Can robotics transform the medical industry? While there are plenty of medicine-focused robotics apps in development, the long-term outlook for their use remains to be seen.
Several industries are seeing the impact of robotics — and medicine is no exception.
While the progress of these applications has been slow compared to other industries, the impact could be huge: robotics in medicine can help to reduce human error, improve recovery time, and reduce hospital stays, ultimately enhancing patients’ quality of life.
The first medical robotic application appeared in 1985, when an early robotic surgical arm assisted in a neurosurgical biopsy surgery. Fifteen years later, the first fully FDA-approved system (known as the da Vinci surgery system) for laparoscopic surgery emerged, giving surgeons the ability to control surgical instruments indirectly via a console.
Today, companies are leveraging advances in the tech to develop new robotic applications to explore the future of medicine — including those related to bionics, disease discovery, and rehabilitation.
Elon Musk’s Neuralink, for example, is working to develop cutting-edge technology to give amputees a better connection to their prosthetics. Auto giant Toyota is developing solutions to serve an aging population, while Johnson & Johnson is heavily investing in medical robotics.
In this analysis, we’ll dig into whether reality is matching those big ambitions, and dive into applications where medical robotics are beginning to enter the mainstream.
Table of Contents
- Robots in the OR
- Robots for disease discovery
- Bionic limbs for both humans and robots
- The growth of rehabilitation robots
- Other common uses for robots in medical settings
From bionic body parts to microrobots you can swallow like pills, robots are coming to a hospital near you — no medical degree required.
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When it comes to surgery, robotics is mostly serving as a high-tech surgical assistant that can help doctors perform minimally invasive surgeries — especially in hard to reach or micro areas.
Most of these systems, classified as robotically-assisted surgical (RAS) devices by the FDA, allow surgeons to perform operations using a console that operates surgical arms, cameras, and other instruments that perform the procedure.
RAS systems can result in fewer and smaller incisions, lowering the likelihood of blood loss and infections — which often translates into less pain and fewer complications for patients.
Given these benefits, surgical robot systems have seen huge growth over the last decade.
Notably, one of the most popular robotic tools is also one of the oldest: the da Vinci surgery system. However, it’s seeing an increasing number of competitors on the scene.
the Orthopedics revolution
RAS systems are poised to make a significant impact on orthopedics.
This “robotic revolution” kicked off in earnest in late 2013, when medical technologies firm Stryker bought Mako Surgical, maker of devices for knee and hip replacement surgeries, for $1.65B.
Mako’s system can create a 3D model of a joint based on a CT scan, allowing the surgeon to pre-operatively plan for each individual patient. The plan is then loaded into the system and adjustments are made as needed. Once the plan is set, the robotic arm sets the angle and plane of the surgical saws and prevents cuts from going too deep.
In 2018, the Mako system performed nearly 80,000 knee and hip replacements in over 650 locations.
Seeing the potential, the orthopedics arms race is on, as some of the biggest names in the industry work to develop better — and smaller — devices to assist surgeons and improve results while being more cost-effective. (For reference, the Mako device costs an estimated $1M.)
One brand that has been a big player in medical robotics is Johnson & Johnson. While the company has made some significant investments in medical robotics over the last few years, orthopedics is a primary area of focus. In an effort to create a direct competitor to the Mako system, Johnson & Johnson’s orthopedics business, DePuy Synthes, acquired Paris-based Orthotaxy.
Orthotaxy has created and developed a surgical robot prototype the size of a shoe box to assist on knee surgeries. Its small size (and smaller price tag) may be a differentiator in the market. Johnson & Johnson has been showcasing the prototype, with an eye on a debut in 2020.
Knee and hip surgeries are on the rise and present some of the most intriguing potential for robotics — especially smaller, less expensive robots that help perform outpatient surgeries, which are more cost-effective than hospital stays.
Visualizing pre- and post-op
Another established company making a play for the knee and hip market is Smith & Nephew, a British medical equipment and manufacturing company.
In early 2019, the company acquired Brainlab’s orthopedic joint reconstruction business. Brainlab develops and creates software-based medical technology, to help orthopedic surgeons design workflows for each surgery from pre-operative planning to post-op evaluation. Currently, that tech is being used in 500 locations.
Smith & Nephew aims to integrate Brainlab’s technology into its handheld NAVIO knee surgery system, purchased for $275M in 2016. The handheld robotics system helps surgeons to be more precise during surgery without the need for preoperative imaging such as a CT scan.
By combining the systems and workflow technology with robotic devices, Smith & Nephew looks to expand beyond knee surgeries and plans to open a research and development center in Pittsburgh that will focus on artificial intelligence, augmented reality, and machine learning with robotics systems.
Johnson & Johnson is also showing interest in this area, and has teamed up with Alphabet’s Verily Life Sciences to create robotic surgery startup Verb Surgical. While both companies have been relatively hush-hush on the details of Verb, the goal is reportedly to combine Verily’s software development expertise and Johnson & Johnson’s product line to create software tools that work with the robotic devices.
exploring remote surgery
Another interesting development in robotic surgery is the potential for doctors to perform minimally invasive procedures remotely.
The first complete remote surgery took place in 2001, when a surgeon in New York used the Zeus robotic surgical system to remotely remove the gallbladder of a patient in France. Since then, many companies have explored “telesurgery,” though the tech remains in the early stages.
One example here is Corindus, a vascular robotics company that raised a $25M Series A round in 2018. With Corindus’ CorPath system, doctors in India were able to place a stent in a blocked artery for five patients from a distance of 20 miles away.
The feasibility of remote telesurgery is currently being studied by the Mayo Clinic, though the tech remains nascent. Some of the challenges of remote surgery include the need for accurate remote haptic feedback (feedback related to the sense of touch) to help surgeons know how forceful or gentle they are being, as well as the need for depth perception, which can be difficult to detect on a flat screen.
Down the road, remote robot-enabled surgery could be particularly beneficial for use cases such as battlefield medical treatment and even long space exploration missions.
In 1895, x-rays changed the face of medicine, offering doctors a powerful tool to help them diagnose disease and injury. More recently, technologies like ultrasounds, CT scans, and MRIs have allowed doctors to pinpoint diseases and make new discoveries.
Today, many researchers are looking for robots for the next big breakthrough — from microscopic bots that can travel inside the human body to robots to diagnose diseases, detect abnormalities, or identify potential at-risk patients.
Robots you can swallow
Capsule endoscopy has been FDA-approved and in use since 2001. The procedure involves putting a tiny camera inside a pill-sized casing. The “pill” is swallowed by patients, and while it makes its way through the GI tract, the camera takes images that doctors can use to determine if there are abnormalities.
While this is a relatively easy way to inspect the inside of the GI tract, doctors are still at the mercy of how the pill navigates through a patient’s system. They can’t control where the pill goes and what pictures are taken — yet.
Now, new technology is looking to give doctors and medical practitioners a way to direct the movement of a pillbot via remote control.
One lab developing these microbots is the Bio-inspired and Medical Robotics Laboratory at Ben-Gurion University.
These pills would allow doctors to control its movement, exploring specific areas as opposed to moving passively through the body. Doctors could examine specific trouble areas that a passive pill is unlikely to reach, offering a new level of diagnostic possibility.
If this technology succeeds, other potential uses include using micro-robots to take biopsies or deliver drug treatments to specific areas of the body.
Although a micro pillbot could represent a dramatic improvement on current diagnostic tools, it’s still in the early stages of research and development.
improving lung health
Lungs are one of the more difficult areas of the body to diagnose. CT scans and MRIs are useful in finding potential masses, but doctors can’t tell whether something is harmless or potentially cancerous without taking a biopsy. Most lung surgeries are complex, and involve a painful recovery process for patients.
Startups and tech companies have been looking for a better way.
In 2019, Johnson & Johnson acquired Auris Health, a surgical robot developer with a specific focus in lung health, for $3.4B.
The FDA-approved system, called Monarch, aims to help doctors identify and treat lung conditions. The Monarch system allows doctors to control a bendable bronchoscope equipped with a small camera to navigate the airways of the lungs, as well as collect lung images and samples. Compared to other current technologies, it is less invasive, generally more reliable, and capable of accessing greater areas of the lungs.
Early results from a small sample of patients have been promising, with the Monarch system successfully able to reach and biopsy targeted nodules in 92% of cases. Johnson & Johnson hopes this system can be used for both pre-screening and treatment of lung diseases and cancers, avoiding or reducing the need for surgery.
While these bots have shown promise in diagnostics, it’s still early in the testing and trial process.
Startups and companies involved in bionics today are looking to create replacement limbs that actually operate like the human body.
more affordable prosthetics
Creating both lightweight and inexpensive prosthetics is an often overlooked area, though it could have a major impact for children who use prosthetics. Kids often outgrow their prosthetics, making it a time-consuming, frustrating, and expensive proposition to get re-fit.
One company focusing directly on that market is Open Bionics, a UK-based firm trying to make prosthetics more affordable. The company recently completed a Series A round of just under $6M.
Open Bionics uses 3D printing technology to create its “hero arm,” which is now available for sale across parts of Europe and the US. The lightweight bionic hands can pick up small objects, grip, and hold.
Applying Neural Technology
While prosthetics have long been functional, they’ve never given users the real “feel” they’d get with a limb. Gripping and holding are possible, but some companies want to connect prosthetics with the nervous system and the brain.
Bios is one company exploring how neural technology can impact bionics. The England-based neural engineering startup, which recently raised $4.5M in seed funding, is looking for ways to create neural connections between the body and prosthetic limbs.
The main technology the company is implementing has been dubbed as a “USB connector for the body.” Called the Prosthetic Interface Device (PID), the design will allow users to connect prosthetics directly to their nervous system. That way, users could control the prosthetics with their brain. The PID is headed for clinical trials soon.
If implanting a chip in your brain seems a little bit too sci-fi right now, Elon Musk is betting that it won’t be in the future. His startup Neuralink is exploring ways to use brain signals to coordinate with prosthetic devices.
This system would have users get a Brain-Computer Interface (BCI) chip implanted, and then link the BCI directly to the prosthetics so movement can be interpreted.
Collaborative robots, or cobots — robots developed to work beside humans — is another area where bionics is looking to make some big moves.
Cobots are increasingly being used in industrial and factory settings, providing a way for humans to interact with robots safely, as many large industrial setups with robot features are not created with that interaction in mind. For example, a robotic arm could easily crush a human’s hand if it is not correctly calibrated to pass an item.
Festo, a German automation company, has created a BionicSoftArm and a BionicSoftHand, both with the end purpose of using them as cobots. The products are built using soft robotics materials (such as air or fluid-filled materials), which makes them lighter, more flexible, and able to interact with humans more safely.
Related to bionics, rehabilitation robots are taking various forms in the medical industry. These robots are being used to help patients recover from strokes and other traumatic brain injuries, as well as help users regain strength, coordination, and agility.
As populations age and people live longer, extending quality of life and reducing recovery time after injuries is becoming more important. Brands looking to the increasing geriatric population may see an opportunity in rehabilitation robots.
The global rehabilitation robot market is estimated to be worth $2B+, according to CB Insights’ Industry Analyst Consensus.
Solutions for an aging population
In the corporate world, Toyota is one of the biggest players in the rehabilitation robot market — with the impetus for innovation coming in part from Japan’s aging population.
One of the rehab robots Toyota has developed is the Welwalk WW-1000 rehab robot, an exoskeleton system built on a treadmill. The system was approved in Japan in 2016 for assisting stroke patients in learning how to walk again — with some studies showing that it can significantly increase the pace of recovery versus traditional methods.
Toyota has broader ambitions in the space — developing robots that range from social robots to engage elderly patients in conversation to human support robots that can perform simple tasks like delivering a bottle of water.
starting rehab sooner
Rehabilitation is just the start of the recovery process, but it can be vital for a patient’s mental and emotional health as well as for their physical well-being. Patients who start rehab early can see reduced hospital stays, a better range of motion, less swelling, and reduced pain over the long-term.
One example of a robot designed for early rehabilitation is Movendo Technology‘s Hunova system. The FDA-approved robot was recently installed at MossRehab, a rehabilitation center in the US that focuses on robot-supported rehabilitation. Hunova serves a dual purpose as a rehabilitation tool and a monitoring system that tracks patients’ movements, providing real-time information to clinicians.
Robotics can help get patients moving more quickly, without the need for multiple medical professionals. This is especially useful for those who are too injured for full body movement.
German-based Reactive Robotics is developing the VEMO rehabilitation system, which is designed to help start rehabbing patients while they are still bedridden in critical or intensive care units. A robotic assistant helps move bedridden patients’ legs so they can perform rehab exercises.
The companies developing these rehab robots hope to leverage the technology to offer patients more tailored care. And, for those working in clinics and facilities, these robots could help medical professionals focus on rehabilitation at an earlier point — which can translate to leaving the hospital sooner.
Robots are being used for more than medical procedures in hospitals. There are a number of other uses that robots are already fulfilling, from communicating between doctors and patients to sterilizing rooms.
cleaner rooms prevent infection
Sterilization is critical for hospitals. Hospital acquired infections (HAI) and surgical site infections (SSI) in patients can increase hospital stays and cost upwards of billions each year, according to CDDEP — but robots that offer cleaning services may be able to help.
Source: The Center For Disease Dynamics, Economics & Policy
Purple Sun and Xenex are two companies offering cleaning bots that use UV light to reduce the pathogens found in hospitals. One recent study found that UV light can eliminate close to 98% of pathogens found in operating rooms.
Xenex, which says it operates in over 400 hospitals across the US, has developed a “germ zapping” robot that uses UV technology to clean hospitals and equipment.
PurpleSun, an early stage company based in New York, recently teamed up with Northwell Health to implement its UV cleaning technology throughout Northwell’s hospital system.
delivery robots free up professionals to focus on patients
Delivery is another area where hospitals and medical facilities are looking to robotics. The hope is that these robots can be used to reduce wait times for medications and test results, as well as take over some more menial tasks so medical professionals can focus on other priorities for patient care.
Aethon has developed Tug, a self-driving robot. Tug serves as a modified delivery service for doctors and nurses in hospitals and can be set up to transport everything from bed linens to medications and test results.
The University of California, San Francisco Medical Center has been one of the main test beds for Tug — purchasing 25 of them in 2015.
Diligent Robotics is aiming to take its bot a step further with Moxi, an AI-supported robotic assistant that can perform non patient-facing tasks for doctors and nurses.
Moxi also has a robotic arm to perform simple tasks, such as picking up boxes. Currently, Moxi works within a somewhat limited scope during trails. It operates mostly at night and can bring pre-set supplies to doctors and nurses, such as an admittance package.
Eventually, the goal is for a robot like Moxi to be programmed with specific time-based tasks — such as taking away dirty sheets every morning — and perform support tasks that are based off the needs of individual patients according to their electronic health records.
One other non-surgical area that is seeing growth is telepresence robots. These robots allow medical professionals to communicate with patients remotely.
InTouch Healthcare created Dr. Robot in 2003. The robot, which works through internet or wireless systems, has a video screen mounted on it to let patients and doctors remotely communicate “face to face.”
A twist on the conventional telepresence robot is one that can track and move on its own, perhaps even going room to room to do “rounds” just as a doctor would in a hospital.
A player to watch here is Ava Robotics, a startup which spun out of Roomba-maker iRobot. The company has developed a robot that can connect with a built-in Cisco conferencing system and uses iRobot technology to map and maneuver through a room on its own.
This type of robot has the potential to improve doctor access for elderly and housebound patients, as well as those who live in more rural communities.
Potential challenges for robotics in medicine
While robotic applications in medicine are advancing, and many are expecting a bright future, the technology faces obstacles to adoption.
A small study based on FDA data on surgical robots from 2015 found that “despite widespread adoption of robotic systems for minimally invasive surgery, a non-negligible number of technical difficulties and complications are still being experienced during procedures.”
The number of mistakes mentioned in the study was fractional compared to the number of clean procedures, but fully relying on robots isn’t risk-free. Below are some of the most pertinent challenges.
Money & time expense: One big hurdle that many robotics companies are facing is the expense of the machines. For instance, building robots that can accurately replicate the way a surgeon’s hands, wrists, and fingers move is very expensive — with a single machine potentially costing a medical facility upwards of $1M.
And that doesn’t include the time doctors and nurses need to spend training on the devices. For some devices, certification might require a 100+ hour commitment.
Regulation & liability: Medical approval is another stumbling block for many startups and healthcare brands. The FDA must approve robotics devices for use on humans, a process that requires long and costly testing periods.
There are liability issues to consider too. If a robot incorrectly diagnoses a patient, where should the blame fall? The more autonomous robots become, the more pressing the questions become concerning the repercussions of mistakes.
Privacy issues: Users may also be concerned about privacy. As more bots are trained in AI and machine learning, the companies that develop them will have access to millions of data points about patients’ personal and private medical information.
Unproven tech: Lack of data could make further adoption more challenging. While many medical robots appear promising, because so many are relatively new there isn’t much real-world data in terms of patient results or cost-effectiveness over the long-term.
Ethical concerns: In early 2019, a man was told he was dying by a telepresence robot — sparking a debate around when the use of telepresence technology is appropriate. Ethical concerns around using robots take a number of forms, from fear about reduced privacy to the concern that the use of robots will deny patients exposure to human social interactions — something many medical professionals consider vital for care.
There’s no doubt that medical robotics technology is here to stay. And there are a number of robotics advances in the medical field that could pave the way for better treatment and improve long-term outcomes for patients — including benefits such as less invasive surgeries, more informed diagnoses, intuitive prosthetics, and faster rehabilitation.
However, there are still a number of hurdles that must be overcome in order for these technologies to make an impact in patient care over the long-run. Beyond complex and often expensive R&D, companies in this area will have to consider factors such as regulations, pricing, and training for medical professionals — not to mention the emotional and ethical considerations in a field as sensitive as medicine.
While robotics technologies could lead to abundant benefits in healthcare, the nascent nature of the space ultimately means the jury is still out as to whether its challenges can be overcome to deliver a practical long-term impact.
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