Innovation

Robots as assistants in the operating room

Innovation, Health, Robotics |

After almost three years of development, the time has come: For the first time, a robot in the experimental operating theatre of the MITI research group takes over the tasks of an "operating theatre jumper" in the non-sterile area. He fetches sterile materials - such as suture material or surgical gloves - from the warehouse, brings them to the operating theatre, opens the packaging and hands the sterile goods to the surgeon. Lukas Bernhard, a doctoral student at the Klinikum rechts der Isar of the Technical University of Munich (TUM), talks about the capabilities of the AURORA robot.

Lukas, you are involved in the AURORA research project with the assistant robot of the same name as a doctoral student and scientific director at MITI. What should a service robot do in the operating theatre?

In our research group there are currently a number of research projects dealing with robots in the operating theatre. Two and a half years ago, in the AURORA project, we started to have the tasks of an operating theatre jumper partly done by an assisting robot. Here, it is mainly a matter of fetching and presenting sterilely packed materials. To do this, the robot has to know where they are, open the packaging and hand over the contents to the operator. In the SASHA-OR research project, which began about a year ago, the colleagues are placing a special focus on the purely sterile area in the operating theatre. The central task at SASHA-OR is to hand surgical instruments - such as scissors, graspers or clippers - to the surgeons and to take them back after use. With the help of artificial intelligence, the robot should be able to anticipate which instrument is needed next. This robot is installed at the operating table and - unlike AURORA - does not leave the sterile area.

What can AURORA already do?

We have specialised in two use cases that our proptotype already handles quite reliably. On the one hand, it's about AURORA going to the warehouse, fetching sterile material, opening the packaging and handing it to the surgeon during the procedure. The challenges: There are many obstacles in the way, there are many people walking around, it is narrow. The whole environment is made for people. The crucial question now is whether one should accept or change such an environment in a future with robots. Some ideas of a compromise between these areas, called "surgerineering", already exist: In this way, we can introduce new types of storage systems from which, for example, suture material is automatically dispensed and is thus easier for the robot to remove. Bearings would therefore have to function in a fundamentally different way, but still be suitable for humans. Another approach is to slightly change the OR layouts so that the robots can drive there without being obstructed by obstacles such as cables or instrument tables. In the second use case, AURORA is there to operate medical devices. The robot fetches the necessary equipment and brings it to the desired state so that the doctor can use it immediately. In principle, these tasks are also relevant for other areas in the hospital, for example on the ward or in the emergency room. Due to the acute shortage of staff in hospitals, it would of course be good if a robot could also take over some of the routine tasks here.

How did AURORA come about back then and what is your doctoral thesis about?

The MITI (Minimally Invasive Interdisciplinary Therapeutic Intervention) research group at the Department of Surgery has always been concerned with developing ideas together with doctors that make work in the operating theatre or hospital easier. This is also where the common idea for assistance robots such as AURORA and SASHA was born. In my doctoral thesis, I am building on AURORA and developing a fleet management system for assistance robots. For me, it's about defining, prioritising and distributing tasks to several robots. However, of course we don't have a fleet of surgical assistant robots available yet, so I'm investigating this fleet management as a simulation first.

Video Lukas Bernhard explains the Auto-navigating Robotic Operating Room Assistance (AURORA)

Publications

Mobile service robots for the operating room wing: balancing cost and performance by optimizing robotic fleet size and composition; Lukas Bernhard, Antony Francis Amalanesan, Oskar Baumann, Florian Rothmeyer, Yanni Hafner, Maximilian Berlet, Dirk Wilhelm & Alois Knoll; International Journal of Computer Assisted Radiology and Surgery (2022) 

Information

Lukas Bernhard, who holds a bachelor's degree in mechatronics and a master's degree in mechanical engineering, is writing his doctoral thesis at the Chair of Prof. Alois Knoll, head of the Department of Robotics, Artificial Intelligence and Real-Time Systems at TUM and, together with Prof. Markus Lienkamp, head of the Mobility Innovation Sector at MIRMI. The main coordinator in the AURORA research project is the head of the research group for minimally invasive interdisciplinary therapeutic intervention (MITI) Prof. Dirk Wilhelm at the Clinic and Polyclinic for Surgery at TUM's Klinikum rechts der Isar, who heads the Health innovation sector at MIRMI together with Prof. Cristina Piazza.