Surgical robots, with their advantages of more precision, less invasiveness, and simplicity, are showing their skills in diagnosis, surgery, rehabilitation and nursing, and have brought profound changes to the medical industry——
The robot is performing surgery, can you rest assured
With the maturity of modern medical technology, surgical operations have gradually entered the era of robots after 2010.
In addition to the most mature laparoscopic surgical robots that cover most of the thoracic and abdominal cavities, there are also orthopedic surgical robots, pan-vascular surgical robots, and percutaneous puncture surgical robots.
Surgical robots have been widely used in orthopedics, urology, obstetrics and gynecology, neurosurgery and other fields.
Since April this year, Beijing and Shanghai have also included the cost of robotic surgery in their medical insurance overall plan.
With the support of policies, the development of medicine and the advancement of technology, robot-assisted surgery will become more and more widespread in the future.
Compared with traditional manual surgery, what are the characteristics of robotic surgery?
Can robots perform surgery at ease?
1. Can robots replace doctors?
At 9pm on October 21st, An Wei, the chief physician of the Second Department of Urology, Bethune First Hospital of Jilin University, completed the fifth operation of the day. Among them, four were operated with robot-assisted surgery: two radical resections of prostate cancer. One nephron-preserving surgery, and one hemi-urinary tract resection for renal pelvic cancer.
"Robot surgery is not a robot to complete the operation, but to become the doctor’s surgical assistant. During the entire operation, the doctor can sit on the console to operate the robot, and the robot simulates the doctor’s actions to perform the operation. The operating table and the robot are completely separated and extremely capable. It greatly relieves the fatigue caused by the doctor standing up and performing the operation." An Wei said.
Since the introduction of medical robots in May 2020, An Wei has led a team to perform nearly 300 robotic surgeries.
An Wei told reporters that robotic surgery is more advantageous in radical treatment of tumors, especially malignant tumors. The miniature camera carried by the robot can magnify the image in the patient's body by more than 10 times and can synthesize high-definition 3D images. The robotic arm has 7 freedoms. Degree, 540 degree rotation, higher accuracy, better surgical field of vision.
Surgical robots have a history of more than 30 years abroad, and have developed more than 20 years in China.
"Medical robots are expected to become the most typical and widely used high-end and intelligent medical equipment in the future. Combined with more advanced technologies such as artificial intelligence and medical diagnosis, medical robots can greatly expand diagnosis and treatment capabilities and improve surgical quality." Harbin Industry Du Zhijiang, deputy director of the University's Robotics Research Institute, said.
According to Su Yonggang, deputy chief physician of the Department of Traumatology and Orthopedics at Beijing Jishuitan Hospital, in traditional orthopedic surgery, the planning of the surgical path relies on X-ray fluoroscopy images, and the surgical operation completely relies on the doctor's experience in manual operation.
After the application of the orthopedic surgical robot navigation system, the robot can input the X-ray navigation image into the computer, and the doctor can use the surgical human-computer interaction software to plan the path on the computer.
"Through the precise image positioning algorithm of the orthopedic surgical robot, the robotic arm can execute the instructions of the doctor's surgical planning." said Sun Dahui, director of the Department of Traumatology and Orthopedics, Bethune First Hospital, Jilin University. .
The selection of the surgical path is based on the doctor's understanding of the three-dimensional anatomical structure of the bone, accurate judgment of the image and a large amount of clinical experience. The robot only uses automatic navigation to find the best channel screw position selected for the surgical planning.
During the interview, many experts said that the advancement of science and technology is constantly subverting traditional medicine, but medicine is not a “technological” field.
In the process of fighting against diseases, robots cannot replace the humanistic care and love of doctors for patients.
2. Is robotic surgery safe?
Will there be accidents in robotic surgery, and do I need to re-operate in case of failure?
What should I do if the power is cut off during robotic surgery?
…… ……
When robotic surgery was first mentioned, most patients were most concerned about the safety of robotic surgery.
The reporter learned that the current advantages of robotic surgery are its stability, accuracy, and resistance to fatigue, and that the entire surgery is done with the participation of doctors.
Ni Duanyu, deputy chief physician of the Department of Functional Neurosurgery of Xuanwu Hospital of Capital Medical University, told reporters that as long as they explain to the patients, most people are willing to accept it, and they can communicate at any time even if they have questions.
The doctor's knowledge of the disease and the understanding of the surgical robot is the confidence for the patient to undergo robotic surgery.
In January 2019, the General Office of the National Health Commission issued the "Notice on the Establishment of an Expert Committee for the Management of Clinical Application of Surgical Robots."
The notice pointed out that in order to standardize the clinical application of surgical robots, improve medical quality, and ensure medical safety, it was decided to establish an expert committee for clinical application management of surgical robots of the National Health Commission.
Sun Dahui is a member of the expert committee. He told reporters that with regard to the application of orthopedic surgery robots, the National Health Commission's requirement for doctors is to achieve "zero risk" and no serious complications during the operation.
"Zero risk" is a hard requirement, and implementation depends on the excellent strength of the doctors who perform robotic surgery.
Han Qin, an attending physician at the Department of Obstetrics and Gynecology of Peking University Third Hospital, told reporters that even with detailed preoperative instructions, some patients would still ask questions, worrying about robot problems during surgery.
In this regard, Han Qin will patiently and meticulously communicate with patients.
"The robot system has a built-in emergency handling mode, and our doctors will make plans in advance to respond to emergencies at any time."
Doctors who perform robotic surgery have rich clinical experience in traditional surgery and can handle and respond to various emergencies.
In addition, doctors and assistants performing robotic surgery need to pass a series of strict and standardized training.
"Robotic surgery is a program execution process under software control. It has a set of software system and hardware operating system. If there are new clinical needs, or for more convenient operation, the doctor will directly communicate with the engineer who develops the robot, whether it is Software updates are still functional improvements, and there has always been a communication mechanism, which is more conducive to clinical operations." Ni Duanyu said.
In addition to safety, cost is also an issue of great concern to patients.
The reporter learned during the interview that in most domestic hospitals, the operating fee for orthopedic surgery robots is 20,000 to 30,000 yuan, and most areas cannot be reimbursed by medical insurance.
But after careful calculation, robotic surgery has its advantages.
“Take pelvic fractures as an example. Under traditional surgery, patients using imported steel plates generally cost 80,000 to 100,000 yuan, while domestic steel plates cost 60,000 to 80,000 yuan. However, if you use an orthopedic surgical robot system for navigation, the total cost is It is 40,000 to 50,000 yuan. The overall cost of the patient is less, the minimally invasive surgery is better, and it can also avoid the defects of traditional open surgery such as long incisions, large trauma, and easy infection." Sun Dahui said.
3. Why is it difficult to popularize robotic surgery?
Statistics show that the size of China's surgical robot market has increased from about 600 million yuan in 2015 to 2.8 billion yuan in 2020, and is expected to reach 25 billion yuan in 2026.
Judging from the current penetration rates of laparoscopic surgical robots and joint surgical robots, the penetration rates of the two major categories in the United States are 13% and 7.6%, respectively, and both are less than 1% in China.
The price of equipment is the primary reason for the low penetration rate.
Take the Da Vinci surgical robot that is currently the most widely used as an example. The price is usually between 20 million and 30 million yuan per unit, and the annual maintenance cost is about 1.5 million yuan.
This also determines that only the top three hospitals in economically developed areas have the strength to purchase surgical robots.
The reporter learned that, with the exception of first-tier cities, hospitals in most provincial capitals also have only two or three surgical robots.
The high price of medical robots is inseparable from the characteristics of their research and development.
"In the research and development of medical robots, the most important thing is to translate doctors’ clinical needs into engineering language, to further condense scientific problems, refine key technologies, and then explore solutions." Du Zhijiang said that the process of finding problems is extremely difficult. It requires the integration of multiple disciplines such as medicine, robotics, materials science, imaging and computer technology.
In addition, medical robots need to strictly abide by the rules and procedures of medical device development and review, and go through the entire process from prototype to product to clinical registration to production. The development cycle is long and there are many uncertainties.
On the whole, China's surgical robots started late, and there is a gap between related technologies and foreign countries, and key core components are heavily dependent on imports.
In recent years, the state's policy support for the surgical robot industry has gradually increased.
In 2015, the State Council issued "Made in China 2025", proposing to focus on the development of high-performance diagnosis and treatment equipment including medical robots.
In February 2021, the Ministry of Industry and Information Technology issued the "Development Plan for the Medical Equipment Industry", proposing to tackle key problems with intelligent surgical robots and promote the standardized application of surgical robots in the treatment of major diseases.
In order to accelerate the speed of localization of medical robots, universities, hospitals, and high-tech enterprises in our country have been jointly exploring for many years, and results have emerged one after another.
Thanks to the scientific research of Harbin Institute of Technology, Tianjin University and other research teams, the market and clinical application of the domestic endoscopic surgical robot system is expected to be realized in a short period of time.
Tian Wei, an academician of the Chinese Academy of Engineering and the former president of Beijing Jishuitan Hospital, led the team. After more than 2,000 failures, the medical, industrial and enterprise joint research and development finally independently developed the third-generation orthopedic navigation robot Tianji in 2015.
The list goes on.
With the advancement of artificial intelligence technology, the development of medical-industry fusion technology and the accumulation of clinical experience, in the future, surgical robots will surely benefit more people at a more inclusive price.
(Our reporter Zhao Jie and Yu Zhiyuan)