1) Orthopedic Surgical Robots
Orthopedic surgical robots are core intelligent devices that promote the precision and minimally invasive development of orthopedic surgery. They are currently mainly used in spinal surgery, joint replacement surgery, and limb fracture surgeries.
The universal orthopedic surgical robot: the Tianji® robotic system is the world’s first universal orthopedic surgical robot, overcoming the limitations of similar products that are only applicable to specific sites. It can be used for surgical treatments across multiple sites, including the entire spine, pelvis, and limbs. It has broken through the bottleneck of clinical accuracy for orthopedic surgical robots, achieving a positioning accuracy of less than1 mm, leading international similar products. The Beijing Jishuitan Hospital has confirmed through prospective randomized controlled studies that the accuracy of the Tianji robot-assisted cervical screw, thoracolumbar screw, and sacroiliac screw fixation surgeries is superior to traditional manual surgery.
Spinal-specific surgical robot:SpineAssist® spinal surgical robot (Mazor Robotics) was the first robot approved by the U.S. Food and Drug Administration (FDA) in2004 for spinal surgery. The ROSA® Spine spinal surgical robot (Medtech) was approved by the FDA in2016. The Excelsius GPS® spinal surgical robot (Globus Medical) was approved by the FDA in2017 for robot-assisted thoracolumbar screw fixation surgery. In2019, the latest ROSA ONE spinal robot passed FDA certification and was approved by the National Medical Products Administration (NMPA) in2020. Clinical studies have shown that robot-assisted spinal surgery has higher patient satisfaction and more precise screw implantation than traditional surgery.
Joint-specific surgical robots:ROBODOC (Think Surgical) was the first active robotic system used in orthopedic surgery, gaining widespread attention in the 1990s and can be used for joint replacement surgeries. Due to system failures, long operation times, and multiple complications, the ROBODOC system is no longer used clinically. The MAKO robot (Stryker) is a semi-active robotic system that can assist in acetabular preparation and femoral prosthesis position assessment in total hip arthroplasty and assist in osteotomy in knee arthroplasty.NAVIO PFS robot (Smith&Nephew) is a non-image semi-active robotic system with similar features to MAKO, mainly used in knee replacement surgeries.
Currently, the Tianji robot, independently developed in China, is the only universal orthopedic surgical robot internationally, and its positioning accuracy in spinal surgery is superior to foreign counterparts. In the research of spinal laminectomy surgical robots, both domestic and international studies are still focused on key technology exploration. The development of joint surgical robots in China started relatively late and is still in the clinical trial stage, lacking products on the market, resulting in a certain gap compared to foreign countries.
(2)Endoscopic Surgical Robots
The application of endoscopic technology has ushered in an era of minimally invasive surgery, with more and more endoscopic surgeries replacing traditional surgeries. In recent years, surgical robots represented by the Da Vinci surgical system have been successfully developed and entered clinical use, achieving widespread application in many surgical fields with good results.
Among the endoscopic surgical robots developed domestically, the “Miracle Hand” series surgical robots jointly developed by Tianjin University and Weigao Group have entered the clinical trial stage and have assisted in performing several complex clinical surgeries, including cholecystectomy, radical colon cancer surgery, and radical gastric cancer surgery. Other ongoing research on minimally invasive surgical robots includes the “Shendao Huatuo” minimally invasive surgical robot developed by Shanghai Jiao Tong University and the “Huaque-II” minimally invasive surgical robot developed by Harbin Institute of Technology.
(3) Neurosurgical Robots
The emergence of robot-assisted neurosurgery began in the 1980s with the use of the PUMA robot in neurosurgery. Neurosurgical robots are mainly used to assist in stereotactic surgery, with major products including the Neuromate robot, ROSA Brain robot, and Ruimi robot.
Due to the special nature of the professional technology in neurosurgery, the application of surgical robots domestically and internationally has also been affected, maturing mainly in stereotactic surgery. Although the technology of neurosurgical robots in China has developed rapidly, there are still many areas that need improvement compared to foreign robots.
2. Rehabilitation Robots
Rehabilitation robots are a type of medical robot that assists the body in completing limb movements, achieving functions such as walking assistance and rehabilitation therapy. They can be considered a special type of “wearable device” in specific environments. Rehabilitation robots can provide differentiated training for patients, enhance their awareness of active movement, reduce rehabilitation training time, and improve rehabilitation training outcomes. Rehabilitation robots are important technical means and methods for rehabilitation training following motor disorders caused by strokes, spinal cord injuries, etc. The main upper limb rehabilitation robots on the market includeArmeo Power,Fourier M2,SPAR, etc.; the main lower limb rehabilitation robots includeMINDWALKER, Ximing Mingyi,ReStore,and NovoSkeleton.
Although rehabilitation robots abroad have achieved industrialization, they impose a technological monopoly on the domestic market, with high product prices, low assistive efficiency, and poor coordination, hindering product promotion and use. There is a huge market and business opportunity for rehabilitation robots in China. While some research results have been achieved, most are still in the experimental stage, with low interaction sensitivity, poor wearing experience, and the accuracy of intent recognition needing improvement, and a lack of mature, widely recognized products in the market.
3. Social Assistance Robots
Social assistance robots are characterized mainly by their assistive and social interaction capabilities. These robots further reduce the communication gap between robots and humans in specific functional areas, balancing caregiving and emotional companionship roles to achieve goals such as rehabilitation and learning. They help address the shortage of medical resources and better serve the medical social field, especially for elderly patients and children with autism.
Social assistance robots cannot yet replace people’s daily communication but can help individuals integrate better into society. In the research and development of such robots, Western countries like Japan, the United States, and Germany are in a leading international position. China also began related technology research in the 1990s, with Tsinghua University proposing the concept and development of care robots for high-level paraplegics in1995.
4. Robots and Telemedicine
The world’s first remote surgical operation was completed in2001 by a medical team in the United States, which used the ZEUS robotic system to perform a laparoscopic cholecystectomy, opening the way for remote surgery. However, due to the network speed and latency at the time, the operating surgeon could feel a significant delay between the operation and the visuals during the surgery.On February 27, 2019, a medical team in Barcelona, Spain, guided the removal of intestinal tumors remotely through a 5G network, becoming the world’s first human surgery performed using 5G technology; on March 16, 2019, the first domestic remote human surgery based on 5G, the “brain pacemaker” implantation surgery, was successfully completed, filling a domestic gap. On June 27, 2019, the world’s first “one-to-many” remote orthopedic robotic surgery based on 5G was completed at Beijing Jishuitan Hospital, further advancing the forms of remote surgery and telemedicine. Although China’s start in remote robotic surgery was later than abroad, it has already surpassed internationally in the exploration and application of the latest 5G technology, leading the world in remote surgery based on 5G technology.
5. Issues in the Development of Medical Robots
The current level of intelligence and automation of medical robots needs improvement. Most medical robots at this stage are either non-automated or task-automated and cannot achieve full automation. In the new development stage, medical robots will gain more “autonomous” permissions, but all of this must be based on safety. In the future, through data accumulation and machine learning, the deep integration of robots and artificial intelligence technology will further enhance medical standards. Robots will increasingly supplement human capabilities, providing more assistance to humans and allowing doctors to focus on high-level intelligent judgments.
As the technology of medical robots continues to develop, we must also consider the ethical issues that robotic technology may encounter. Especially when robots develop to a high level of intelligence in the future, it will be necessary to adhere to ethical norms, ensuring that intelligent technology positively aids medicine rather than seeking to replace doctors. It is essential to avoid conflicts that may arise in medical ethics, health law, health economics, and medical sociology while promoting the development of medicine through intelligent technology. Robots will surpass certain human skills, but creative abilities will always be controlled by humans. The future of medical robots will be built on deep collaboration between humans and machines.
Conflict of Interest The author declares no conflict of interest.
References (omitted)
Cite this article: Tian Wei. Overview of the Current Development of Medical Robots[J]. Chinese Medical Journal, 2021, 101(05): 374-378. DOI: 10.3760/cma.j.cn112137-20200914-02646.
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