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Imagining Investigation 8 December Dec 2017 1100 8 December 2017

Bioengineering is a new frontier of medicine (but robots won’t replace human doctors)

Since the year 2000, more than two million surgical operations have been carried out with the use of robotic arms. Developments in robotics applied to medicine are ongoing and will revolutionise the sector, although the intervention of humans will always be required

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Robotics, automation, artificial intelligence, medicine. In a word: bioengineering. This is the new frontier of innovation. Since the year 2000, over two million surgical operations have been performed using one of the three thousand Da Vinci surgical systems scattered in various operating theatres worldwide, making up for the lack of surgeons, reducing the number of doctors needed to perform surgery, and drastically cutting surgery waiting times. And there’s more: robotics can also be very useful in caregiving. The Anybot Inc remote-controlled robotic nurses, for example, can interact with patients, monitor their health conditions, and request specialist examinations. InTouch Health, instead, allows for high quality, remote medical consultations, allowing physicians to monitor a patient’s health from afar, especially in emergencies. This ongoing revolution is also making inroads in Italy. There is no shortage of concrete examples: Bts Engineering, for instance, has devised ReoGo (an arm rehabilitation exoskeleton) and Anymov (a robotic hospital bed designed for patients with limited mobility).

Since the year 2000, over two million surgical operations have been performed using one of the three thousand Da Vinci surgical systems scattered in various operating theatres worldwide.

Another case in point is Lurch (reminiscent of the Addams family’s butler), a robot mounted on standard wheelchairs to enable them to move independently within a space bounded by special markers. “The idea is to give disabled people a device designed to increase their independence, adapting the technology to individual needs,” explained Andrea Bonarini, the Politecnico di Milano Professor of Electronics at the head of the team that designed Lurch. It is unfortunate that Lurch has failed to move beyond the research and experimentation phase and to make it on the market. But why is that? “It is a question of funding and regulations,” continued Mr Bonarini. “While produced using inexpensive technologies such as Arduino, these innovations struggle to find a sales channel enabling them to be purchased by consumers. When they do, it is generally because some entrepreneur philanthropist, who is perhaps already sensitive to the issue for personal reasons, decides to invest in them. Moreover, the safety standards and certifications in Europe, and especially in Italy, are very strict.”

In what direction is innovation taking us? Mr Bonarini believes that “robots certainly won’t replace human beings” because they cannot recreate the empathy established between patients and doctors. “Take physiotherapy, for example,” continued Mr Bonarini. “This field is marked by several innovations, such as exoskeletons that allow patients to make certain movements. This, however, does not diminish the role of the physiotherapist. To the contrary, it gives him more time to devote to the doctor-patient relationship, and this is a big step forward.”

In short, the white coats will remain firmly where they are. However, what is required is a genuine turnover, to tackle the loss of 50,000-60,000 hospital doctors and 25,000 general practitioners expected over the next five years. This poses the perfect chance to include in the operating theatres a series of professional figures specialised in the use of technology. New opportunities open up, over and beyond the use of increasingly complex and precise instruments to replace the doctor’s “firm hand”. One relates to the maintenance of the machines, which will be entrusted to human technicians. Another has to do with prosthesis design, and requires a profound understanding of the human anatomy and of materials (or of mechatronics, in the case of automatic devices). Then, there will be the need for technicians to create the algorithms required to analyse images during an operation, highlighting poorly visible elements such as blood vessels, nerves or the outer edges of a tumour. Surgeons, instead, will have to learn to use technologies such as Microsoft Kinect, allowing them to view data and video images without having to touch or click on a screen, but simply with the movement of an arm or eye.

Robots certainly won’t replace human beings because they cannot recreate the empathy established between patients and doctors.

Andrea Bonarini, Politecnico di Milano

The same goes for the Medical Imaging Interaction Toolkit, a free open-source platform developed by the German Cancer Research Center in Heidelberg, which frames the body of the patient on an iPad and overlays the relevant MRI or X-ray images.

And then there’s Big Data. Since last year, DeepMind - the Google Department dedicated to AI - has been collaborating with the British health system to sift through the medical records of 1.6 million patients who have voluntarily provided access to their data. The aim is to detect early signs of undiagnosed diseases. Drawing the appropriate conclusions from this wealth of information will require programmers with an understanding of different pathologies. Because, as demonstrated by a YouGov survey commissioned by Pwc in late 2016 involving 12,000 people in 12 EMEA countries, citizens are becoming increasingly open to robotics and AI in return for improved access to care. But the “human component” of the doctor-patient relationship remains of the utmost importance.