A surgeon peers into a high-definition monitor, studies the ragged edge of a heart valve, and twiddles her fingers in a gizmo-laden glove. Meanwhile, miles away, a robot that looks like a cross between a loom and a torture device reproduces her every delicate move with a pair of tiny pincers, suturing up the damaged heart.
This isn’t reality. This is last week’s episode of NBC’s “Heartbeat” medical drama, featuring a version of the University of Washington’s Raven robo-surgeon that’s been souped up just for show.
The real-life world of robot-assisted surgery may not be as edgy as Hollywood makes it out to be. But it’s here, it’s profitable, and it could soon get a lot edgier.
The market leader is Intuitive Surgical, the maker of da Vinci Surgical Systems. Last week, the Silicon Valley company reported a nearly 17 percent rise in da Vinci procedures worldwide over the past year, and a 41 percent rise in quarterly profit. That boom came even though a single robot costs $2 million – a price tag that’s generated controversy in the health-care community.
Other types of medical robots are on the rise as well, such as Panasonic’s Hospi, a mobile cabinet that negotiates hospital hallways autonomously to deliver supplies and dispense medications. Medrobotics’ Flex Robotic System is custom-made to operate inside a patient’s hard-to-reach nooks and crannies.
And then there’s the InTouch Vita doctor-bot, which is equipped with two-way video links to let a physician check up on patients remotely.
The way things are going, we’ll soon be seeing the kinds of surgical droids that took care of Luke Skywalker in the “Star Wars” movies, right?
Wrong, says Blake Hannaford, director of UW’s Biorobotics Laboratory and one of the leaders of the Raven robo-surgery research effort.
“I don’t know any robotics person who thinks that. Nor any surgeon. Nor any patient,” he told GeekWire. “That’s not the point.”
So what is the point?
“The point is, expanding the capabilities of human surgeons under their control, and increasing the precision of the treatment,” Hannaford said.
Charting a robotic route
The Raven project began at UW in 2002, with funding from the Defense Department. The idea was to build a compact robot that could be based close to the front lines and perform operations under the guidance of a surgeon in a different location – potentially thousands of miles away.
In 2007, during one of NASA’s NEEMO underwater exercises off the Florida Keys, researchers demonstrated how surgical procedures could be conducted by remote operators in Seattle and Cincinnati.
The robot’s arms look like 2-foot-long knitting needles, with pincers or surgical instruments attached to the tips. The manipulator system can be connected wirelessly to the surgeon’s control station, and a remote surgeon can use controllers to conduct the operation while a camera provides a close-up view.
Raven can be programmed to perform laparoscopic procedures autonomously or under remote control – which is a key difference from the da Vinci robots. Researchers even experimented with Microsoft’s Kinect video-game system to give the robot a synthetic sense of touch.
Raven robots haven’t yet gone through the Food and Drug Administration’s approval process for human clinical applications, so for now they’re being used only for research and training purposes. The robots also come in handy as science-fiction props: Years before its star turn in “Heartbeat,” the Raven had a cameo role as a telerobotic brain surgeon in the movie “Ender’s Game.”
There’s a darker side to the story of robotic surgery: Last year, UW researchers used the Raven system to demonstrate how easy it could be for cyber-attackers to disrupt a remote-controlled surgical operation.
Another report provided a sobering reality check for the field in general: An analysis of more than 10,000 FDA incident reports between 2000 and 2013 turned up 144 cases in which the patient died during robot-assisted robotic surgery, and another 1,391 cases in which the patient was injured.
The most common causes of injuries had to do with technical malfunctions – for example, when pieces of the instruments burned up or broke off and fell onto the patient. Such problems suggest that the technology still has a long way to go.
Robots on the frontiers
Research into battlefield robotic surgery is continuing, but Raven’s team is currently focusing on other applications. A company called Applied Dexterity was spun out in 2013 to commercialize the technology.
Applied Dexterity is working with NASA to develop a miniaturized Raven robot for use on the International Space Station. It wouldn’t be used on people – not yet, at least. Instead, the robot would be teleoperated from planet Earth to dissect lab mice.
The moustronauts are kept in the station’s Rodent Research Facility to study the health effects of zero-G, but at the end of each experiment, two astronauts have to euthanize the mice and extract samples for shipment back down to Earth.
“Flight crew time on the space station is a very precious resource, and the rodent research is consuming a significant chunk,” Applied Dexterity CEO David Drajeske explained. If an earthbound researcher can do the work by controlling a mini-Raven robot inside the station’s glovebox, the crew’s time commitment could be cut in half.
“This is mainly looking at leveraging the crew’s resources,” Drajeske said. “It’s also an example of how to make expertise available at a distance.”
In February, Drajeske and his team traveled to Johnson Space Center in Houston to demonstrate the technology to astronauts and other NASA personnel. “They sat down and started doing dissections after about 15 seconds of verbal instructions,” he said.
If NASA decides to move ahead with the project, it would take about two years to get the mini-robot ready for liftoff, Drajeske said. He declined to say how much it would cost, other than to acknowledge it would be more than a million dollars.
Meanwhile, Hannaford and his colleagues are working on a robotic system that could someday semi-automate the removal of brain tumor tissue. The concept takes advantage of “Tumor Paint,” a biomarker technology developed in Seattle under the leadership of cancer researcher James Olson.
The biomarker, which is derived from scorpion venom, is absorbed by cancer cells and fluoresces when exposed to near-infrared light. The weak emission can’t be seen with the naked eye, but it can be picked up by a camera and translated into a 3-D virtual model of the tumor.
That’s where the Raven robot can play a role: The robot could be programmed to remove the cancerous tissue with high precision, preserving as much of the healthy brain tissue as possible. In this case, the robot could do the job better than the best human surgeon.
Hannaford said the project has been pushing ahead for several years with funding from the National Institutes of Health, and it’ll take at least several more years to get the technology ready for prime time. Even then, it’ll be up to the surgeon to approve and monitor the robot’s course of action.
“It’s the surgeon’s responsibility to determine whether the operation is appropriate on a moment-by-moment basis,” Hannaford said.
Which brings us back to Hannaford’s main point: He doesn’t see robots as replacements for human surgeons. Instead, they’re gradually become part of the typical tool set in the 21st-century operating room.