". Translation into Russian by the editorial website

2.3 Medicine and robotics

2.3.1 Scope overview

Healthcare and robots

As a result of demographic changes in many countries, health care systems are facing increasing pressure to serve an aging population. As demand for services increases, procedures are being improved, leading to improved results. At the same time, the costs of providing medical services are rising, despite a decrease in the number of people employed in the provision of medical care.

The use of technology, including robotics, appears to be part of a possible solution. In this document, the medical field is divided into three subfields:

- Robots for hospitals (Clinical Robotics): Relevant robotic systems can be defined as those that provide "caring" and "healing" processes. First of all, these are robots for diagnosis, treatment, surgery and medication administration, as well as in emergency systems. Such robots are controlled by hospital staff or trained patient care professionals.

- Robots for rehabilitation (Rehabilitation): Such robots provide post-surgical or post-traumatic care where direct physical interaction with the robotic system will either accelerate the recovery process or provide replacement of lost functionality (for example, when it comes to a prosthetic leg or arm).

- Assistive robotics: This segment includes other aspects of robotics used in medical practice, where the primary purpose of the robotic systems is to provide support either to the person providing care or directly to the patient, regardless of whether we are talking about a hospital or other medical facility.

All of these subdomains are characterized by the fact that they require safety systems that take into account the clinical needs of patients. Typically, such systems are operated or configured by qualified hospital personnel.

Medical robotics is more than just technology

In addition to the development of robotic technology itself, it is important that appropriate robots are introduced as part of hospital treatment processes or other medical procedures. Requirements for the system should be formed on the basis of clearly identified needs of the user and recipient of services. When developing such systems, it is critical to demonstrate the added value they can provide when implemented, this is critical to continued success in the market. Achieving additional benefits requires the direct involvement of medical professionals and patients in the development of this technology, both at the design and implementation stages of robot development. Developing systems in the context of their future application environment ensures stakeholder involvement. A clear understanding of existing medical practice, the obvious need to train medical personnel in using the system, and knowledge of various information that may be required for development are critical factors in creating a system suitable for further implementation. The introduction of robots into medical practice will require adaptation of the entire healthcare delivery system. This is a delicate process in which technology and health care practices interact and will need to adapt to each other. From the moment development begins, it is important to take this aspect of "interdependence" into account.

The development of robots for medical purposes includes a very wide range of different potential applications. Let's consider them below, in the context of the three main market segments identified earlier.

Robots for hospitals

This segment is represented by a variety of applications. For example, the following categories can be distinguished:

Systems that directly enhance the surgeon's capabilities in terms of dexterity (flexibility and precision) and strength;

Systems that allow remote diagnosis and intervention. This category can include both tele-controlled systems, when the doctor can be located at a greater or lesser distance from the patient, and systems for use inside the patient’s body;

Systems that provide support during diagnostic procedures;

Systems that provide support during surgical procedures.

In addition to these hospital applications, there are a number of hospital support applications, including robots for sampling, laboratory testing of tissue samples, and other services required in hospital practice.

Robots for rehabilitation

Rehabilitation robotics includes devices such as prosthetics or robotic exoskeletons or orthoses that provide training, support or replacement for lost activities or impaired functionality of the human body and its structure. Such devices can be used both in hospitals and in the everyday life of patients, but usually require initial setup by medical specialists and subsequent monitoring of their proper operation and interaction with the patient. Post-surgical recovery, especially in orthopedics, is predicted to be the main application area for such robots.

Expert support and assistive robotics

This segment includes assistive robots intended for use in hospitals or home environments that are designed to assist hospital staff or caregivers in performing routine tasks. One can note a significant difference in the design and implementation of robotic systems associated with the place and conditions of their use. In the context of use by skilled personnel, whether in a hospital setting or in a home setting when using the robot to care for an elderly person, developers can rely on the robot being controlled by a skilled person. Such a robot must meet the requirements and standards of the hospital and healthcare system and have the appropriate certificates. These robots will assist the staff of relevant medical institutions in their daily work, especially nurses and caregivers. Such robotic systems should allow the caregiver to spend more time with patients, reducing physical activity, for example, the robot will be able to lift the patient in order to perform the necessary routine operations on him.

2.3.2 Opportunities now and in the future

Medical robotics is an extremely challenging area to develop due to its multidisciplinary nature and the need to meet various stringent requirements, and also because in many cases medical robotic systems physically interact with people who may also be in a very vulnerable state . Let us present the main opportunities that exist in the segments of medicine we have identified.

2.3.2.1 Hospital robots

These are robots for surgery, diagnostics and therapy. The surgical robot market is large in size. Robot-assistive capabilities can be used in almost all areas - cardiology, vascular medicine, orthopedics, oncology and neurology.

On the other hand, there are many technical challenges associated with size limitations, capacity limitations, environmental constraints, and few technologies that are available for immediate use in hospital settings.

In addition to technological problems, there are also commercial ones. For example, related to the fact that the United States is trying to maintain a monopoly position in this market due to its extensive intellectual property. This situation can only be circumvented through the development of fundamentally new hardware, software and management concepts. Such developments also require substantial financial support for high-cost but necessary development and associated clinical trials. Typical areas where there are opportunities now:

Minimally Invasive Surgery (MIS)

Advances can be made here by developing systems that can extend the flexibility of instrument movement beyond that provided by the anatomy of the surgeon's hands, increasing efficiency, or supplementing the systems with feedback (for example, allowing judgment of pressure) or additional data to help guide the procedure. Successful market adoption may depend on the product's cost effectiveness, reduced deployment time, and reduced additional training required to learn how to use the robotic system. Any system developed must clearly demonstrate the “added value” in the context of surgery. Clinical pilot implementation and evaluation of such testing in clinics are mandatory for the system to be accepted by the surgical community.

Compared to other forms of minimally invasive surgery, robotic-assistive systems potentially provide the surgeon with better control of surgical instruments as well as better visibility during surgery. The surgeon is no longer required to stand throughout the operation, so he does not tire as quickly as with the traditional approach. Hand tremors can be almost completely filtered out by the robot's software, which is especially important for applications in surgery that deals with microscale surgery, such as eye surgery. In theory, a surgical robot could be used almost 24 hours a day, replacing the teams of surgeons who work with it.

Robotics can provide rapid recovery, a reduction in injuries and a decrease in the negative impact on the patient’s tissue, as well as a reduction in the required radiation dose. Robotic surgical instruments can free up the doctor's brain, shorten the learning curve, and improve workflow ergonomics for the surgeon. Therapy methods that are limited by the limits of the human body also become possible with the transition to the use of robotic technologies. For example, a new generation of flexible robots and instruments that allow access to organs deeply hidden in the human body, making it possible to reduce the size of the entrance incision in the human body or make do with natural openings in the human body to perform surgical operations.

In the long term, the use of learning systems in surgery can reduce the complexity of surgery by increasing the flow of useful information that the surgeon will receive during the operation. Other potential benefits include the ability to enhance the ability of paramedics to perform standard clinical emergency procedures using robots in the field, and to perform tele-surgery in remote locations where only a robot is available and no trained surgeon is available.

The following possibilities can be distinguished:

New compatible tools that provide increased safety while maintaining full handling capabilities, including rigid tools. Through the use of new control methods or special solutions (which, for example, can be built into the tool or external to it), the functioning of the tools can be adjusted in real time to ensure compatibility or stability, when that is more important;

The introduction of improved assistive technologies that guide and warn the surgeon during surgery, which allows us to talk about simplifying the solution of surgical problems and reducing the number of medical errors. This “training support” should improve “compatibility” between the equipment and the surgeon, ensuring that the system is used intuitively and without hesitation.

Application of suitable levels of robot autonomy in surgical practice up to full autonomy of specific well-determined procedures, for example: autonomous autopsy; taking blood samples (Veebot); biopsy; automation of some surgical actions (tightening knots, supporting the camera...). Increasing autonomy has the potential to improve efficiency.

- “Smart” surgical instruments are essentially controlled by surgeons. These instruments are in direct contact with the tissue and enhance the surgeon's skill level. Miniaturization and simplification of surgical instruments in the future, as well as the availability of surgical procedures inside and outside the "operating theater" is the main way for the development of such technologies.

Education: Providing physically accurate models, achieved through the use of tools with haptic feedback, has the potential to improve learning, both in the early stages of learning and when achieving confident performance skills. The ability to simulate a wide variety of conditions and challenges can also enhance the effectiveness of this type of training. Currently, the quality of tactile feedback still contains a number of limitations, which creates difficulties in demonstrating the superiority of this type of training.

Clinical samples: There are many applications for autonomous sampling systems, from systems for collecting blood samples and tissue samples for biopsy to less invasive autopsy techniques.

2.3.2.2 Robotics for rehabilitation and prosthetics

Rehabilitation robotics covers a wide range of different forms of rehabilitation and can be divided into sub-segments. Europe has a fairly strong industry in this sector and active interaction with it will accelerate technological development.

Rehabilitation means

These are products that can be used after injury or after surgery to train and support recovery. The role of these products is to support recovery and accelerate recovery, while protecting and supporting the user. Such systems can be used in a hospital setting under the supervision of medical staff or act as a stand-alone exercise where the device controls or limits movements, depending on what is required in a given case. Such systems can also provide valuable data on the recovery process and monitor the condition more directly than even monitoring a patient in a hospital setting.

Functional replacement means

The purpose of such a robotic system is to replace lost functionality. This may be a result of aging or traumatic injury. Such devices are developed to improve the patient's mobility and motor skills. They can be designed as prosthetics, exoskeletons or orthopedic devices.

In developed rehabilitation systems, it is critical that existing European manufacturers are involved in the process as known market participants, and that relevant clinics and clinic partners are involved in the development process. Europe currently leads the world in this area.

Neuro-rehabilitation

(COST Network TD1006, European Network of Robotics for Neuro-Rehabilitation provides a platform for sharing standardization of definitions and examples of developments across Europe).

Currently, few robotic devices are used for neuro-rehabilitation because they have not yet been widely used. Robotics is used for post-stroke rehabilitation in the post-acute phase and other neuromotor pathologies such as Parkinson's disease, multiple sclerosis and ataxia. Positive results using robots (as good or better than using traditional therapy) for rehabilitation purposes are beginning to be confirmed by research results. Recently, positive results have also been confirmed by neuroimaging studies. It has been proven that integration with FES has shown increased positive outcomes (both for the muscular system and for the peripheral and central motor systems). Exercises with biofeedback and gaming interfaces are beginning to be seen as solutions that can be implemented, but such systems are still in the early stages of development.

In order to develop workable systems, several problems must be solved. These include low device costs, proven clinical trial results, and a well-defined patient assessment process. The systems' ability to correctly identify the user's intent and thereby prevent injury currently limits the effectiveness of such systems. Control and mechatronics integrated to meet the capabilities of the human body, including cognitive load, are in the early stages of development. Improvements in reliability and operating time must be achieved before commercially usable systems can be developed. Development goals should also include rapid deployment time and adoption by therapists.

Prosthetics

Significant progress can be made in the production of smart prostheses that can adapt to the user's movement patterns and environmental conditions. Robotics has the potential to combine improved self-learning capabilities with increased flexibility and control, especially for upper limb prostheses and hand prostheses. Particular areas of research include the ability to adapt to personal, semi-autonomous control, providing artificial sensitivity through feedback, improved verification, improved energy efficiency, self power recovery, improved myoelectric signal processing. Smart prosthetics and orthoses controlled by the patient's muscle activity will allow large groups of users to take advantage of such systems.

Mobility support systems

Patients with reduced physical capacity, either temporary or permanent, may benefit from increased mobility. Robotic systems can provide the support and exercise needed to increase mobility. There are already examples of the development of such systems, but they are at an early stage of development.

In the future, it is possible that such systems could even compensate for cognitive impairment, preventing falls and accidents. The limitations of such systems are related to their cost, as well as the ability to wear such systems for a long time.

In a number of rehabilitation applications, it is possible to use natural interfaces such as myoelectrics, brain signals, as well as interfaces based on speech and gestures.

2.3.2.3 Specialist support and assistive robots.

Expert support and assistive robotics can be divided into a number of application areas.

Caregiver support systems: Support systems used by caregivers who interact with patients or systems used by patients. These may include robotic systems that administer medications, take samples, or improve hygiene or recovery processes.

Lifting and moving the patient : Patient lifting and positioning systems can range from precise positioning during surgery or radiation therapy to assisting nursing staff or caregivers in lifting a person out of or into a bed, or in transporting patients around the hospital. . Such systems can be designed to be configured depending on the patient's condition and used so that the patient has a certain degree of control over their position. Limitations here may be related to the need to obtain safety certifications and safely manage sufficient forces to move patients in a manner that avoids possible patient injury. Energy-efficient structures and space-saving designs will be critical for efficient implementations.

When developing assistive robotics solutions, it is important to adhere to a set of basic principles. Development should focus on supporting functionality gaps rather than creating specific conditions. Solutions must be practical in terms of their use and provide tangible benefits to the user. This may include using technology to motivate patients to do as much as possible for themselves while maintaining safety. The implementation of such systems will not be viable and in demand if they do not provide the ability to reduce the workload on personnel, creating an economic case for implementation, while simultaneously being reliable and safe to use.

Biomedical laboratory robots for medical research

Robots are already finding their way into biomedical laboratories, where they sort and manipulate samples during research. Applications to create complex robotic systems are expanding the capabilities even further, such as into advanced cell screening and manipulations related to cell therapy and selective cell sorting.

2.3.2.4 Requirements in the medium term

The following list represents "growth points" in the field of medical robotics

Lower torso exoskeletons that adapt their function to the patient's individual behavior and/or anatomy, optimizing support depending on the user or environmental conditions. The systems can be adapted by the user to different conditions and to perform different tasks. Areas of application: neuro-rehabilitation and support for workers.

Robots designed for autonomous rehabilitation (e.g., play-based rehabilitation, upper limb rehabilitation after stroke) must perceive the patient's needs and reactions, and also adapt the therapeutic intervention to them.

Robots designed to support patient mobility and manipulation must support natural interfaces to ensure safety and performance in life-like environments.

Rehabilitation robots designed to enable sensor and motor integration by providing bidirectional communication, including multi-mode command input (myoelectric + inertial sensing) and multi-mode feedback (electro-tactile, vibro-tactile and/or visual).

Prosthetic arms, wrists, hands that automatically adapt to the patient, allowing him to control individually any finger, thumb rotation, wrist DOFs. This should be accompanied by the use of multiple sensors and pattern recognition algorithms to ensure natural control (constant force control) through possible DOFs. Areas of application: restoration of hand functionality for amputees.

Prosthetics and rehabilitation robots equipped with semi-automatic control systems to improve the quality of functioning and/or reduce the cognitive load on the user. Systems must allow perception and interpretation of the environment down to a certain level to enable autonomous decision making.

Prosthetics and rehabilitation robots are capable of using a variety of online resources (information storage, processing) through the use of cloud computing to implement advanced functionality that is significantly beyond the capabilities of on-board electronics and/or direct user control.

Inexpensive prosthetics and robotic solutions created using additive technologies or mass production (3D printing, etc.)

Home-based therapy that reduces the intensity of neuropathic pain or phantom pain of the upper limbs through improved interpretation of muscle signals through the use of robotic limbs (with less flexibility than in previous examples) and/or “virtual reality”.

Biomimetric control of interaction with a robot surgeon.

Adequate mechanical actuation and sensing technologies for the development of flexible miniature robots with force feedback, as well as instruments for advanced and advanced minimally invasive surgery.

Environmental charging systems for implantable micro-robots.

To obtain biomimetric control of rehabilitation processes: integration of volitional “impulses” during the movement of the subject, with the support of FES for improved re-learning of motor skills, when controlling the robot.

Developing hospital-applicable methods for restoring mobility that goes beyond the paradigm of commonly used static, manually adjusted mechanisms.

On low TRL

Automated cognitive understanding of required tasks in an ongoing environment. Seamless physical combination of man and robot for “normal” environmental conditions based on an additional control interface. Full, no-adjustment adaptability to the patient. Reliability of intent detection.

Microrobots capable of independently functioning inside the human body are playing an increasingly important role. Let us note that medical robotic systems are medical in nature, combining into a single whole mechanical and electronic components that function as part of an intelligent robotic system. Robots for the rehabilitation of disabled people. Medical rehabilitation robots are designed mainly to solve two problems: restoring the functions of lost limbs and life support for disabled people confined to...

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Introduction

The last decade has been marked by the rapid development of high medical technologies, shaping the face of medicine in the 21st century. In many developed countries, various mechatronic devices for medical purposes are being actively developed. The main directions of development of medical mechatronics development of systems for the rehabilitation of disabled people, performing service operations, as well as for clinical use. The main directions of development of medical mechatronics are presented in Fig. 1.

Figure 1. Main directions of development of medical mechatronics.

Microrobots that can function independently inside the human body are playing an increasingly important role. Note that medical robotic systems are medical in nature, combining into a single whole mechanical and electronic components that function as part of an intelligent robotic system. Below we discuss the main achievements in the field of medical mechatronics and outline the prospects for its further development.

Robots for the rehabilitation of disabled people.

Medical rehabilitation robots are designed mainly to solve two problems: restoring the functions of lost limbs and life support for disabled people confined to bed (with visual impairments, musculoskeletal disorders and other serious diseases).

The history of prosthetics goes back more than one century, but only so-called reinforced prostheses are directly related to mechatronics. Modern automated prostheses have not found widespread use due to design and operational imperfections and low operational reliability. But much is already being done to improve their characteristics by introducing new materials and elements into their design, such as film strain gauges to control the force of compression of the fingers of a prosthetic hand, electro-optical sensors mounted in the frame of glasses to control a prosthetic hand using patient's eye, etc.

A mechanical arm has been developed in Japan, the executive body of which has six degrees of freedom and a prosthesis control system. In Oxford (Great Britain), a control system was created for manipulators intended for prosthetics, the peculiarity of which is the ability to perform tasks that are not pre-programmed. They provide sensory processing, including speech recognition. One of the problems is the formation of control signals by the patient without the help of limbs. Devices are known to assist patients with double or quadruple amputations or paralysis, driven by an electrical signal resulting from contraction of the muscles of the head or torso. A design has been developed for a mechanical arm with a telesystem, which is controlled by sensors on the patient’s head that respond to the movement of the head or eyebrows and send signals to the microprocessor that controls the executive body of the manipulator.

To solve the problems of life support for immobile patients, various versions of robotic systems have been created. A qualitatively new design solution is an anthropomorphic arm manipulator, mounted on a wheelchair and controlled by a computer. This system allows a patient with a minimal level of training to control a manipulator arm to satisfy physiological needs, use the telephone, etc.

Medical robotic systems are known, the functioning of which is carried out through a central control post or using various command devices, the task for which the patient forms using speech commands. The system includes an anthropomorphic arm - a manipulator, control equipment, a command device, a television monitor, and an automated transport cart. At the request of the patient, the TV, radio, and lighting devices are turned on, the position of the patient on the bed changes, and the manipulator is activated.

An important problem associated with the rehabilitation of disabled people is the creation of jobs for them. An automated workplace for disabled people with musculoskeletal system disorders has been developed in the UK. The robot is a manipulation system that controls the operator’s speech commands; he is able, at the patient’s request, to select music discs, books, turn the pages of a book being read, switch computer peripherals, and dial phone numbers.

In the USA, an automated workstation with an anthropomorphic arm and a manipulator was developed for disabled people suffering from severe musculoskeletal system disorders. A patient with minimal training can operate a robot designed for eating, drinking, grooming, brushing teeth, reading, using the telephone, and working on a personal computer. The controller, located under the patient's chin, can be mounted on a wheelchair or on the workstation table to control the automated workstation. This makes it possible, in particular, to use a large number of automated workstations to simultaneously feed a group of patients. Such activities provide patients with the opportunity to communicate with each other and contribute to their awareness of themselves as a full member of society.

Service robots.

Medical robots for service purposes are designed to solve transport problems of moving patients, various items related to their care and treatment, as well as perform the necessary actions to care for bedridden patients.

The introduction of robots from this group into the healthcare system will free medical staff from routine auxiliary work, giving them the opportunity to engage in their professional affairs.

A robot has been developed that performs functions that require great effort: transportation, positioning of patients, etc. The robot is an electro-hydraulic system with an autonomous power source. The ability to control the robot is provided to both the patient and medical staff. It is equipped with a touch system. The robot is capable of serving a patient whose weight does not exceed 80 kg.

In the UK, a robotic device is being developed that can perform operations to turn over bedridden seriously ill patients in order to eliminate their bedsores. As a result, it is possible to eliminate unnecessary waste and free nurses from performing this exhausting work. Such devices allow, in particular, one health worker to wash seriously ill patients in the bath without the help of other employees.

A sample of a mobile robot guide has been developed in Japan Meldog for the blind, which is a small four-wheeled all-wheel drive trolley, the control system of which is equipped with a technical vision system and a computer. The route of movement within a given locality is recorded in the computer memory. Some robot sensors identify street intersections based on the location of house walls and selected reference points, while others detect road obstacles. Based on signals from sensors, the robot’s on-board computer develops a strategy for overcoming obstacles. The guide robot controls the movement of a blind patient using communication elements located on a soft belt adjacent to the disabled person’s body. The electrical impulses generated by this belt are commands for the patient to stop the robot or turn it left or right. The robot controls the speed of its movement and stops 1..2 m ahead of the driven blind patient. In the future, the emergence of similar mobile robots with an improved control system based on the principles of probabilistic logic.

The introduction of transport mobile robots into the infrastructure of Russian medical institutions will significantly facilitate the solution to the problem of the shortage of junior medical personnel.

The main types of transportation work that are expected to be entrusted to medical mobile robots are: centralized delivery of medical materials and equipment, trays and pallets with food for patients, laboratory tests, finished medications, mail for patients, as well as disposal and transportation of materials and waste from office premises .

A transport mobile robot for hospitals has been developed in the USA. At Danbury Hospital, this robot delivers trays of food in autonomous control mode. The hospital has 450 beds for patients. Every day, the robot delivers about 90 pallets or trays of food to newly arrived patients.

Medical robot Helpmate equipped with a technical vision system consisting of several color TV cameras, acoustic locators and non-contact NK sensors for detecting road obstacles, measuring the distance to them and drawing up a safe route. On the front wall of the robot there is also an electric emergency stop switch (duplicated on the rear wall), a warning lamp flash and turn signals.

On the back wall of the robot there are devices for reading the area map: a keypad, a switch for the type of work, a cabinet for food trays and a niche for batteries.

The strategy for overcoming obstacles is solved using an on-board computer based on a map of the area. Data received from primary information sensors is logically processed and displayed on a map of the area. Sensors scan the area in front of the moving robot, so that if an obstacle appears, the robot stops based on signals from the sensors. Within a few minutes, the computer processes the data and confirms the presence of an obstacle. If the obstacle moves, the robot waits until it disappears. If the object is stationary, then the robot begins to maneuver to avoid the obstacle from the side. All maneuvering processes are recorded in the machine’s memory. In case of failure, all recorded maneuvering parameters are compared with the true position of the robot and the program and control system are adjusted. The time it takes to train a mobile robot to move autonomously depends on the complexity of the route, the size of the corridors and doorways in the hospital.

In addition to the Helpmate robot A hospital robotic system has been developed in the USA Robotek simplified design and lower cost.

In Canada, research is underway to create an autonomously controlled medical mobile robot with high tactical and technical characteristics. In order to ensure high functional reliability, the robot's control system is equipped with a backup control system, as well as a self-diagnosis system that can automatically detect failures in the control system and their causes.

In Japan, a medical mobile robotic system, which is a remote-controlled transport cart, is being developed to transport bedridden patients within a hospital. The robot is equipped with a device for transferring a patient from a hospital bed to a transport vehicle, consisting of a board with fastening soft belts at the top and bottom. This mobile device can move between the patient and his bed mattress and allows the patient to move on a board that is suspended from the robot in two places allowing it to take the configuration of a chair.

According to experts Japan Industrial Robot Association (JIRA) ), the Japanese market for hospital mobile robots grew from 1000 in 1995 to 3200 in 2000.

In recent years, interest in mobile hospital robots has increased in a number of European countries. In France and Italy, a number of leading robotics and electronics companies have become involved in the development of robotic systems for food transport, both in the hospital and in the office. Work is underway to create robots for evacuating the wounded from areas of natural and man-made disasters.

Clinical robots.

Clinical robots are designed to solve three main tasks: disease diagnosis, therapeutic and surgical treatment.

A number of existing diagnostic systems with an image of the area under study on a screen (for example, a computer-controlled tomographic device) already use elements of mechatronics and robotics. It is expected that the massive appearance of computer-controlled medical devices for various purposes will have a strong impact on medical practice.

A micromanipulator has been patented in Japan, designed for medical and biological research at the cellular level, allowing one to measure the electrical resistance of a cell, microinject drugs and enzymes into the cell, change the design of the cell and extract its contents.

Another area of ​​application of robots is radiotherapy, where they are used to reduce the level of radiation hazard for medical personnel. The use of robots is considered most appropriate when replacing several expensive stationary radioactive sources in multibeam installations. The development of manipulators for radiotherapy departments is in the experimental phase. At the same phase, work is underway to create a robotic massager.

There are a number of complex surgical operations, the implementation of which is hampered by the lack of experienced surgeons, since such operations require high precision of execution. For example, in eye microsurgery there is such an operation as radial incisions of the cornea ( radial keratotomy ), with which you can correct the focal length of the eye to eliminate myopia. The ideal depth of the incision in the eye shell should not exceed 20 microns. An experienced surgeon can make incisions to a depth of 100 microns during this operation. In Canada, a medical robotic complex is being developed that can make high-precision incisions on the eye cornea and provide the desired curvature of the eye. Another example of high-precision surgical operations is microneurosurgery. A medical robot for brain microsurgery has already been developed in the UK.

A medical robot with a Puma manipulator, created in the USA, has demonstrated the ability to extract a piece of brain tissue for a biopsy. Using a special scanning device with a three-dimensional information display system, the location and speed of insertion of a two-millimeter drill for collecting samples of brain tissue were determined.

In France, a medical robot assistant is being developed to assist during spinal surgeries, when any mistake by the surgeon can lead to complete paralysis of the patient. In Japan, a medical robot created demonstrated the possibility of transplanting a cornea taken from a dead donor.

The advantages of medical robots include their ability to reproduce the required sequence of complex movements of executive instruments. A medical robot has been demonstrated in the UK - a simulator for training doctors and simulating the processes of prostate surgery, during which a series of complex incisions are made in various directions, the sequence of which is difficult to remember and perform.

A robotic system has been patented in the United States to assist a surgeon in performing bone operations. This system is used in orthopedic operations in which precise positioning of the instrument relative to the knee joint is critical. The robotic system consists of an operating table, a fixed device, a robot, a controller and a supervisor. The patient is positioned so that the thigh is immobile within the device. The patient's other thigh is secured to the operating table with straps.

The robot base is firmly fixed to the operating table. The tool is installed on a robot, the manipulator of which can move with 6 degrees of freedom. The manipulator contains a positional sensor device for generating signals indicating the position of the manipulator relative to the coordinate system. The robot uses a serial manipulator PUMA 200, which, due to its relative simplicity, is easily adapted to surgical operations. The controller monitors all movements of the robot and transmits them to the supervisor. Commands for movement and control of auxiliary operations generated by the controller are transmitted to the robot by positioning signals arriving via connecting cables.

There are several ways to control the robot's movement. During manufacturing, the robot is equipped with an additional device with a training program. The training device is a device with semi-automatic control of robot maneuvering. Maneuvering consists of a series of individual steps movements. The controller records these steps so that the robot can then repeat them itself. Voice commands or another type of control can be used to control the robot. The robot can also move passively, for which the manipulator provides manual motion control.

The supervisor, like the controller, is provided with control commands and programs in the language VAL 11. When working with a supervisor, all movement commands pass through the controller. A special screen is installed in front of the display, known under the trademark “ Touch window" (TSW ), which is used as a device for entering commands during the operation. All changes in the bone are displayed on the monitor screen. In the operating room, this screen is covered with a sterile film, allowing the surgeon to directly control the surgical procedure. Operation programs are based on geometric relationships between the parameters of the prosthesis, the parameters of bone cuts and the axes of drilling holes. The robot will move the tool to certain positions in the appropriate planes. The origin of the coordinate system will be some fixed point on the reference surface.

In recent years, in the field of automation of surgical processes, there have been reports of attempts to create robotic systems for remote surgery using television installations, when the surgeon and patient are separated by large distances.

The most pressing tasks include the diagnosis and surgery of vascular diseases. In Japan, Italy, and Russia, work is underway to create mobile microrobots designed to destroy atherosclerotic deposits in blood vessels. It is assumed that mobile microrobots will work automatically, moving along the anatomical bed of the circulatory system.

Currently at MSTU. N.E. Bauman, work is underway to create a robotic system that allows solving these problems. The system includes an arterial carrier - a microrobot, capable of moving along the bloodstream and equipped with an ultrasonic microsensor, as well as the necessary working tools. The functional diagram of this system is shown in Fig. 2. The surgeon operator, receiving information about the condition of the vessel, has the opportunity, with the help of a microrobot, to carry out procedures of both a medicinal and surgical nature.

In Canada, experimental research is being conducted on a teleoperator robot for laparoscopic operations. New medical technology is based on the use of a miniature camera and special instruments inserted through the abdominal wall. The video image is transmitted to the monitor, and the assistant coordinates the movements of the operating group in a given direction. The position of the miniature video camera in the abdominal cavity is coordinated using a manipulator controlled by the surgeon.

Figure 2. Functional diagram of a robotic system for intravascular diagnostics and surgery

Note that clinical robotic systems are ergatic, i.e. operate with the participation of the operator. The high level of technology allows us to significantly expand the possibilities of surgical intervention. An example is a remotely controlled manipulation system for cardiac surgery. In the latter case, the surgeon gets the opportunity to perform operations with a resolution that is 2-3 times less than what his hand allows when working directly with the instrument. It should be emphasized that this kind of operation is possible only with a sufficiently high level of information technology, the use of an active interface and expert systems that ensure a dialogue between the surgeon and the robotic system throughout the entire operation, monitoring his actions and preventing possible errors. Along with direct control of the movement of mini manipulators and microrobots using manual controls, the surgeon has the ability to use speech commands to control both the working tool and the information support tools. Thus, the use of clinical robotic systems allows not only to abandon traditional medical technologies in some cases, but also to significantly facilitate the working conditions of the surgeon and diagnostician.

Conclusion.

From the above it follows that medical mechatronics is in a state of rapid growth, the pace of which is much higher than in the traditional fields of mechatronics. At the same time, it is necessary to mention the factors hindering the use of mechatronic devices in medical practice, which are true not only for Russia, but also for all developed countries. The most important among them is the psychological factor associated with the dehumanization of medical care and manifested not only on the part of patients, but also on the part of medical personnel. This factor causes rejection of the idea of ​​​​using mechatronics for such a delicate area as the human body. Overcoming it requires treating mechatronics, first of all, as a means, an instrument of medical practice for a doctor or surgeon. It is necessary to pay attention to ensuring the reliability of mechatronic systems and their safety for the patient.

Another limiting factor is the disunity and incomplete mutual understanding of specialists in the field of technology and medicine. This circumstance requires the training of a new type of specialists who possess not only engineering knowledge, but also are well acquainted with the features of medical technologies. It is necessary to pay attention to the fact that at present a biotechnical methodology has not yet been fully developed, providing for a systematic approach to the design of mechatronic medical systems.

The most difficult problem that arises when designing medical mechatronic systems is the coordination of individual elements of the system. In this case, the following compatibility conditions can be distinguished:

1. biophysical compatibilitycharacteristics of the biological object and technical elements of the mechatronic system;
2. information compatibilitymechatronic system and system operator;
3. ergonomic compatibilitymechatronic system in relation to both the operator and the patient;
4. psychological compatibilitytechnical part of the system with the operator and the patient.

Compliance with these conditions will make it possible in the near future to overcome the factors hindering the widespread use of mechatronic systems in medical practice.

Medical robots

Rehabilitation

service

Clinical

Prostheses

Manipulators

Automatic workstation

Diagnostics

Guide

Therapy

Surgery

Evacuation of victims

Nursing

Surgeon - operator

Safety system

Manual control

Computer

Monitor

Communication interface

Implementation system

Microrobot

Ultrasonic sensor

Micromotor

Surgical instrument

Blood vessel

Biological object

Patient's condition

ARMH

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All over the world, medical robotics is actively developing in three areas: rehabilitation, service and clinical. Rehabilitation robots are designed to solve the problems of restoring the functions of lost limbs and life support for people with disabilities who are bedridden (with visual impairment, musculoskeletal disorders and other serious diseases). Medical robots for service purposes are designed to solve transport problems of moving patients, various cargo, as well as caring for bedridden patients. Clinical robotics provides full or partial automation of the processes of diagnosis, therapeutic and surgical treatment of various diseases.

The greatest practical application has been found in surgical robots used to perform robot-assisted operations in various fields of medicine. The use of robotics during operations reduces the dependence of the result of surgical intervention on the human factor and helps to expand technical capabilities when performing complex operations. With the use of robots, ergonomic indicators in the work of a surgeon are noticeably improved, and the accuracy and controllability of the impact increases. In minimally invasive surgery, robots increase the manipulability of a surgical instrument, allowing the surgeon to increase the amount of space inside the patient's body. An important advantage of robotic surgery is the ability to convert traditional operations into minimally invasive interventions.

The modern stage in the development of minimally invasive surgery has been the introduction of specialized robots into clinical practice, the most famous of which is the Da Vinci robot. In many countries, work is underway to create specialized surgical robotics (USA, Germany, Japan, South Korea, France, etc.).

In Russia, for the first time, the idea of ​​​​the possibility of robotic surgical intervention in relation to blood vessels was prof. G.V. Savrasov and academician A.V. Pokrovsky began to be discussed in the 80s of the last century. This was a period of development and active introduction into clinical practice of ultrasound angiosurgery technologies intended for intravascular effects.

The advantage of intravascular reconstruction lies, on the one hand, in its physiology, since the natural course of the circulatory system is restored, and on the other hand, in the possibility of minimal trauma due to the fact that the restoration of vessel patency is carried out over a considerable distance from the site of surgical access. However, the removal of the impact zone from the insertion site of the technical device, as well as the absence, as a rule, of direct visual information from the impact zone, complicates the work of the surgeon, making the results of surgical intervention directly dependent on the individual qualities of the surgeon himself. But the influence of the human factor is especially strong in cases where the main physical agent influencing the blood vessel is not the muscular effort of the surgeon, but a high-energy and fast-acting source, for example, ultrasound. In order to significantly improve the surgeon’s working conditions and at the same time increase the efficiency and quality of the operations he performs, it is necessary to fundamentally change the technique of surgical operations using mechatronics and robotics.

• mobile microrobotic systems, capable of moving through tubular organs in automatic and semi-automatic modes, carrying out diagnostics and influencing pathological ones;
• robotic manipulators to perform a wide range of surgical interventions in various fields of medicine.

You can see the problem in more detail in the video:

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O.V. CHERCHENKO,

Researcher, Federal State Budgetary Institution "Directorate of Scientific and Technical Progress", Moscow, Russia, [email protected]

S.A. SHEPTUNOV,

Doctor of Technical Sciences, Director of IKTI RAS, Moscow, Russia, [email protected]

ROBOT-ASSISTED SURGERY AND ROBOT-EXOSKELETONS FOR REHABILITATION OF PEOPLE WITH MUSCULOSKETAL DISORDERS: WORLD TECHNOLOGICAL LEADERS AND PROSPECTS FOR RUSSIA

Cherchenko O.V., Sheptunov S.A. Robot-assisted surgery and robotic exoskeletons for the rehabilitation of people with musculoskeletal disorders: world technological leaders and prospects for Russia (Federal State Budgetary Institution “Directorate of Scientific and Technical Progress”, Moscow, Russia; IKTI RAS, Moscow, Russia)

Annotation. The results of an analysis of publication and patent activity in the two most actively developing areas of the medical robotics industry are presented: robotic exoskeletons for the rehabilitation of people with impaired musculoskeletal functions, robot-assisted surgery. A discrepancy in the structure of global and national publication and patent flows has been revealed. The shortcomings of foreign developments in robot-assisted surgery are noted, which create the prerequisites for the promotion of import-substituting developments of domestic engineers.

Key words: robot-assisted surgery, exoskeletons for the rehabilitation of people with musculoskeletal disorders, technological leaders, competitiveness, scientometric analysis, patent analysis.

© O.V. Cherchenko,

S.A. Sheptunov, 2015

Medical robots can be defined as electronic-mechanical devices that partially or completely perform the functions of a person or his individual organs and systems in solving various medical problems. Back in 1998, Joseph Endelberger, an American engineer and entrepreneur who created the world’s first private company for the production of programmable machines and received the title “father of robotics” for this, introducing the HelpMate Trackless Robotic Courier robot assistant, said that hospitals This is the very environment that is ideal for the use of robots.

Robots are likely to create new added value in healthcare by:

1. reducing labor costs by performing certain operations not by humans, but by robotic means;

2. social and economic benefits by increasing the independence and social activity of people in need of specialized care;

3. increasing the quality of care provided by robotic systems (robots can perform more subtle manipulations and perform repetitive actions with a greater degree of accuracy than humans);

4. performing operations that a person cannot perform, including surgery, due to size limitations or non-

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2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Aggregate forecast

Market growth rate

Rice. 1. Global market forecast for robotic surgical systems (excluding radiosurgery systems) (Source: Wintergreen Research, BCC Research, Global Data)

the need for increased accuracy of operations performed.

Medical devices account for the bulk of the professional service robot market in value terms. This segment includes robotic surgical systems, radiation therapy devices and devices for patient rehabilitation. According to an analytical review by RVC, sales of such devices amounted to 1.45 billion US dollars, or 41% of the cost of all professional robots sold in 2013, excluding military systems.

In various forecasts, the volume of the global market for medical robotic systems by 2018 is estimated in the range from $13.6 billion to $18 billion, and by 2020 it is likely to reach more than $20 billion with an annual growth rate of 12-12 billion. 12.6%.

Surgical robots are expected to make up the largest share of revenue.

According to the combined forecast of Winter-green Research, BCC Research, Global Data, the estimated market size of robotic surgical systems (excluding components and consumables,

excluding radiosurgery) by 2025 will amount to 6.6 billion US dollars (Fig. 1).

A separate sector in the overall medical equipment market will be the exoskeleton market, which is expected to grow even more. According to the study “Rehabilitation robots: the stock market,

strategies and forecasts worldwide from 2015 to 2021" from Wintergreen Research, published in Research and Markets, the market size of medical rehabilitation robots and mechanisms in 2014 was $203.3 million and is projected to reach a profit of $1 by 2021 .1 billion.

The purpose of this study was to determine, based on data from multi-criteria scientometric and patent analyses, the main trends in the scientific and technological development of medical robotics in the world, as well as to assess the competitiveness of scientific and technological advances and Russia’s position in this technological market using the example of the two most actively developing areas of the industry:

Robotic exoskeletons for the rehabilitation of people with musculoskeletal disorders;

Robot-assisted surgery.

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Rice. 2. Dynamics of publication activity in the area of ​​“technology for creating an exoskeleton robot for the rehabilitation of people with musculoskeletal disorders”

(according to Web of Science Core Collection as of March 25, 2015)

An analysis of the current level and trends in the development of research activity in selected areas in the world and in Russia was carried out using one of the most authoritative sources of analytical information about key scientific research in the world - the international citation index Web of Science Core Collection.

To determine the industrialization potential of the areas under study and the competitiveness of Russian technological advances, this study used the author’s methodology of multi-criteria patent analysis of the working group led by N.G. Kurakova, which includes an assessment of the dynamics of patent activity in the world by direction, an assessment of the distribution of patent documents by their status, an assessment of the share of applications for inventions compared to the share of issued patents and other indicators. Patent analysis was conducted using Orbit and Thomson Innovation patent databases.

Scientometric and patent analyzes were performed for the period from 1995 to 2015.

Technologies for creating an exoskeleton robot for the rehabilitation of people with musculoskeletal disorders

An exoskeleton is an external frame that makes it easier for a person to perform musculoskeletal functions. In medicine, this is the name for devices that could be used by people with limited mobility to provide movement through support, as well as for regular training aimed at restoring lost mobility.

According to the international index Web of Science Core Collection, the volume of publications in this scientific area is growing exponentially (Fig. 2).

The leading countries in the world by the number of articles are the USA, China, and Italy. Russia accounts for only 0.1% of the global publication flow.

There is an exponential growth in patent activity in the area under study in the world. This is evidenced by our analysis, performed using two patent databases: Orbit (Fig. 3) and Thomson Innovation (Fig. 4).

Noteworthy is the increase in the number of applications for inventions, the number of which exceeds the number of valid patents, which is a sign of great potential for the development of a technological area (Fig. 5).

The drivers of the direction are the USA, China and the Republic of Korea - it is between these countries that the struggle for future niche markets created by devices of such functional purposes will most likely unfold. Data from the Orbit database (Fig. 6) and Thomson Innovation (Fig. 7) visualize the technological leadership of these three countries in the projection of patent analysis.

Russia is in 11th place in the number of patents received by residents of the country, but the share of national patents is only 1% of the global total in this area (Fig. 6).

Analysis of the distribution of patents by year made it possible to record the change in the world technological leader. As follows from the data,

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Publication years

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Rice. 3. Dynamics of patent activity in the area of ​​“technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” (according to Orbit data as of March 25, 2015)

Rice. 4. Dynamics of patent activity in the area of ​​“technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” (according to Thomson Innovation as of April 13, 2015)

Rice. 5. Distribution of patent documents by legal status in the area of ​​“technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” (according to Orbit data as of March 25, 2015)

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Priority countries

Rice. 6. Distribution of patents in the area of ​​“technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” by priority countries (according to Orbit data as of March 25, 2015)

Rice. 7. Distribution of patents in the area of ​​“technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” by priority countries (according to Thomson Innovation as of April 13, 2015)

presented in Fig. 8, in the development of technologies for creating an exoskeleton robot, since 1996, developers from many countries have taken part, making commensurate contributions to its industrialization. However, according to Thomson Innovation, in 2012 China takes first place in the total number of patents received by residents of the country. The patenting activity of Korean technologies has also been growing rapidly since 2005 (Fig. 8).

Patent analysis data obtained using the Orbit database allows us to note the same pattern in the change of technological leader: until 2006, several industrialists took part in the development of technologies for creating an exoskeleton robot

developed countries, the research and inventive activity of the United States especially stands out. However, since 2006, China begins to increase its activity in patenting national technical solutions and becomes the obvious world technological leader by 2012. The Republic of Korea has also demonstrated an increase in patent activity since 2007. Unfortunately, the scientific and technological groundwork of Russia during 2007-2013. are not reflected or protected by any significant number of patents (Fig. 9).

Among Russian patents on technologies for creating an exoskeleton robot, 65% were issued to residents of the country, more than a third of Russian patents were received by non-residents (Fig. 10).

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Rice. 8. Dynamics of patent activity in the area of ​​“technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” in different countries by priority (according to Thomson Innovation as of April 13, 2015)

Rice. 9. Dynamics of patent activity in the area of ​​“technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” in different countries by priority (according to Orbit data as of March 25, 2015)

Rice. 10. Dynamics of patent activity of residents of the Russian Federation in the direction of “technology for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions” (according to Orbit data as of March 25, 2015)

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Table 1

Top 10 patent holders in the world in the field of “technologies for creating an exoskeleton robot for the rehabilitation of people with musculoskeletal disorders”

Patent holders Number of patents

ZHEJIANG UNIVERSITY 40

SHANGHAI JIAO TONG UNIVERSITY 25

UNIVERSITY OF ELECTRONIC SCIENCE & TECHNOLOGY OF CHINA 18

HARBIN INSTITUTE OF TECHNOLOGY 17

UNIVERSITY OF CALIFORNIA 14

SOGANG UNIVERSITY INDUSTRY-UNIVERSITY COOPERATION FOUNDATION 12

SOUTHWEST JIAOTONG UNIVERSITY 11

BEIJING UNIVERSITY OF TECHNOLOGY 10

UNIVERSITY OF SHANGHAI FOR SCIENCE & TECHNOLOGY 9

Source: according to the Orbit database as of March 25, 2015.

In table 1 presents the top 10 patent holders in the world with the largest portfolios of patents in the field.

Most of the patents with Russian priority belong to Moscow State University named after M.V. Lomonosov (45%).

Technologies of robot-assisted surgery

Robot-assisted surgery is the latest achievement in laparoscopic technology and minimally invasive surgery, implying minimal surgical trauma and reduced pain for the patient.

There are a number of advantages of robot-assisted surgery that suggest that widespread adoption of the technology would take surgery as a whole to a new level:

A fundamental change in the work of a surgeon with the provision of a wide range of opportunities;

Improved 3D visualization of anatomical structures, especially neurovascular bundles;

Ensuring that young specialists perform high-quality operations after completing a specialized training course;

Performing high-quality operations in those anatomical areas where it was previously impossible to perform minimally invasive interventions;

Absence of tremor, careful and “gentle” tissue excision;

Minimal traction and displacement of neighboring organs.

Publication activity in the field of robot-assisted surgery, according to the Web of Science Core Collection, has been growing steadily over the past twenty years (Fig. 11).

The publication leaders are the USA, Germany and Japan, the share of Russian publications is 0.1% of the global flow (41st place in the world).

The activity of patenting technological solutions in the area under study is also growing exponentially, according to the Orbit database (Fig. 12) and the Thomson Innovation database (Fig. 13).

The number of patents issued annually since 2009 amounts to two hundred.

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Rice. 11. Dynamics of publication activity in the area of ​​“technology of robot-assisted surgery”

(according to Web of Science Core Collection as of March 24, 2015)

nami, and the number of patent applications filed is growing exponentially (Fig. 14).

The technology leaders in this area include the USA, the Republic of Korea, and China - this is evidenced by the Orbit database data (Fig. 15) and patent analysis data performed using the Thomson Innovation database (Fig. 16). The United States is listed as the priority country in half of the patent documents issued in this area. The share of patents received by Russian residents is only 1.91% of the global number of patent documents. With this indicator, the Russian Federation ranks 8th, but in this indicator it lags behind China, which occupies third position in the ranking of the patent portfolio, by 6.7 times (Fig. 15).

Rice. 12. Dynamics of patent activity in the area of ​​“robotic-assisted surgery technology” (according to Orbit data as of March 24, 2015)

Rice. 13. Dynamics of patent activity in the area of ​​“robotic surgery technology” (according to Thomson Innovation as of April 13, 2015)

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■ Inactive ■ Applications ■ Active

US WO KR CN DE EP JP RU GB FR CA IT ES AU UA Priority countries

Fig. 14. Distribution of patent documents by legal status in the area of ​​“robot-assisted surgery technology” (according to Orbit data as of March 24, 2015)

Rice. 15. Distribution of patents in the area of ​​“robotic-assisted surgery technology” by priority country (according to Orbit data as of March 24, 2015)

Rice. 16. Distribution of patents in the area of ​​“robotic-assisted surgery technology” by priority country (according to Thomson Innovation as of April 13, 2015)

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Rice. 17. Dynamics of patent activity in the area of ​​“robot-assisted surgery technology” in different countries by priority (according to Thomson Innovation as of April 13, 2015)

Rice. 18. Dynamics of patent activity in the area of ​​“robot-assisted surgery technology” in different countries by priority (according to Orbit data as of March 24, 2015)

RU WO US EP CA IT ES KR DE FR

Priority countries

Rice. 19. Dynamics of patent activity of residents of the Russian Federation in the area of ​​“robotic-assisted surgery technology” (according to Orbit data as of March 24, 2015)

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table 2

Top 10 patent holders in the world in the field of robot-assisted surgery technology

Quantity

patents

INTUITIVE SURGICAL 246

ETHICON ENDO SURGERY 45

SAMSUNG ELECTRONICS 39

HANSEN MEDICAL 39

JOHNS HOPKINS UNIVERSITY 30

DEUTSCH ZENTR LUFT & RAUMFAHRT 25

TIANJIN UNIVERSITY 24

OPERATIONS INTUITIVE SURGICAL 23

Source: (according to Orbit data as of February 24, 2015)

According to the Thomson Innovation database, the United States has maintained leadership as a priority country from 1995 to the present. In the Republic of Korea, the first patents were received by residents in 2006, and by residents of China in 2003, but today both countries are actively involved in the struggle for the markets for robot-assisted surgery devices (Fig. 17).

The Orbit database visualizes the same trend. US researchers have demonstrated consistently high patent activity in this area over the entire twenty-year observation period, and since 2006, China and the Republic of Korea have entered the competition for leadership. Russia, unfortunately, is the country of priority for single patents in the period from 2002 to 2013. (Fig. 18).

In total, 64 Russian patents have been issued for solutions in the field of robot-assisted surgery technologies, of which 40 belong to Russian applicants. The distribution of Russian patents by priority country (Fig. 19) shows that non-residents account for 37.5% of patents issued in the Russian Federation, most of which were issued to US companies.

In table 2 presents the top 10 patent holders in the world in the field of robot-assisted surgery. The absolute leader among them is Intuitive Surgical (USA), which became the developer of the system

"Da Vinci" The company's patent portfolio greatly complicated the development of the robot-assisted surgery market, since it covered the fundamental design solutions and elements of the surgical robot. But, as can be seen from the examples of China and the Republic of Korea, new technological solutions can still be found in conditions of actively developing technology with an obvious monopolist.

Ethicon Endo Surgery, which occupies third position in the ranking, has received 4 Russian patents.

Russian patent holders in the area of ​​“robotic-assisted surgery technologies” are represented by companies and universities that each have 1-2 patents.

Conclusion

The presented data does not allow us to characterize the scientific and technological progress of the Russian Federation in the field of robotic exoskeletons for the rehabilitation of people with impaired musculoskeletal functions and robot-assisted surgery as competitive. Unfortunately, it was not possible to find patents of domestic technology companies, indicating the latter’s readiness to offer serial products not only to the global, but also to the domestic market.

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Meanwhile, the growth rate of the global markets for robotic surgeons and robotic exoskeletons for the rehabilitation of people with musculoskeletal disorders allows us to characterize them as new and dynamically growing. Therefore, Russian developers have every chance to occupy niche markets. The need for new Russian developments in robotic surgery is also due to a number of shortcomings in the Da Vinci system used in the world:

The surgeon lacks tactile sensations;

Large weight and size of the system;

Long period of preparation for surgery;

Lack of tracking system to the target (pathology site);

Small viewing angle (lack of peripheral vision) for the operator of the surgeon's console;

Using one mechanism to perform different movements;

Long-term installation of trocars compared to standard laparoscopic operations;

Lack of contact with the patient;

Lack of 3D vision for a doctor assisting directly next to the patient.

In addition to the above-mentioned areas of technological development of these systems, special mention should be made of the cost characteristics of the Da Vinci system and individual instruments and accessories (the average cost of one complex is 3 million euros). Training of personnel to work with the system is possible only abroad. A big problem is technical support and maintenance of the system in Russia.

All the noted shortcomings create excellent prerequisites for the promotion of import-substituting developments of domestic engineers, which means that the inclusion of technologies for creating an exoskeleton robot for the rehabilitation of people with impaired musculoskeletal functions and robot-assisted surgery among the priorities of scientific and technological development of Russia is fully justified.

LITERATURE

1. Kraevsky S.V., Rogatkin D.A. Medical robotics: the first steps of medical robots // Technologies of living systems. 2010. - T. 7.

- No. 4. - P. 3-14.

2. Expert-analytical report “The potential of Russian innovations in the market of automation systems and robotics.” 2014. The report was prepared by Larza LLC at the request of RVC OJSC.

Http://www.rusventure.ru/ru/programm/analy-tics/docs/Otchet_robot-FINAL%>20291014.pdf.

3. Transparency Market Research. Medical Robotic Systems Market (Surgical Robots, Non-Invasive Radiosurgery Robotic Systems, Prosthetics and Exoskeletons, Assistive and Rehabilitation Robots, Non-Medical Robotics in Hospitals and Emergency Response Robotic Systems) - Global Industry Analysis, Size, Share, Growth,

Trends and Forecast 2012-2018. - http:// www.transparencymarketresearch.com/medical-robotic-systems.html.

4. Could Titan Medical Storm The Robotic Surgery Market? March 27th, 2014 by Alpha Deal Group LLC. - http://alphanow.thomsonreuters.com/ 2014/03/titan-storm-robotic-surgery-market/#

5. Market of rehabilitation robots until 2021 - http://robolovers.ru/robots/post/783338/ry-nok_reabilitatsionnyh_robotov_do_2021_goda/

6. Kurakova N.G., Zinov V.G., Tsvetkova L.A., Erem-chenko O.A., Komarova A.V., Komarov V.M., Sorokina A.V., Pavlov P.N. , Kotsyubinsky V.A. Model of “rapid response” science in the Russian Federation: methodology and organization. - M.: Publishing house "Delo" RANEPA, 2014. - 160 p.

1. Kraevskij S.V., Rogatkin D.A. Medical robototronics: first steps of medical robots // Technologies of live systems. - 2010. - Is. 7. - No. 4. - P. 3-14.

2. Expert-analytical report “Potential of Russian innovations on the market of automation and

ECONOMICS OF SCIENCE 201 5, T. 1, No. 2_______

robototronics" (2014) Report is prepared by LLC "Larza" on behalf of JSC "RVK". http://www.rus-venture.ru/ru/programm/analytics/docs/Otchet_ robot-FINAL%20291014.pdf.

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3. Transparency Market Research. Medical Robotic Systems Market (Surgical Robots, Non-Invasive Radiosurgery Robotic Systems, Prosthetics and Exoskeletons, Assistive and Rehabilitation Robots, Non-Medical Robotics in Hospitals and Emergency Response Robotic Systems) - Global Industry Analysis, Size, Share, Growth, Trends and Forecast 2012-2018. - http://www.transparencymarketrese-arch.com/medical-robotic-systems.html.

4. Could Titan Medical Storm The Robotic Surgery Market? (2014) Alpha Deal Group LLC. http://

alphanow.thomsonreuters.com/2014/03/ti-

tan-storm-robotic-surgery-market/#.

5. Market of rehabilitation robots until 2021 year (2015). http://robolovers.ru/robots/post/783338/rynok_reabilitatsionnyh_robotov_do_2021_goda/.

6. Kurakova N.G., Zinov V.G., Tsvetkova L.A., Ye-remchenko O.A., Komarova A.V., Komarov V.M., Sorokina A.V., Pavlov P.N., Kotsubinskiy V.A. (2014) Model of a “direct action” science in the Russian Federation: methodology and organization // Publishing House “Delo” RANEPA. - 160 p.

Cherchenko O.V., Sheptunov S.A. Robot-assisted surgery and robots exoskeletons for rehabilitation: world technological leaders and perspectives of Russia (Directorate of State Scientific and Technical Programs, Moscow, Russia; Institute for Design-Technological Informatics Russian Academy of Sciences, Moscow, Russia) Abstract. There was analyzed the publication and patent activity with regard to two actively developing areas in the field of medical robototronics: robots-exoskeletons for rehabilitation of people with musculoskeletal disorders and robot-assisted surgery. There was identified discrepancy in the structure of global and national publication and patent flows. There were revealed disadvantages of foreign innovations on robot-assisted surgery, which create prerequisites for promoting import-substituting innovations of domestic engineers.

Keywords: robot-assisted surgery, robots-exoskeletons for rehabilitation of people with musculoskeletal disorders, technology leaders, competitive ability, scientometric analysis, patent analysis.

new regulatory document

RAS RESEARCH PLANS NOW APPROVED BY FANO

Decree of the Government of the Russian Federation of May 29, 2015 No. 522 “On some issues of the activities of the Federal Agency of Scientific Organizations and the Federal State Budgetary Institution “Russian Academy of Sciences”

In accordance with the new rules for coordinating the activities of FANO and the RAS, the latter must coordinate with FANO research plans developed by scientific organizations within the framework of the Program of Basic Scientific Research of State Academies of Sciences for 2013-2020.

FANO approves, in agreement with the RAS, programs for the development of scientific organizations, as well as state assignments for conducting fundamental and exploratory scientific research of organizations subordinate to the agency.

If irresolvable disagreements arise between the agency and the RAS, the work to overcome them is transferred to the Deputy Chairman of the Government, who coordinates the work of federal executive bodies on issues of state policy in the field of science.

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