Release date: 2016-01-13 When it comes to medical robots, many concept-level vocabularies come from abroad: Dabai or Da Vinci. These robots represent the most advanced concepts and products in the world. Since the development of surgical robots in the 1980s, many teams in China have tried in related fields. This article will review the development process and the status quo. Main function module Usually, the main functional modules of the surgical robot are shown below. The intermediate module is the core software development part, including image reconstruction, spatial registration and positioning control; and the surrounding hardware auxiliary facilities such as medical image acquisition, robotic devices and positioning devices need to fully meet the space requirements of clinical surgery; Machine interaction and display is the most intensive part of the interaction with the doctor, and needs to fully consider the surgical needs and the use of the operator. Therefore, most of the teams that started the research of surgical robots in China were composed of mechanical experts and scholars from science and engineering colleges and related doctors in the corresponding hospitals. They developed a combination of radiology, computer graphics, robotics, medicine and many other disciplines. Products that meet clinical use standards and surgical needs. 1997: Neurosurgery, Remebot The earliest trial of surgical robots in China began in 1997, led by Dr. Tian Zengmin, a neurosurgical expert of the PLA Navy General Hospital, and Professor Wang Tianmiao, a robotic expert at Beijing University of Aeronautics and Astronautics. The neurosurgical robot uses the PUMA 262 passive five-joint manipulator and entered the National 863 Program in 1998. The latest generation, called Remebot (below), is currently in clinical use. Neurosurgery has always had pain points such as small operating space and difficulty in positioning. The invention of the stereotactic device is to assist the doctor in accurately positioning the patient's head lesion while serving as a surgical operation platform. The doctor fixed the frame to the patient's head with four screws, converted the position of the lesion by spatial coordinates, and the surgical instrument was loaded on the frame structure. This technique has been widely used in the surgical treatment of brain tumors, abscesses and hematomas. Since surgical trauma is smaller than that of craniotomy, most patients are willing to accept this treatment. The neurosurgery robot Remebot is based on the idea of ​​stereotactic orientation. The computer software system, robotic arm and camera of the robot in the operation act as "brain", "hand" and "eye" respectively, and realize two core functions: First, the medical images are presented in three dimensions, assisting the doctor to observe the lesions more clearly and comprehensively, and complete the surgical planning; The second is to accurately deliver the surgical instrument installed at the end of the patient to the lesion of the patient's head according to the command trajectory movement; The third is to drive the surgical instrument movement according to the command trajectory to complete the auxiliary operation task. Automatic positioning by the robot eliminates the need for frame positioning, reduces patient suffering and improves surgical precision. At present, Remebot has been successfully applied in clinical practice, with different surgical instruments for biopsy, aspiration, destruction, transplantation, radiotherapy, etc. It is suitable for 12 kinds of neurosurgical diseases in 12 categories, including cerebral hemorrhage, brain cyst and Parkinson's disease. , epilepsy, trigeminal neuralgia and so on. Capsule endoscopy The traditional method of gastroscopy is that the lens body enters the esophagus and stomach from the oral cavity of the subject through the pharynx, which is easy to stimulate the pharynx with higher sensitivity. Capsule endoscopy achieves image collection through oral capsules with built-in camera and signal transmission devices. The technology was first formed in Israel in the 1990s. Currently, Given Imaging's M2A capsule endoscope has entered clinical use and entered China in 2002. The domestic capsule endoscopy research also started earlier. OMOM is a capsule endoscope developed by Chongqing Jinshan Science and Technology Group under the support of several national research projects such as the National “863 Program†and the International Cooperation Program. Mirror system. In 2004, the team completed the development of key technologies for capsule endoscopy and took out the prototype. After a series of animal experiments, the first generation of products was finalized in June 2004. The working principle of the capsule endoscope is: the patient swallows a smart capsule of size φ13.0mm×27.9 like a medication, which follows the rhythm of the gastrointestinal muscles along the stomach→duodenum→jejunum and ileum→colon → The direction of the rectum is running, and the continuous cavity is continuously photographed, and the image is transmitted by digital signals to store and record the image recorder carried by the patient outside the body. This small robot has a working time of 6 to 8 hours, and it will be excreted with feces after 8 to 72 hours of ingestion. By analyzing the images recorded by the image recorder through the image workstation, the doctor can understand the patient's entire digestive tract and diagnose the condition. The core module of the capsule endoscope is a remotely controllable MEMS (Micro-Electro-Mechanical Systems) system, behind which is the IT platform based on DB2 database provided by information technology service company IBM. 2005: Double plane orthopedic robot, Tianzhihang The biplane orthopedic robot is a robotic system developed by Beijing University of Aeronautics and Astronautics and Beijing Jishuitan Hospital. It is mainly used for orthopedic surgery such as femoral neck cannulated screw fixation, pelvic ankle screw internal fixation, etc. Problems such as fluoroscopy, difficulty in positioning, and lack of stability in operation. In the screw fixation of patients with complex fractures such as pelvic fractures and long bone fractures, the robot can assist in determining the position and direction of the distal screw hole after the intramedullary nail is inserted into the long bone marrow cavity, thereby improving the surgical precision. The C-arm real-time X-ray image was introduced during operation, and the position of the distal hole of the intramedullary nail was determined by combining different positioning systems such as photoelectric, electromagnetic and robot, which effectively reduced the intraoperative radiation. On November 19, 2015, Beijing Tianzhihang Medical Technology Co., Ltd. was listed on the National Small and Medium Enterprise Share Transfer System (New Third Board). The stock name "Tianzhi Hang", stock code 834360, became the first medical robot enterprise listed in the New Third Board in China. 2014: Mirror Robot, Master “Master†is a master-slave endoscopic surgery robot similar to Da Vinci. It is affiliated with the National 863 Program and the main R&D team is from Tianjin University. The system consists of the main operator (left and right hand), slave operator (left and right hand), image system, control system, various surgical instruments and other auxiliary equipment, which can be cut, separated, peeled, stitched under the control of a doctor. In the surgical operation, the vascular anastomosis of the rabbit neck and leg artery has been successfully performed in the scientific research stage. The system entered the clinical trial stage in 2014. The first generation of the “Small Hand S†robot was used by the Third Xiangya Hospital of Central South University. Gastric perforation repair and appendectomy were performed for three patients. As shown in the figure below, the doctor controls the robotic arm that extends into the patient's body through the joystick, and uses different end surgical instruments and flexible wrist rotation to complete different actions. Similar to Da Vinci, this type of master-slave surgical robot has the following advantages for doctors: 1. The operation comfort is improved, the doctor can perform laparoscopic surgery in a sitting posture, the arm is fully supported, and the hand shake is appropriately weakened to avoid fatigue; 2. The imaging effect is good. Compared with the traditional laparoscopic surgery, the distance is determined according to the deformation of the object in the field of view, and the direct view effect brought by the camera at the end of the robot arm is more accurate; 3. The manipulator is flexible, the feedback rate is high, the delay is weak, and various complicated actions can be completed, and the range of activities is limited by the manpower. According to Wang Shuxin, dean of the School of Mechanical Engineering of Tianjin University, Master has achieved important breakthroughs in three aspects: First, the use of minimally invasive surgical instruments multi-degree of freedom wire drive decoupling design technology to solve the problem of motion coupling, fixed, anti-skid, anti-loose, more conducive to precision maintenance; The second is to realize the reconfigurable layout principle and implementation technology from the operator, so that the "arm" of the robot is lighter and more suitable for the needs of surgery; The third is to use the system allogeneic isomorphic control model construction technology to solve the consistency of hand-eye-device movement in stereoscopic environment. The access lens that enters the human body breaks through the limits of the human eye and can magnify the surgical field of view several times or even dozens of times. Doctors can remotely perform surgery that requires more than a few people to complete. For the time being, foreign medical robot products are also actively expanding into the Chinese market. For example, Da Vinci’s direct competitor, Da Vinci’s expansion in China, is extremely fast. As of November 2015, 46 units were introduced in the mainland and Hong Kong. In the third quarter of the year, the amount of surgery achieved a 15% year-on-year increase. On the whole, domestic medical robot products have generally entered an important period of transition from scientific research and clinical trials to industrialization. The above four products are relatively fast commercialized and have already become the best in the industry. There are still some scientific research achievements in China, such as the minimally invasive surgical robot system developed by Harbin Institute of Technology and the spinal surgery robot system developed by Shenyang Institute of Automation. Source: Remebot
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