surgical robot
There are "masters" to speed up "onboarding"
Medical equipment welcomes renewal and transformation
Pan Xutao Yang Linna
The surgeon sits at the console, like driving a car, with his feet on the pedals and his fingers on the control levers. As the doctor's fingers move slightly, the delicate robotic arm flexibly turns over and threads needles and threads inside the patient's body... This is a robotic surgery.
Robotic surgery is not performed independently by the robot, but by the doctor controlling the robot to perform the surgery. Robotic surgery has the advantages of less clinical trauma, fewer complications, and faster postoperative recovery, and is increasingly favored by doctors and patients.
Not long ago, the State Council issued the "Action Plan for Promoting Large-Scale Equipment Updating and Trade-in of Consumer Goods", proposing to "encourage qualified medical institutions to accelerate the upgrading and transformation of medical equipment such as medical imaging, radiotherapy, remote diagnosis and treatment, and surgical robots." Industry insiders say that surgical robots will usher in larger-scale clinical applications.
Obvious clinical advantages and increasingly widely used
In January this year, Ms. Han came to the outpatient clinic of Qiang Guangliang, executive deputy director of the Thoracic Surgery Department of Peking University Third Hospital. As soon as she sat down, she anxiously handed a stack of imaging results and report sheets to the doctor. Ms. Han, 60 years old, has suffered from pulmonary nodules for 5 years. During a chest CT scan 2 weeks ago, she found that a 15 mm nodule in the upper lobe of the right lung was significantly larger than before.
"If we do surgery, can it be as minimally invasive as possible?" Ms. Han asked. "You can try to drill a hole and use a surgical robot to eradicate it. This is currently the most minimally invasive and accurate method." After watching the chest CT, Qiang Guangliang said. After observation and further review, Ms. Han was admitted to the ward of the Thoracic Surgery Department of Peking University Third Hospital.
On February 1, robotic surgery was officially launched. "Compared with traditional thoracoscopes, surgical robots have obvious advantages. It has a 3D high-definition field of view, flexible robotic arms and can filter out tremors and jitters of human hands. The surgical results are better and safer," Qiang Guangliang said. In order to reduce the patient's surgical trauma, the Qiangguangliang team decided to implement pure single-hole robotic surgery, that is, only one hole is opened in the patient's body to complete the robotic surgery. The team members worked together accurately to solve the problem of mutual interference during the single-port operation of the robotic arm, and finally completed the first pure single-port robot-assisted lobectomy in Beijing. After about 3 days of postoperative recovery, Ms. Han was successfully extubated and discharged from the hospital, recovering well.
Surgical robots are not only popular among patients, but also among doctors. A complex operation often takes several hours or even ten hours, which is a test of the doctor's physical strength, endurance and energy. The surgical robot is easy to operate, and the surgeon can complete the operation while sitting, saving time and effort.
At the Children's Hospital of Zhejiang University School of Medicine, the da Vinci surgical robot has participated in more than 2,300 surgeries in three years. Gao Zhigang, deputy director of the Children's Hospital of Zhejiang University, was one of the early doctors who advocated the introduction of surgical robots. "I have been a surgeon for so many years and only after doing robotic surgery did I experience how comfortable surgery can be. The doctor can complete the surgery while sitting at the console, with clear vision and stable operation." Gao Zhigang said that the doctors There are queues to "cooperate" with surgical robots, and many surgeries have to be scheduled until the middle of the night.
Tao Chang, deputy director of the Department of Urology at the Children's Hospital of Zhejiang University, made a vivid metaphor: performing ordinary laparoscopic surgery is like holding a pair of chopsticks in human hands, and then using the chopsticks to hold a needle to perform surgery; using a robot to perform surgery is like The human hand can directly hold the needle to perform surgery without using chopsticks, which allows for a more dexterous operating experience.
"The promotion of surgical robots in hospitals has not been smooth sailing." Shu Qiang, Secretary of the Party Committee of Zhejiang University Children's Hospital, said that at that time, some doctors believed that the old surgical forms were very mature, and the introduction of new technologies not only required learning costs, but also had great impact on surgical results. Uncertainty. However, with the accumulation of practical cases, the advantages of robotic surgery have gradually been recognized by doctors. The Children's Hospital of Zhejiang University has now formed a surgical robot team composed of experts from six departments.
Nowadays, robots are appearing in more and more operating rooms of hospitals. They use their "wonderful hands" to become good helpers for doctors. The First Affiliated Hospital of Zhengzhou University has completed more than 13,000 da Vinci robot surgeries. The Fourth Affiliated Hospital of Harbin Medical University completed 100 cases of robotic surgery within 3 months, and many patients requested the use of surgical robots by name.
Robots can especially come into play during difficult surgeries. Recently, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine used a surgical robot to radically remove dual lesions of gastric cancer and kidney cancer in a patient in a single operation. Recently, Beijing Friendship Hospital used surgical robots to systematically complete multiple partial nephrectomies for complex renal tumors.
The "2023 Medical Robot Industry Development Report" released by the 2023 World Robot Conference shows that China's medical robot market size will be approximately 9 billion yuan in 2022, and the market size is expected to reach 22.1 billion yuan in 2025.
Aiming at emerging tracks, domestic brands make efforts
For a long time, imported surgical robots represented by da Vinci have dominated the Chinese market. In recent years, more and more domestic surgical robots have begun to emerge, accelerating the realization of domestic replacement.
"Here are four hands peeling raw quail eggs together!" At the entrance of the 2023 Service Trade Fair exhibition, a robot peeling quail eggs was surrounded by curious audiences. Under the remote control of a staff member not far away, the robot inserted its arm into the container through a circular hole with a diameter of several centimeters, and used a snake-shaped manipulator slightly longer than a human finger to peel off the eggshell. After peeling, the egg membrane is intact. Then, the staff replaced it with a damaged quail egg membrane, and the robot began to simulate surgical suturing, slowly sewing the egg membrane back so that the egg liquid would no longer flow out.
This laparoscopic single-hole surgical robot named "Shu Rui" breaks the foreign technology monopoly, allowing the robot to perform various abdominal surgical operations within a 2.5 cm long skin wound, achieving operations with a precision of 0.07-0.1 mm.
Surgical robots are the “crown jewel” of the robotics industry. According to the classification of the International Federation of Robotics, it can be divided into different types according to clinical application, such as laparoscopic surgical robots, orthopedic surgical robots, neurosurgical surgical robots, and vascular interventional surgical robots. At present, laparoscopic surgical robots have the largest market size among surgical robots. Other types of surgical robots have great application potential and are also important subdivisions for domestic brand R&D and innovation.
The SR series of neurosurgery robots launched by Huake Precision Medical Technology Co., Ltd. currently have a higher market share than some imported surgical robots that entered the Chinese market earlier. Wang Peng, director of precision products of Huake, said that the company has been focusing on the field of neurosurgery since 2003. After the first imported neurosurgery robot entered the Chinese market, the team saw its huge clinical value and market prospects. After several years of research and development, Huake has launched the world's first 3D structured light neurosurgery robot.
3D structured light can obtain the three-dimensional structure of the photographed object through optical means. Huake's precision technology team applies 3D structured light to surgical robots. By adjusting and optimizing algorithms, it can instantly collect patient brain data and complete the reconstruction of a three-dimensional model of the patient's head within tens of seconds, greatly improving surgical accuracy.
In the field of orthopedic surgical robots, domestic brands have also made new breakthroughs. As a national-level specialized "little giant" enterprise, Changmugu Medical Technology Co., Ltd. has developed an artificial intelligence orthopedic surgical robot that integrates hardware and software to achieve precise coordination of the robot's "brain", "eyes" and "hands". The robot's "intelligent brain" can accurately design the angle at which the artificial prosthesis is placed, and visualize it through three-dimensional images, allowing doctors to simulate the entire surgical process before surgery. At the same time, it can also convert doctors' surgical experience into standard algorithms for self-training and learning.
The development of the domestic surgical robot industry cannot be separated from the promotion at the policy level. In December 2021, 10 departments including the Ministry of Industry and Information Technology jointly issued the "14th Five-Year Plan for the Development of the Medical Equipment Industry", proposing to "research on intelligent surgical robots and accelerate breakthroughs in rapid image registration, high-precision positioning, and intelligent human-computer interaction." , multi-degree-of-freedom precise control and other key technologies.” In January 2023, 17 departments including the Ministry of Industry and Information Technology issued the "Implementation Plan for the "Robot+" Application Action", proposing to "encourage hospitals with conditions and needs to use robots to perform precise minimally invasive surgeries, build standardized operating rooms for robot applications, and research "Standard specifications for clinical application of surgical robots".
In recent years, some regions have targeted the surgical robot track layout industry. The action plan for the innovation and development of the robot industry formulated by Beijing proposes, "Facing the forefront of the industry and medical application needs, improve the full-process surgical assistance capabilities of surgical robots; give full play to the collaborative advantages of the capital's medical industry, optimize medical device registration and health insurance policies, and increase Clinical application promotion efforts." Shanghai has also formulated an action plan to promote the development of the medical robot industry. The proposed goal is to create no less than two characteristic industry clusters for medical robots and cultivate about 10 leading companies in the medical robot segment.
"Currently, domestic medical robots are in a critical period of accelerating independent innovation and clinical application promotion." Yang Jianlong, deputy secretary-general of the China Medical Equipment Association, said that industry companies are looking forward to receiving more policy support in terms of medical service pricing and medical insurance payment.
Surgery "crosses mountains and seas" and medical resources sink
When robotic surgery is combined with 5G, remote surgery becomes a reality, effectively promoting the sinking of high-quality medical resources.
A few days ago, Meng Yuanguang, director of the Department of Obstetrics and Gynecology of the People's Liberation Army General Hospital, performed a surgery that "crossed mountains and seas": ultra-remote 5G total hysterectomy + bilateral fallopian tube resection under robot assistance. The chief surgeon, Meng Yuanguang, is in Beijing, operating the surgical robot's console, while the patient is far away in the operating room of Hainan Hospital of the People's Liberation Army General Hospital. The display screen clearly showed the surgical conditions in the patient's abdominal cavity. With the slight movement of Meng Yuanguang's fingers, the robotic arm, which was nearly 3,000 kilometers away, moved lightly to find the best surgical position, resection, and hemostasis... It took more than an hour to complete the operation. .
The characteristics of 5G network, such as high speed, large bandwidth and low latency, provide guarantee for the stability, reliability and safety of remote surgery. Meng Yuanguang said that remote surgery through surgical robots can save people from the pain of traveling to seek medical treatment and enjoy high-quality medical resources in other places "at their doorstep".
The application of "5G+ surgical robot" provides greater market space for domestic surgical robots. Although domestic surgical robots started late, they focused on integrating with new technologies such as 5G and artificial intelligence at the beginning of their research and development, and have shown certain advantages in remote surgery.
In July 2023, the team of Professor Hua Keqin from the Yangpu Campus of the Obstetrics and Gynecology Hospital of Fudan University performed surgery on a patient with multiple uterine fibroids who was 2,000 kilometers away. This was the first 5G+AI ultra-remote operation in Shanghai. Domestic robotic minimally invasive surgery. "There is almost no delay in the entire surgical process." Hua Keqin said that 5G+AI technology ensures the real-time, accuracy and high-speed of real-time collection and transmission of long-distance data.
Not long ago, Zhang Dahong, deputy director of Zhejiang Provincial People's Hospital, successfully completed a radical prostate cancer surgery for a patient 4,000 miles away in the operating room in Hangzhou. "5G robotic remote surgery has entered a relatively mature stage." Zhang Dahong said that on the one hand, domestic surgical robot equipment has been relatively mature; on the other hand, 5G transmission systems have gradually been rolled out. With the gradual popularization of 5G signals, this This remote surgery model will enter more primary hospitals.
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How much do you know about surgical robots?
Surgical robots are new medical devices that integrate clinical medicine, biomechanics, mechanics, computer science, microelectronics and many other disciplines. Through clear imaging systems and flexible robotic arms, surgical robots assist doctors in performing minimally invasive surgeries. Complex surgical operations, including intraoperative positioning, cutting, puncture, hemostasis, suturing and other operations, are the third technological revolution in surgery after open surgery and laparoscopic surgery.
The surgical robot consists of three parts: the video imaging system, the bedside robotic arm system and the surgeon's console.
The video imaging system is the image processing equipment of the robot. The endoscope is a 3D lens that can magnify the surgical field of view. It is also equipped with a high-definition magnification display to present the anatomical structure more clearly.
The bedside robotic arm system is located next to the patient, and the robotic arm is inserted into the patient's body to complete various surgical actions. During the operation, the assistant doctor works next to the bedside robotic arm system, replaces instruments and endoscopes, and assists the surgeon in completing the operation.
The surgeon's console is operated by the surgeon. The doctor sits on the seat and controls the robotic arm and endoscope by operating the two main controllers with both hands and pressing the foot pedals with his feet. At the same time, the doctor watches the surgical field in the stereoscopic eyepiece, and the tips of the surgical instruments move synchronously with the surgeon's hands.
Although it is called a "robot", surgical robots are still a long way from the intelligent era of truly independent surgeries. They are still in the semi-automatic stage of assisting doctors in completing surgeries. Surgical robots integrating intelligent technology are the future development direction. Recently, the Artificial Intelligence and Robotics Innovation Center of the Hong Kong Institute of Innovation, Chinese Academy of Sciences, released a large AI multi-modal model for the medical vertical field, providing effective support for functions such as real-time image intelligent recognition during surgery. During surgical operations, large models can remind doctors how to operate at which stage through the historical records of a large number of previous expert operations. Experts say that allowing robots to perform some non-critical operations autonomously is achievable in the foreseeable future.
(Compiled by Yang Linna, People’s Daily Overseas Edition)