Robotics - curse or blessing

Will robots be operating on patients alone in hospitals in the future? What exactly is clinical robotics and in which areas is it possible to use it? Find out more about technical developments and the ethical challenges in the field of clinical robotics in the following interview with Prof. Dr. Dirk Wilhelm from Klinikum rechts der Isar.

What are the current fields of application for robotics in the healthcare sector?

Professor Wilhelm: Robotics is already a very broad field. There are countless systems or products that we could use. In the field of care, for example, there is the Paro seal, which is used for patients with dementia to support social interaction, or robotic systems such as Pepper and Moxi, which are used as care robots. There are also telemanipulators, which we use for example in abdominal surgery and trauma surgery during operations. There are also robotic systems for logistics and (bed) transportation. In Germany, however, the use of robotics is still in its infancy and we currently use telemanipulators almost exclusively for surgical procedures.

What is the current status of robotics in everyday clinical practice?

Professor Wilhelm: Telemanipulators are already routinely used in many procedures. Robotic systems are used in soft tissue surgery, such as abdominal surgery, gynecology and urology, for example for prostate resection, but also in trauma surgery and orthopedics. In endoprosthetics, for example, they support the doctor when implanting prostheses. The proportion of operations currently performed using robots is still very low and is well below 10%.

High-tech applications such as robotics are cost-intensive. So what advantages do systems such as robots or telemanipulators offer in surgery?

Professor Wilhelm: These systems offer very high precision, are technically very advanced, but are also expensive to purchase and operate, i.e. maintenance and the consumables used. Since surgery was already at an extremely high level, the advantages are rather small and gradual. For example, patients have less nerve damage after complex procedures. The conversion rates, i.e. the probability that a minimally invasive robotically planned procedure will have to be performed openly, are also significantly lower. Overall, the length of stay of patients in hospital is shorter and there are fewer complications. On the other hand, we are only at the beginning of the potential benefits that we can really expect from such systems. Although we operate with these robotic systems, we do not have access to all the data. In future, we want to use this information and incorporate safety routines, as is already the case in trauma surgery and orthopaedics, for example. Structures, ligaments and blood vessels can be marked in advance and safely protected during surgery. The training of young surgeons who have grown up on computers and perform better on these systems will also bring a qualitative improvement.

What is the level of acceptance on the part of the medical profession? And how high is the level of trust on the part of the people being treated? Are there ethical concerns or is there active demand for interventions with robots?

Professor Wilhelm: The introduction of the new technology in Germany is primarily being supported by doctors who use established methods, who have experience with interventions and who demand that studies be carried out. In the field of robotics, however, acceptance on the part of the medical profession is very high. Especially among younger doctors and those who are trying to push the boundaries of minimally invasive surgery. On the patient side, confidence is very high. However, it is not yet common for patients to actively ask for robotic interventions. I don't think we need to have any ethical concerns at all, as these systems do not work autonomously. The surgeons who use these systems are appropriately trained and there are many safety precautions in place. The patient is still fully in the hands of the surgeon.

You are head of the MITI research group. What does this abbreviation stand for and what exactly is the research focus of this group?

Professor Wilhelm: MITI stands for Minimally Invasive Interdisciplinary Therapeutic Intervention and is a working group that has been active for over 20 years. Our aim was to make interventions gentler and therefore less stressful for patients. People from various medical disciplines and the engineering sciences work together to further develop medical care. We look for medical problems that currently affect the healthcare system and try to modify, adapt and develop technologies for them. In addition to surgical care, there is currently the large field of nursing shortages. In order to ensure that patients can still be fully cared for in the future, we are currently working on robotic approaches in several projects to support or, if necessary, replace nursing care, primarily in the operating room, but also on wards and in the care area in the long term. We have also developed systems for the safe telerobotic treatment of infectious patients.

What do you think the operating theater of the future will look like?

Professor Wilhelm: I see it as separate from the technology. If I see myself as a patient, then my wish for an operation of the future would be that I don't actually have an operation at all. This means that the problem I have is solved and I go home on the evening of the treatment without pain, without scars and without having actually experienced an operation. Such visions are important in order to further develop the technologies or approaches that we currently have available. Robotics is a very important tool to avoid wounds on the patient and to act specifically in areas of the body without major trauma, because hands can be replaced by something comparable but much smaller, and remote-controlled systems are also conceivable for the future. This will still take a long time, but we need to work in this direction, whereby artificial intelligence and other approaches that modern technologies offer us are also important alongside robotics.

The interview was conducted by Dr. Petra Blumenroth, Project Manager Technology I Frugal Innovation at Bayern Innovativ GmbH.

Listen to the full interview as a podcast: