Robot Surgeons Coming Soon, to a Future Battlefield Near You

Technology can bring modern medicine anywhere in the world, if the phone system is working, but humans have to remain in control, says Technion professor Alon Wolf

Israeli soldiers testing battle robots: the next stage is robots that can heal the soldiers in the field.
Ofer Vaknin

As the bleeding soldier screams, the medic arrives on his mag-lev hoverboard, unstraps a surgical robot from his back and flips the switch. The medic trains the robot's camera on an injury. Using its built-in satphone, the robot calls a medical hub on the other side of the planet. A doctor watching the feed instructs the robot how to operate on the soldier, using minimally invasive technologies, insofar as possible.

That's futuristic, but not very. The American army for one thinks it's realistic, which is one reason for the money pouring into robotics. The main snag in the scenario is less the levitating skateboard or scalpel-wielding bot and more whether the satellite phone will be working.

"Technology can bring modern medicine anywhere in the world, if there's a communications system," smiles Alon Wolf, a professor at the Technion University's Mechanical Engineering faculty. More exotically, he's working on robots, with a focus on medical robots. His son the mechanical doctor. 

"Think about a specialist doctor doing thousands of operations a year, working from his own hub, not flying about," he suggests. "The robots could be placed throughout the third world and operated by a doctor logging in, supported by a local medical team in case something goes wrong."

Medical robots are nothing new and the Technion, perched on the mountaintop in Haifa, has been there from the get-go. The school was even involved in developing the robot technology behind the successful company Mazor Robotics, which sells robotic guidance systems to make spinal surgery more accurate. If you're having a spinal implant, you'll appreciate micro-millimeter precision.

Today robots are everywhere in medicine, even if people don't call them by name. Not every application is like the famous Da Vinci Surgical System "minimally invasive robotic surgery" technology that took the world by storm, for everything from removing warts to heart surgery, which began as an industrial application that was converted to medicine. (This is not the place to get into criticisms of its surgical prowess, which do exist and which could be under-reported.) A bionic contact lens is also a robot, arguably, as is the Rewalk system for the paralyzed to regain some mobility (also developed by aTechnion graduate).

"Man and machine is also robotics," explains Wolf, and elaborates: "Robot eyes, robot ears – implants in the ear with electrodes in the brain – suddenly people can hear."

Note ye though that the one in charge of robot "surgeons" is a humanoid, not the robot. It is a machine. It doesn't make decisions. What robots have over say plastic forks is a cognitive aspect, Wolf explains – they can learn, within their parameters, and change behavior. And they have motoric aspects: they can move.

The cancer sniffer developed by Technion professor Hossam Haick, who was inspired by dogs, is an example of a robot that learns but doesn't move.

Smart man, dumb snake

"Nowadays [robot] surgery begins with getting an MRI of the patient in advance and planning the operation using the scan. The robotic system executes your preoperative planning – it's like a printer," says Wolf. And, assuming the phones are working and hackers haven't shut down the Internet, the doctor does not have to be on-patient. "With da Vinci, the surgeon could be in Milan and operate in New York over a fast, secure phone line," he says.

Or take the bionic contact lens, which is under development by Prof. Zeev Zalevsky at Bar-Ilan University and has undergone successful human trials, he tells Haaretz: it's really a tiny camera watching the environment that transmits signals to a bionic contact lens sitting on the eyeball. The lens passes the signals via electrodes to the cornea and from there to the brain, which learns how to interpret the signal as images.

How about snakes? Robot snakes, brought to the world by the Technion in collaboration with the Carnegie Mellon University of Pittsburgh, began as a technology to find people trapped under earthquake debris and so on, beyond the line of sight. Those robot snakes were larger – think garden hose plus, but the point is they could penetrate deep nooks and crannies in collapsed buildings, seeking survivors.  Wolf even presented the technology to Barack Obama during the U.S. president's visit to Israel in 2013.  Now a miniaturized, disposable robot snake evolved from that is being developed through the Boston-based company Medrobotics, which Wolf founded together with two colleagues from Carnegie Mellon and the University of Pittsburgh. That one is for crawling through the nooks and cranny of your torso

"The snake is a conduit," Wolf reassures. "The doctor passes surgical stuff through it, directing its movement from the workstation."

Prof. Alon Wolf, left, showing U.S. President Barack Obama the robot snake that can slither around corners through rubble, for instance left by quake, to find casualties beyond the line of sight (2013).
Kobi Gideon / GPO

Presently, minimally invasive surgery is done using "chopsticks" with a scalpel-camera at the end. This technique cannot overcome obstacles. "If something blocks the way from the entry port to the point of interest, the doctor needs to make another keyhole incision, and maybe another. You wind up with multiple ports," says Wolf. The snake can overcome obstacles, using its embedded flexibility to go around them. It can enable true single-port surgery, bringing the doctor "around the corner" without need for extra incisions, Wolf explains.

Sounds expensive. "Manufacturing is advancing. The vision is mass produced home robotics, affordable for everyman," says the professor optimistically. Haaretz is in doubt whether everyman needs one, at least in youth. But come old age, it might be a whole other story, and now the Technion has cast its talent at robots for the golden years.

Soft shoe, smart shoe

The latest wrinkle in the Technion's robotic research is robots for medical rehab and assisted living for the aging population.

These aren't bots that wash the dishes. Asked for an example, Wolf shares that he is working on smart shoe insoles, for instance for diabetics, who, because of neuropathy, may not even know that their shoes are pressing so hard (or so long) that a wound has formed on their foot. The smart insole would know (and tell you).

Or, this machine for absolutely anybody who’s ever been to any hospital anywhere – "Robots that perform rehabilitation in the home environment ," says Wolf. "You stand in front of your 3-D screen, not a television any more, with the special 3-D camera that's already available today and maybe wearing a smart vest with sensors or exoskeleton. Your screen becomes a game and you work with the game, which is tailored to your specific needs."

Prof. Alon Wolf, right, wearing a light blue striped shirt, and his postdoctoral fellow Dr. Ariel Dowling from Stanford University, and a robot snake that can move around corners to find victims after earthquakes and the like.
Technion University

A "smart vest" might have sensors woven into the material that can tell the device which muscles are working and which are slacking, for instance, and rat to your doctor.

Why stop at diabetics? Smart insoles can help identify the risk of falling among the elderly, for whom hip and knee fractures are a huge risk. "We demonstrated a correlation between stability and stride variability, which means the variability between one step to another, because of changes in muscle activity and balance," says Wolf. Pressed on price, he observes that sensors have become "dirt cheap" these days, mainly thanks to the smartphone industry – each smartphone carries multiple sensors produced, nowadays, in mass production.

Smart shoes? How about smart houses? As big data and the Internet of Things take off, health-protective homes are taking shape, some of which may have Big Brother sensors monitoring your condition and checking whether you took your pills. "The No.1 reason for revisiting the ER is patient non-compliance," says Wolf, who will be chairing the Robotics’ Role in Healthcare section of the IATI-Biomed conference, May 24 to 26 in Tel Aviv.

Imagine your living room wall making sure forgetting a pill isn't why you flop over, your shoes making sure you can't, and your rug phoning for an ambulance when you do anyway. Then the robot in hospital studies your shattered paw, bionically shrugs, removes it and replaces it with a fake one.  What makes a person a person and a machine a machine? We may yet find out. "We are going in that direction. There will be ethical boundaries and it will be time dependent," Wolf predicts. "What had been unethical 50 years ago will be ethical today."

Reuters