Artificial intelligence Robot Assisted Surgery (RAS) is a milestone in the development of clinical medicine. One of the greatest significances of developing surgical artificial intelligence robots is to directly expand surgical capabilities. From the definition point of view, a surgical robot is a medical device product integrating multiple disciplines such as medicine, mechanics, biomechanics and computer science. With the development of minimally invasive surgery and related underlying technologies, it can perform visual, auditory and tactile operations for doctors. It provides support for surgical operations and is used in the field of minimally invasive surgery beyond human capabilities to achieve precise control of surgical instruments. Robot-assisted surgery has the advantages of flexibility and precision, large and clear field of view, filtering tremor, small wound and quick recovery, less bleeding and less complications, natural intuition, and easy to learn. Consumption upgrade attributes, application scenarios are expected to continue to break through. After 20 years of development, the surgical robot industry will enter the next period of rapid development from the initial stage.
The business model of the artificial intelligence robot industry in surgery covers "equipment + consumables + service". Its business barriers are higher than the pure consumables model, and the revenue growth brought by the number of equipment and the output of a single device is predictable and relatively stable. From the perspective of technical barriers, in the early stage of competition, the technical basis determines the clinical comparison, and the pros and cons of the clinical comparison dominate the commercialization process. Taking the master-slave teleoperated surgical robot as an example, the technical difficulty lies in the system and the robotic arm. The key technologies in the system include the control system, the master-slave control of visual presence, etc. The key technologies of the robotic arm include the configuration of the slave-operated arm and the telecentric mechanism. , surgical instruments, etc. These technologies involve the combination and application of multiple disciplines. With the breakthrough and development of future surgical robots in key technical fields, and more and more domestic products are integrating with global technologies such as 5G, AR, and artificial intelligence, the prospects of domestic leading enterprises are promising. This article will mainly introduce laparoscopic surgical robots, orthopedic surgical robots, pan-vascular surgical robots, trans-natural orifice surgical robots and percutaneous surgical robots that have a high degree of participation in the clinical field from the perspective of technical points.
Laparoscopic surgery robot
At present, artificial intelligence robots for endoscopic surgery are the most successful representatives of commercialization. Laparoscopic surgery Artificial intelligence robots are designed to complete a variety of complex minimally invasive surgeries. It usually adopts the control method of master-slave remote control operation, which is composed of a surgeon's console, a patient-side operating car and a set of three-dimensional high-definition imaging system. Since traditional minimally invasive surgery (MIS) mainly uses endoscopes and related instruments to perform surgical operations in the natural cavities (abdominal, pelvic, thoracic, etc.) It is more about the precise control of the robotic arm by the operating system to achieve surgery. Compared with MIS surgery, laparoscopic surgical robots have significant advantages such as minimally invasive, delicate and flexible, which can expand the surgical ability of surgeons to a greater extent, and have good application prospects in urology, gynecology, and general surgery.
The application of endoscopic surgical robots in the field of urology includes artificial intelligence robot-assisted radical prostatectomy, robot-assisted partial nephrectomy, robot-assisted radical bladder cancer surgery, etc. In the field of gynecology, the application of endoscopic surgical robots is gradually opening up the market. For benign diseases, robot-assisted surgery includes hysterectomy, myomectomy, vaginal sacrofixation, endometriosis surgery; for malignant diseases, robot-assisted surgery includes endometrial cancer, cervical cancer and ovarian cancer Operation. The field of general surgery is also the main track for robotic surgery, with the main surgical procedures including hernia repair, colorectal surgery, bariatric surgery and cholecystectomy.
Since the approval of the artificial intelligence robot for Da Vinci surgery in 2000, artificial intelligence robotic surgery has truly become commercialized. In the Chinese market, endoscopic surgical robots are in their infancy. In 2020, the domestic endoscopic surgical robot market will exceed 2 billion yuan, but the ratio of robots used in domestic top three hospitals is less than 10%. The large market space means that the industry will grow rapidly in the future. From the perspective of the development process of domestic products, the minimally invasive robot from Thumai has developed rapidly. It is currently in the stage of applying for indications for radical prostatectomy, and will be used in partial nephrectomy (including retroperitoneal surgery) in the future. Other urology, gynecology, general surgery and other urology, gynecology, general surgery to expand the indications. The rest of the products, Weigao's Microhand-S and Condo systems are still in the clinical stage.
Orthopedic surgery robot
Orthopedic artificial intelligence surgical robots are used to assist orthopedic surgery. Its core functions include customizing 3D preoperative plans, improving image clarity of the surgical site, reducing tremors and improving surgical precision, reducing damage to healthy bones and tissues, reducing blood loss, protecting nerves, Shorten hospital stays and speed up recovery, and can guide telesurgery and reduce intraoperative fluoroscopy (X-rays) to reduce radiation.
Orthopedics Artificial intelligence surgical robot is one of the earliest surgical robots in human history. In 1985, the United States used industrial robots for the first time to perform biopsy examinations of brain tumors, which verified the precision advantages of surgical robots. In 1987, the first clinical patent application for positioning robots in orthopedics appeared. From 1997 to 2009, computer technology assisted the development of surgical technology, and orthopedic surgical robots were gradually used in hip and knee replacement surgery. In 1998, Davis and others at Imperial College London developed the Acrobot robotic system for knee surgery. In 2008, Mako Surgical Company of the United States developed the RIO surgical robot, which is used for total knee joint or knee unicondylar replacement surgery.
The composition of orthopedic surgical robot can be roughly divided into control system, positioning and navigation device, mechanical arm device and supporting tool set. The control system is the core of the orthopaedic surgical robot. In addition to the integration of various components, the algorithms involved in the image processing software module, the surgical planning software module, and the robotic arm control module are the core secrets independently developed by each robot company. The positioning and navigation system includes an imaging module, a tracking module and a display module. The system can form a 3D model based on the images imported before surgery, and unify the 3D model with the actual body position of the patient and the real-time position of the surgical instruments in the same coordinate system. It shows that the doctor performs navigational surgical treatment on the patient by observing the relative positional relationship between the surgical instrument and the lesion in the three-dimensional model. For manipulators that operate surgery, the manipulators currently used in medical robots are mainly divided into two types: wire drive and gear drive. The advantage of the wire-driven manipulator is that it is small in size, can achieve a certain degree of mechanical back-drive, and the manipulator has less stiffness in operation; the disadvantage is that the fatigue of the wire drive will relatively affect the accuracy, and it needs to be replaced regularly. The other is the gear motor transmission system, which has the advantage of maintaining accuracy for a long time, but the disadvantage is that it is large in size and feels stiff in operation.
Pan-vascular surgical robot
Pan-vascular surgery The artificial intelligence robot is a master-slave electromechanical device, which can assist doctors to remotely control catheter guide wires in interventional surgery for heart, brain, and peripheral vascular diseases. Generally, the doctor inputs the action through the handle, and the robot reproduces the doctor's hand action from the end. Its advantages lie in both accuracy and radiation. By intervening with equipment such as catheters and guide wires in the operating cabin, the operator can get rid of the burden of lead clothing and reduce radiation absorption.
Experiments have shown that artificial intelligence robot-assisted percutaneous coronary intervention surgery can reduce the radiation exposure of doctors by 95%, while reducing radiation exposure of patients by 20%. Interventional doctors can achieve millimeter-level control of the catheter through robot assistance, reducing the collision between the catheter and the vessel wall, reducing the incidence of complications, and the success rate of complex cases exceeds 98%, reducing the use of some unnecessary consumables. According to Sullivan data, from 2015 to 2020, global panvascular surgeries increased from 11.3 million to 14.3 million, and it is expected to grow at a compound rate of 8.1% to 22.9 million from 2020 to 2026.
Natural Orifice Surgical Robot
Surgery through natural orifice Artificial intelligence robot refers to a robot that enters the target site through the natural path of the human body and can control it for diagnosis or surgery. Such artificial intelligence robots are used in natural orifice endoscopic procedures, such as bronchoscopy (pulmonary tuberculosis), colonoscopy (intestinal examination) and gastroscopy (stomach examination). The natural orifice surgical robot can provide a clearer view of the target site, allowing the surgeon to maneuver the tool more dexterously. At present, the natural orifice surgical robots mainly include Ion from Intuitive Surgery, Monarch from Johnson & Johnson and MedRobotics.
percutaneous surgical robot
The percutaneous surgical robot is a robot that uses magnetic resonance imaging (MRI), ultrasound, computed tomography (CT) and other imaging technologies to locate the target anatomy, guide the feedback needle to reach the target anatomical structure, and assist in the completion of percutaneous surgery. Its application is mainly to collect tissue samples for diagnosis, such as detection of early stage lung, breast and prostate cancer. The percutaneous robot is also capable of performing procedures such as nephrostomy lithotripsy to remove kidney stones, inserting a needle through a small incision in the patient's back, and removing kidney stones. Compared to traditional biopsy procedures that rely on the radiologist's hand to insert the needle, the robotic-assisted approach provides greater stiffness and precision through a robotic arm that is more stable than the human hand.
