Medical robotics: Automated machines that can help you eat or amputate your leg

The future is already here

A few decades ago, when we thought about the future and technological advancement, we imagined high technology, futuristic robots and advanced transportation: from spaceships and flying cars to humanoid robots, teleportation machines and laser guns.

However, this era has finally arrived, and although innovation has followed different paths (we don't have teleportation machines, but we do have the Internet and mobile phones), it has brought with it a series of extremely important inventions with technology that was unimaginable 20 years ago.

Today we talk about medical robotics.

The most advanced science

Medical robotics has revolutionized the healthcare field by integrating robotic systems into various areas, improving the precision of procedures and facilitating patient recovery. Unlike industrial robots , which focus on automated tasks without direct interaction with humans, medical robots are characterized by a direct physical relationship with the patient , that is, their design is oriented to work in contact with the human body, which allows them to collaborate in surgeries, rehabilitations and care.

Medical robots differ from industrial robots not only in their direct interaction with humans, but also in the complexity of the biological interfaces they use to capture signals from the human body and adapt to the individual needs of each patient. This makes medical robotics a key tool for the future of medicine, improving both clinical outcomes and the quality of life of patients.

Connection between human and machine

The connection or interface with the machine is one of the most important points of medical robotics and there are different types that allow capturing useful information from the patient so that the robot acts efficiently:

• Brain-computer interface : Captures electroencephalographic (EEG) signals to control robots using brain activity.
• Myoelectric interface : Uses electromyographic (EMG) signals to measure muscle force and control robotic prosthetics.
• Eye interface : Detects eye movements using electrodes to enable control of robotic devices.
• Multimodal interface : Combines several interaction modalities to improve communication between the robot and the patient, especially useful for people with disabilities.

To achieve effective human-robot interaction in the field of medical robotics, the following elements are required:

• Sensors on the robot : The robot needs to have sensors that allow it to know the status of the machine. These include:
• Position sensors.
• Speed ​​sensors.
• Acceleration sensors.
• Presence sensors.
• Force sensors.
• Monitoring the patient's condition : It is equally important to have systems that allow us to know the human being's condition, through the acquisition of different biosignals linked to their physical, neurological or emotional state. These signals are crucial to adjust the interaction in a personalized way according to the patient's needs.

Both factors are essential to achieve effective human-machine interaction, particularly in areas such as rehabilitation and robotic assistance , where physical contact and cooperation between the person and the robotic device are indispensable for the success of therapies or assistance.

Rehabilitation robots

Rehabilitation robots are technological devices designed to assist patients in the process of recovering their motor skills after injuries, illnesses or disabilities. These robots allow repetitive and controlled exercises to be performed, which facilitates neuronal reorganization and functional recovery of the limbs. Unlike traditional rehabilitation methods, rehabilitation robots offer an accurate and real-time assessment of the patient's progress, allowing exercises to be tailored to their specific needs.

Rehabilitation robotics focuses on promoting patient autonomy by helping them perform biomechanical movements in a controlled manner. The goal is for patients to recover their motor skills through the assistance and continuous monitoring that these devices offer. Exoskeletons are a fundamental part of rehabilitation robotics, as they provide physical support to the limbs, helping in the recovery of mobility and muscle strength.

Among the rehabilitation robots, the most important are the devices from the Hocona brand, a Swiss company that is a world leader in the development of robotic rehabilitation technology, which allows its robots to carry out personalized therapies for each patient.

Lokomat

It is one of the company's most emblematic devices. This exoskeleton is designed for gait rehabilitation in patients with mobility disorders in the lower limbs, especially in neurological injuries, strokes, traumatic brain injuries and neurodegenerative diseases.

The Lokomat guides the patient’s legs through a naturalized walking motion, while their trunk is suspended to reduce body weight and allow the patient to practice assisted walking. In addition, the system allows assistance levels to be adjusted based on the patient’s progress and collects real-time data to assess their progress.

The cost of the Lokomat varies depending on the configuration and additional options chosen. Although there is no specific price easily accessible, the estimated range is between 300,000 USD and USD 400,000, depending on the model and features such as the pediatric module or visual feedback and data analysis systems.

 

Lokomat has a significant global presence. Currently, more than 300 Lokomat systems have been installed in over 50 countries , with wide representation in North America, Europe and Asia. Hocoma has a network of distributors and sales partners on all continents, making it easy to purchase and support in various parts of the world.

Armeo

It is a line of products aimed at the rehabilitation of the upper limb, both the arm and the hand . Hocoma has developed several versions of this device to adjust to different phases of the recovery process:

• Armeo Power : Aimed at patients with limited or no mobility in the arm. It uses a motorized system to assist movements, allowing the performance of specific exercises.
• Armeo Spring : For those in the middle of recovery, this non-motorized exoskeleton helps offset the weight of the arm, allowing the patient to perform active movements.
• Armeo Senso : Ideal for the advanced phase of arm rehabilitation, this device uses a suspension system that facilitates movement and can be used with less medical supervision.

Prices may vary depending on the model and features of the system. The ArmeoSpring and ArmeoPower , which are two of the most prominent devices in this series, have an approximate cost ranging from 80,000 USD and 150,000 USD , depending on the configuration and optional modules added, such as the ManovoPower hand training system

Surgical robots

Surgical robots are transforming the field of medicine by allowing surgeons to perform operations with greater precision, control and safety . Far from replacing the surgeon, these systems assist them in performing minimally invasive surgeries , facilitating more complex procedures with less impact on the patient, such as achieving better alignment between the bone and the prosthesis, greater contact surface between both parts and an increase in the longevity of the prosthesis. Not only do they minimize human errors but they also achieve results that would be impossible for a person. The introduction of these robots has improved postoperative recovery and significantly reduced the risk of complications. Equipped with advanced technologies such as 3D visualization and joystick control , they offer extremely precise movements, which exceed the capabilities of the human hand, especially in procedures where precision is essential.

These devices have already been adopted in several medical specialties, such as neurosurgery , orthopedics , and general surgery . Each surgical robot is designed to adapt to the specific needs of each procedure, which has expanded its applications in the medical environment.

For example , in retinal surgery , it is crucial to achieve precise laser placement within a target of just 25 microns to avoid damaging retinal vessels. However, human precision is limited, as it is not possible to guide an instrument within a range of less than 100 microns . This is where surgical robots show their true potential, providing the level of accuracy needed to perform these types of interventions without compromising delicate tissues.

Neuromate

The Neuromate is a wonderful surgical robot and specializing in stereotactic neurosurgery. It offers millimeter precision in complex neurosurgeries, allowing surgeons to perform delicate procedures such as brain biopsies, electrode implantation for epilepsy treatment with an unmatched level of accuracy, or complex brain stimulation for Parkinson's patients. Its ability to integrate with high-resolution images and its robotic design help reduce the margin of error, minimizing the risk of collateral damage to healthy brain tissue. This makes it an invaluable tool in neurological treatments that require extreme surgical precision.

Stereotaxy or Stereotactic surgery is an advanced neurosurgical technique that allows access to deep areas of the brain with great precision using a biopsy needle. Through this needle, surgeons can take samples of brain tissue, remove lesions or evacuate fluids, all with millimetric accuracy. Today, this technique has been adapted to work with computed axial tomography (CAT) and magnetic resonance imaging (MRI) , which allows the brain lesion to be clearly identified and the exact point where the intervention will be carried out to be determined. The spatial coordinates x, y, z , derived from the images, are introduced into the stereotactic system, which guides the intervention towards the selected area with absolute precision. This procedure allows access to regions of the brain that would otherwise be unreachable through traditional open surgeries.

To perform the surgery, the neurosurgeon uses the robot's software to design the intervention based on a high-resolution CT scan or MRI of the patient, so that all the coordinates of each action are spatially recorded and the robot precisely intervenes at each point.

In the first video you can see the planning of a surgery and in the second how the robot works on the patient.

• Company : Renishaw Neuro Solutions , a division of Renishaw , is responsible for its development.
• Country : United Kingdom.
• Year of creation : The first Neuromate was developed in the 1980s.
• Approximate Price : Price can range from $500,000 to $700,000 , depending on configurations.
• International distribution : It is present in hospitals in Europe, North America and Asia.
• Approving bodies : FDA approved and CE marked in Europe.
• Main features : High precision in neurosurgery, robotic guidance for cranial surgeries, compatible with imaging systems such as tomography and magnetic resonance imaging.

Renaissance

The Renaissance is a special, small surgical robot that sits directly on the patient's back. It is used to perform high-precision spinal procedures, such as screw placement in spinal fusion surgeries. It is configured by integrating preoperative imaging, such as CT scans, which create a three-dimensional map of the patient's spine. During surgery, the robot guides the surgeon's instruments with millimeter accuracy, ensuring optimal implant placement while minimizing patient exposure to radiation and reducing the risk of errors.

It also has a brain module for intracranial surgeries.

In the video you can see some very good animations created by the manufacturer on how a surgery is planned and performed with this robot. The second one is more realistic.

• Company : Developed by Mazor Robotics , an Israeli company.
• Country : Israel.
• Year of creation : Introduced in 2011 .
• Approximate price : Its cost is between 800,000 and 1.2 million USD .
• International distribution : Present in hospitals in more than 20 countries , mainly in Europe and America.
• Approving bodies : It has FDA approval and CE marking.
• Main features : Compatible with preoperative and real-time images, precise guidance in the placement of spinal implants, reduction of postoperative complications.

Robodoc

The Robodoc stands out as a revolutionary tool in orthopedic surgery for its ability to perform high-precision procedures, especially in hip and knee replacements. This robot is configured from preoperative 3D images that create a detailed model of the patient's bone, allowing the surgeon to meticulously plan the necessary cuts.

This robot, which is approximately two metres tall, is equipped with an advanced drilling system that operates autonomously. Once the surgeon places the sensors on the patient's body, the Robodoc proceeds to drill the bone in a matter of minutes , allowing the placement of prostheses with unparalleled accuracy. Although the system acts actively and autonomously during the intervention, the surgeon remains essential in guiding the process, ensuring both surgical precision and patient safety. With this technology, post-operative outcomes are optimised and the quality of life of patients is significantly improved.

• Company : Originally developed by Integrated Surgical Systems in collaboration with IBM . Currently marketed by Curexo Technology Corp.
• Country : United States.
• Year of creation : Approved by the FDA in 2008 , although its development began in the 1992s.
• Approximate price : Between 500,000 and 700,000 USD .
• International Distribution : Extensive presence in the US , Europe and Asia, with multiple hospitals using the system.
• Approving bodies : Approved by the FDA and the CE in Europe.
• Main features : Ability to make precise cuts in bones, integration with preoperative 3D images, less invasive than conventional surgeries.

Mako robotic arm

Stryker’s Mako robot is unique in its ability to perform complete hip and knee replacement surgeries using robotic assist technology. It is configured using a personalized 3D model of the patient, generated from a computed tomography (CT) scan. This model allows the surgeon to plan the procedure in detail, adjusting implant positioning to fit the patient’s specific anatomy. During the procedure, the surgeon uses the Mako robotic arm, which provides assistance to make precise bone cuts, while the surgeon remains in full control of the procedure, adjusting in real time as needed to ensure optimal results.

• Company : Developed by Stryker , a global medical technology company.
• Country : United States.
• Year of creation : Commercially launched in 2006 .
• Approximate price : Its cost ranges between 1 million and 1.5 million USD .
• International distribution : It is present in more than 25 countries , including the USA, Canada, Europe and Asia .
• Approving bodies : FDA approved and CE certified for use in Europe.
• Key Features : 3D image-based surgical planning, robot-assisted bone cutting for increased precision, improved patient recovery and reduced postoperative pain.

Da Vinci

The Da Vinci is the master-slave surgical robot, the most well-known in the world and the most widely used for minimally invasive surgery, as it has extreme precision and control, widely used in areas such as urology, gynecology, cardiac surgery and general surgery. It offers the surgeon 3D vision and precise control of robotic instruments, overcoming the limitations of conventional surgery.

It is configured using 3D imaging and preoperative planning to guide the procedure. During the procedure, the surgeon controls the robotic arms from a console, which translates the movements of his or her hands into precise actions inside the patient's body. The Da Vinci offers high-definition 3D visualization and allows complex movements to be performed through microinstruments, all under the full control of the surgeon, who monitors and adjusts each action in real time.

In the first video you can see a simulation of the use of the robot and its control panel and in the second video you can see how surgery is performed on a grape, a common method of training surgeons, where you can appreciate the great precision that this robot provides.

• Company : Powered by Intuitive Surgical .
• Country : United States.
• Year of creation : Approved by the FDA in 2000 .
• Approximate price : The basic system costs around 2 million USD , and the annual maintenance and accessories cost can reach 150,000 USD .
• International distribution : More than 5,000 Da Vinci systems are installed in 70 countries, of which more than 3,000 are located in the USA.
• Organizations that approve it : Approved by the FDA , with CE certifications in Europe and endorsed by various organizations in Asia and Latin America.
• Main features : Extremely precise movements with a scale of 1:10, high-definition 3D images, allowing complex procedures to be performed with minimal incisions.

Alvarogarciamd , CC BY-SA 4.0 , via Wikimedia Commons

A.BourgeoisP , CC BY-SA 4.0 , via Wikimedia Commons

Cyberknife

The Cyberknife is unique in its ability to perform noninvasive radiosurgery , targeting tumors anywhere in the body without the need for incisions. It uses imaging such as CT scans or MRIs to plan treatment, pinpointing the area to be treated with sub-millimeter precision. One of the most impressive factors of the Cyberknife is that it can follow the patient’s natural movements, such as breathing, automatically adjusting radiation beams in real time, making it extremely effective.

The system features a linear accelerator mounted on a flexible robotic arm, capable of delivering radiation from multiple angles, maximizing dose to the tumor while minimizing damage to surrounding tissue. During the procedure, the surgeon plans the treatment and monitors the process, but the robot performs the treatment autonomously .

A curiosity is that it can treat mobile tumors , such as those of the lung, without the need for internal markers.

• Company : Powered by Accuray .
• Country : United States.
• Year of creation : Introduced in 2001 .
• Approximate price : Between 4 and 6 million USD , depending on the configuration.
• International distribution : It is distributed globally, present in hospitals in the USA, Europe, Asia and Latin America .
• Approving bodies : FDA approved and CE marked for use in Europe.
• Main features : Non-invasive radiosurgery, high precision to treat tumors without damaging healthy tissue, outpatient treatment with minimal discomfort for the patient.

Assistance robots

Assistive robots are designed to improve the quality of life of people with physical or neurological disabilities by facilitating everyday tasks such as feeding, moving or manipulating objects. These devices provide autonomy and dignity to their users, allowing them to participate in daily activities with greater independence. Below are some prominent assistive robots in the healthcare field, with details on their features, costs and distribution. The main objective is to re-teach the patient to be autonomous.

Neater Eater

Feeding assistant designed for people who can chew and swallow, but have difficulty getting food into their mouths due to tremors, muscle weakness, or motor disabilities. This device is modular and can be customized to the user's needs, including configurations for people with different degrees of mobility.

• Features : Touch or switch control, adjustment options for plate and utensil position, and now with voice commands for greater accessibility.
• Price : Cost varies, but is estimated between $6,000 and $9,000
• Distribution : It is distributed worldwide, with free home assessments available in the UK and a distribution network in several countries.

Lift Ware Robotic Spoon

Designed for people with tremors, such as those with Parkinson's disease, this spoon stabilizes hand movements so the user can eat without spilling food.

• Features : Uses stabilization technology to reduce shaking by up to 70%, and features different interchangeable utensils such as a spoon and a fork.
• Price : The starter kit is valued at approximately $195 , with additional utensils costing around $35 each.
• Distribution : It is available globally through the official website and specialized medical equipment stores.

Manus

Robotic manipulator that mounts on wheelchairs and helps users with limited mobility perform everyday tasks such as grasping objects, eating, and operating electronic devices.

• Features : This robotic arm is highly adaptable and easily controlled using joysticks or voice commands.
• Price : Depending on the features and adaptations, the cost may vary, but is estimated between 25,000 and 35,000 USD .
• Distribution : It is mainly distributed in Europe and North America, and can be purchased through distributors specialized in assistive robotics.

Care-O-bot

A mobile robot designed to assist elderly or disabled people with tasks such as carrying objects, reaching for items, and manipulating utensils. It is used in homes, hospitals, and care facilities to support daily living.

• Features : It integrates an autonomous navigation system and a robotic arm to manipulate objects with precision. It can be controlled through voice commands and has a user-friendly interface.
• Price : The Care-O-bot 4 has an estimated price of $250,000 , depending on specific features and the environment in which it is used.
• Distribution : It is distributed mainly in Europe, with a presence in several countries, and is available for institutions that work with elderly people or people with physical disabilities.

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