Page 88 - Read Online

Page 8 of 16 Nawrat. Mini-invasive Surg 2020;4:28 I http://dx.doi.org/10.20517/2574-1225.2020.08

[5]
specific procedures . Creating a network in which surgical operations are possible at a distance is a
technological and political challenge. But only in this way we will then be able to solve the problem of “equal
opportunities” for access to appropriate quality medical services.

Autonomy - independence of medical robots
For medical robots to play their role fully in the face of challenges from the growing needs of services, and
the need to increase their quality, they must soon become independent. Stand-alone robots should operate
in an information network, which allows access to all information needed to optimize operations in every
situation. In history, medical robotics has already received support, several times, from technologies that
were perfected for performing industrial tasks, aerospace or military projects. This time, the growing
interest of the industry in co-robots - robots cooperating with employees on production lines - and
strategies for the development of automation in the field of autonomous vehicles will give appropriate
acceleration for the new projects of medical robots. Autonomous vehicles are currently being developed
by technology giants such as Google, Apple, Tesla and Uber, a number of automotive companies including
Mercedes, Volkswagen/Audi, BMW, General Motors, Volvo, Ford, a consortium of Renault-Nissan-
Mitsubishi and Toyota, and companies producing computer components like Nvidia and Intel.

We probably will not make the mistake of systematizing the autonomous capabilities of medical robots
based on the five-level classification of autonomous vehicles introduced by the SAE International (Society
of Automotive Engineers) standardization organization. The autonomy of medical robots on a five-point
scale (modeled on the SAE J3016 standard) though, with the lowest level, 0, is a lack of autonomy:
1. Level 1 is telemanipulation (remote control) with support. In this type of robots, some elements have
been introduced to support operations automatically. It can be, for example, an emergency stop system
for a robot in a hazardous situation. Surgical robots such as da Vinci and Robin Heart are currently in
this group.
2. Level 2 represents robots with the option of partly automated work. A robot that can perform one of
the tasks in an automated manner, e.g., tying a node or orientation of the cam-vision track to a tool.
3. Level 3 is highly automated work. The system moves independently in the work space and scope of
tasks but is still able to assess the limits of its freedom. If it judges that the working conditions are
outside the defined area, the operator must immediately take control of the robot. In the absence of
such a reaction, the robot stops. Such robots are self-propelled robots for tele-presentation and so-
called robotic nurses for communication and transport of various products and materials in hospitals.
4. Level 4 is fully automated work. The robot works independently but should still be supervised, e.g.,
by a doctor, rescuer or physiotherapist. An example of a vehicle - a robot - included in this level is
the autonomous Volvo XC90 used in Uber tests (in the vehicle there is a driver - a human verification
element that can take over steering, after warnings from the control system). Such machines are
currently computer tomography or robotic radio-surgical knives that move and operate in accordance
with the planned trajectory and tasks specified before the surgery.
5. Level 5 means a robot working fully autonomously. The medical robot works independently, sharing
space with the patient and medical staff, makes independent decisions and performs tasks provided for
in its specialization. The robot has no tele-manipulation system. An example is the city car prototype
developed by Google, Waymo Firefly i.e., a car without a manual control system, including the steering
wheel, gear lever or pedals. There are currently no such medical robots.

FRK OWN EXPERIENCE
The Professor Zbigniew Religa Foundation for Cardiac Surgery Development in Zabrze is a pioneer in
Poland in the field of medical robots for heart prostheses and surgery. Robin Heart is the name of the
whole family of Polish surgical robots intended for heart surgery (also soft tissue) and for now, consists
of: Robin Heart 0, Robin Heart 1 and Robin Heart 2 created in 2000-2003; Robin Heart Vision in 2007-