Experts: Stefan Weber (Universität Bern)
Medical robots assist surgeons and, thanks to their high precision, enable operations that are minimally invasive, safe and more cost-effective. This makes complicated operations in particular somewhat less difficult: There are fewer complications and patients leave hospital earlier on average than after operations using conventional technology. Ideally, this reduces costs in the healthcare sector. Despite the strict regulatory requirements, medical robots offer a great opportunity for the Swiss medical technology industry, as their development and production require precision and quality, which justifies high prices.
Picture: CASCINATION AG
Medical robots are a class of medical devices used in surgical and interventional procedures or rehabilitation applications. The former include systems that are not robots in the conventional sense, but rather robotic arms that assist surgeons during operations. They enable minimally invasive interventions. Surgical robots scale down surgeons’ larger movements into micro-movements, which simplifies operations, especially on small vessels and other tiny structures, and compensates for involuntary movements. They consist of a console, at which the operator sits, controls the robotic arms and observes the inside of the body via a monitor, and a patient-side robotic unit comprising a robotic arm, a 3D camera and a control centre. Surgical robots also include devices that perform surgical or interventional procedures more or less automatically on the basis of medical image data.
Rehabilitation robots are robots in the conventional sense. Their key strength is their ability to repeat movements that are monotonous or beyond therapists’ capabilities. Rehabilitation robots do not necessarily have to be better than human therapists, but they should be less cost-intensive and not tire.
Following the latest advances, not least in the field of artificial intelligence, there is considerable hype surrounding the development and marketing of surgical robots. Surgical robotics is already a reality in numerous applications. The best-known representative is the Da Vinci surgical robot (actually a robot-assisted surgical system) from the US firm Intuitive Surgical, which used to perform minimally invasive operations in the fields of urology and gynaecology. Other applications include head and spine surgery, thoracic, visceral and ENT surgery, as well as orthopaedic surgery on hip and knee joints. Robots are also involved in interventional procedures, such as the insertion of stents, or in cancer treatment. Robotic systems are only used in surgical or interventional procedures if their use promises significant medical added value, resulting from positionability, precision and repeatability, and outweighing the cost of their use.
The next few years will be crucial for improving robots, increasing integration of various components, such as surgical instruments, sensors and software, and for material development. The more complex the applications become though, the more expensive the technical solutions are. The interplay between the human being and the technology will continue to be one of the biggest challenges going forwards. It is also important to bear in mind that medical robots, due to their technical complexity, have to go through demanding medical procedures to obtain authorisation.
In general, medical robots offer patients the possibility of minimally invasive procedures, resulting in smaller wounds, faster wound healing, less blood loss and shorter rehabilitation time. Patients experience fewer post-operative complications and leave hospital sooner, which has a positive impact on healthcare costs. However, if surgical robots are to be adopted in new applications, manufacturers and hospitals must first prove that their use makes sense, not only medically but also economically. Conducting large-scale studies to demonstrate cost efficiency is expensive and time-consuming, which presents a challenge for a medical technology industry dominated by small and medium-sized enterprises.
The Medical Device Regulation (MDR) enacted at EU level, which is also relevant to export-oriented Swiss firms, inhibits innovation involving complex medical devices, and makes their development and approval significantly more expensive. Nevertheless, medical robots offer considerable opportunities for the Swiss economy. The systems must meet strict requirements in terms of precision and reliability, which suits Switzerland as a location internationally recognised for its high quality standards, justifies high prices and promises healthy margins. Medical robots also open up important opportunities for suppliers of surgical instruments, materials and software solutions. In Switzerland, this sector thrives on the high standard of research and development, as well as the close cooperation between industry and universities, which is reflected in a strong start-up scene and an extraordinarily high number of companies.
The Swiss National Science Foundation has been regularly and significantly involved in funding medical robotics. Between 2001 and 2013, for instance, the National Centre of Competence in Research "Co-Me – Computer Aided and Image Guided Medical Interventions" laid the foundations for activities that are still visible today as firms. Alongside established funding schemes, the newly created Bridge scheme run by the Swiss National Science Foundation is highly suitable for funding the development of medical robots. A very large amount of financing is needed though, as advances in medical robotics also require research and development for surgical instruments, materials, mechatronics and software.
In medical robotics, linking clinical institutions to technical ones is essential. Although this works well in Switzerland, the establishment of networks that include academic, technical and clinical players could be more actively promoted by politicians. Support from politicians for Switzerland as a centre of research creates high-quality jobs in the long term, thus attracting capable scientists, specialists and firms.
Export-oriented Switzerland will need to comply with European regulations on medical technology in the future as well. However, politicians are in a position to minimise the additional requirements that Switzerland will have to meet.
