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How will robots change the world? A frequently asked and as yet unanswered question. After all, we do not have a crystal ball. What we do know is that digitalization and automation have changed the world enormously in recent decades. At Eindhoven University of Technology (TU/e) in the Netherlands, the potential of smart machines in industry and daily life is being researched each and every day. Scientists immerse themselves in technology and student teams get to work on concrete solutions to social problems. This series will tell you about the latest robots, their background, and their future. The sixth episode today: surgical robots.

“A surgeon is able to work much more accurately with a surgical robot,” says Maarten Steinbuch, renowned professor of Systems and Control at the Eindhoven University of Technology (TU/e). In recent years, he and his group have been doing a lot of research into a cross-section of surgical robots. He was also involved in setting up three start-ups.

Several surgical robots are undergoing development. The three start-ups stemming from research at the TU/e are all working on a different type of robot assistant. The robots have one thing in common: They can be used for precision operations. “That fits in well with the precision manufacturing industry that we excel at here in the Netherlands,” Steinbuch states. “The surgical robots must be mechanically sound. They must also be easy to manufacture and not too expensive.” This should lead to an improvement in patient care, according to the professor. “A successful robot will make surgical procedures much faster, better and cheaper,” he adds.

Eye surgery

The most well-known precision robot is the ophthalmic surgical robot from Preceyes. This enables doctors to place and hold their instruments much more precisely on a specific point in the eye, even to an accuracy of more than 20 micrometers. “This means that operations can be performed more accurately. For example, the robot can be used to peel off a membrane in the retina so that people are able to see better again. If you have a slightly shaky hand, you could puncture through someone’s retina just like that,” Steinbuch goes on to explain.

“Moreover, because of its very high level of precision, the robot also makes new treatment techniques feasible. For example, a doctor can inject medication into a specific section of the retina by using this robot,” Steinbuch notes. In 2016, the robot will be used for the first time in surgery. “The robot is already available in England and Rotterdam and will soon also be heading to New York.”

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PRECEYES eye surgery robot Photo: Bart van Overbeeke

Lymphatic vessels

Microsure, the second start-up, is working on a precision robot designed to reattach blood vessels and nerves, for example. The robot is mainly intended for reconstructive surgery. Tissue is removed from somewhere in the body to repair something in another part of the body. One of the applications the company deals with tackles lymphedema. Breast cancer can spread to lymph nodes in the armpits; these are subsequently removed. This can cause fluid to accumulate in unwanted areas. “With this robot, the lymphatic vessels can be reattached to each other. This alleviates or even resolves the problem,” Steinbuch states. “There is now a robot like this in the University Medical Center Maastricht. A number of tests are currently being carried out with it.”

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Microsurgery robot from MicroSure. Photo: Bart van Overbeeke

Hearing implants

Lastly, Eindhoven Medical Robotics is working on a bone milling robot. In order to insert a hearing implant, the bone behind the ear has to be partially removed. This is now done with a small milling cutter. “This is the hardest bone inside your body, so the doctor will have to work on this for a while. They also have to be very careful. There are very important nerves in the bone. If they hit them, the patient’s face can become paralyzed,” Steinbuch stresses. This start-up is working on a more efficient and accurate way to perform such operations. A CT scan of the bone can be used to create a 3D map. This serves as navigational information for the robot so that it knows exactly where everything is and can automatically mill it into the bone.

Shorten waiting lists

Often there are waiting lists for operations because there are only a certain number of doctors who can perform such specialist operations. “This is the case, for example, with hearing implant surgery. Using the robot, even a doctor who is not specifically trained for this could perform this operation. That would shorten waiting lists,” says Steinbuch. The robots can perform parts of an operation autonomously, but according to him, there would always be a doctor present during these operations. “Unexpected things can always happen, which means that supervision will always be necessary. Given that supervision is provided by a doctor, the threshold is lower for patients to allow themselves to be operated on by a robot,” Steinbuch continues. “The robot is then more of an instrument for the doctor.”

Further development is still needed before robots can be extensively used in hospitals. “Bringing a robot onto the market is quite something else than demonstrating that the technology works in the lab,” Steinbuch goes on. “The start-ups now have to ensure that they have a robust and extremely safe system. Of course, the robot has to be safe for patients under all circumstances.” That’s exactly what the Brainport region is very good at, he says. “We have Philips here. That’s a major company that has plenty of experience with medical equipment. Many people who work there or have worked there know very well how to market a product. It’s not necessarily about robotics, but about systems and processes that help healthcare.”

To the extreme

Steinbuch continues: “Apart from that, the Dutch manufacturing industry makes us unique in the world. ASML demands the utmost from their suppliers when it comes to technology. This assures that companies here are able to deliver the highest level of performance there is in the manufacturing industry. Which in turn is exactly what we need when it comes to medical robots.” According to the scientist, all these parties, from universities to multinationals, also know where to find each other when it comes to collaboration. “This means that we can deliver first-class robots. In other countries, such as Germany and Switzerland, we are also working on instruments for healthcare, but that doesn’t specifically concern precision robots.”

Read more about Maarten Steinbuch here.

New industry

Steinbuch’s dream is to build up a new industry around medical robots in the Netherlands. “I hope that in ten years’ time there will be at least a thousand people working in this new industry and that customers all over the world will be satisfied,” he says. “We can combine our high tech know-how and the manufacturing industry’s mentality for getting the best result in medical terms.” Meanwhile, the development of new robots is ongoing. “There are now developments underway in the field of robotics inside the body. Take, for example, small robot pills that are sent through the body via image processing,” he notes. “In future, I personally find it interesting to look at instruments for brain research.”

Steinbuch: “The operating theater of the future is one wherein technology supports processes in a patient-friendly way, thereby making operations faster and better. This technology will also enable us to perform operations that are not yet possible.”

Curious about the other extraordinary robots at the TU/e High Tech System Center? Read earlier episodes here.