Dupont Pierre E,  Nelson Bradley J, Goldfarb Michael, Hannaford Blake, Menciassi Arianna, O'Malley Marcia K, Simaan Nabil, Valdastri Pietro, *Yang Guang-Zhong

Science Robotics 2021，6，eabi8017.

Abstract

Robotics is a forward-looking discipline. Attention is focused on identifying the next grand challenges. In an applied field such as medical robotics, however, it is important to plan the future based on a clear understanding of what the research community has recently accomplished and where this work stands with respect to clinical needs and commercialization. This Review article identifies and analyzes the eight key research themes in medical robotics over the past decade. These thematic areas were identified using search criteria that identified the most highly cited papers of the decade. Our goal for this Review article is to provide an accessible way for readers to quickly appreciate some of the most exciting accomplishments in medical robotics over the past decade; for this reason, we have focused only on a small number of seminal papers in each thematic area. We hope that this article serves to foster an entrepreneurial spirit in researchers to reduce the widening gap between research and translation.

Introduction and Methods

As we consider some of the key research activities in the past decade, we obtain a glimpse of where medical robotics will head in the coming decades. This article focuses on the past 10 years and provides a retrospective assessment of the major accomplishments in medical robotics. We use an inclusive definition for what constitutes a medical robot that is intended to cover all material that would be appropriate for inclusion in a major robotics research journal or conference. This encompasses single- and multi–degree-of-freedom (DOF) motorized systems with motions that may be preprogrammed, joystick-prescribed, autonomous, or some combination of the three. We define medical robotics research as the creation of new robots and robotic technologies for medical interventions. A large body of medical journal papers devoted to the evaluation of existing medical robots has also been published over the past decade. Because these robots largely represent technologies developed during prior decades, they are not discussed here. Here, our goal was to identify the major research themes or “hot topics” in medical robotics over the decade and to summarize the seminal research papers that concisely highlight these themes.

Key Results and Conclusions

Bringing robotic technology to clinical use requires much more than simply well-cited research articles. A genuine clinical need must be identified. A relevant technology must be developed to address this need that considers the specifics of how the robot adds value for the clinician and for the patient. Medical doctors must be convinced of this value proposition. The technology must also be developed with hospital administrative and financial constraints well considered and without hindering well-established clinical workflows. Potential risks must be identified early on so that ethical approvals can be obtained. Last, attractive business models must be developed to ensure that sufficient investment can be obtained to bring the technology through the complex pathways that must be navigated for any medical device to achieve commercial success. Maximizing the chance of success suggests that technology researchers stray from their ivory towers to form deep collaborations with clinicians, regulators, investors, and the business community.

Fig. 1：Example clinical applications for the eight hot topics of the decade.

Starting at 8 o’clock and proceeding clockwise: Laparoscopic robots are the success story of medical robotics with applications including radical prostatectomy, radical cystectomy for bladder cancer, rectal cancer resection, and hysterectomy. Continuum robots are robotic versions of manual medical instruments including catheters, bronchoscopes, uteroscopes, and colonoscopes. Nonlaparoscopic robots have been developed for varying applications including electrode implantation in the brain and microsurgery inside the eye. Soft robots have been used, e.g., to create soft sleeves to assist heart contraction and for hand rehabilitation of daily living tasks. Assistive wearable robots are used to augment or replace arm and leg motion in the cases of motion impairment or amputation. Capsule robots are pill-sized devices that are swallowed for endoscopic diagnosis and treatment of the alimentary canal. Therapeutic rehabilitation robots assist patients with neurological injuries in performing repetitive movements to relearn tasks such as walking and grasping. Magnetic actuation enables the wireless generation of forces and torques inside the body to actuate an untethered robot or to orient the tip of a catheter.

Fig. 2：Medical robotics papers published in engineering and medical journal papers from 1990 to 2020.

Curves report total numbers along with subsets corresponding to hot topics of laparoscopic robots, therapeutic rehabilitation robots, and assistive wearable robots. Note that 2020 publications were potentially reduced by coronavirus disease 2019 (COVID-19) shutdowns (data from Web of Science; see Materials and Methods).

Fig. 3：Medical robotics papers published in engineering and medical journal papers from 1990 to 2020.

Curves report paper numbers for hot topics of soft robotics, magnetic actuation, capsule robots, and continuum robots. Note that 2020 publications were potentially reduced by COVID-19 shutdowns (data from Web of Science; see Materials and Methods).

Fig. 4：Application-specific trend toward increasing medical robot autonomy.

In current use, the level of autonomy is typically the minimum needed to be clinically useful. For example, radiotherapy robots operate at a level of conditional autonomy computing and executing a radiation exposure trajectory to provide the desired radiation dose inside a patient while minimizing exposure of surrounding tissues. Orthopedic robots are capable of autonomously milling out a prescribed cavity for knee and hip implants. In contrast, laparoscopic surgical robots have proven successful under continuous operator control and so currently offer only limited robotic assistance. Transcatheter mechanical thrombectomy and heart valve repair are examples of clinical applications for which robotic solutions have yet to be developed, although both could potentially benefit from robotic solutions. In the future, it is anticipated that the level of autonomy of current robotic systems will increase. The biggest increases will be for those applications for which autonomy is vital to their function. For example, highly autonomous systems for remotely performing emergency mechanical thrombectomies to treat stroke would substantially increase the accessibility of this treatment while also decreasing the time to treatment. As a second example, bionic implants that improve or restore body functions will be sufficiently integrated with their host to not require continuous conscious control.

https://www.science.org/doi/10.1126/scirobotics.abi8017