Robot-assisted surgery in space: pros and cons. A review from the surgeon's point of view

Telesurgery and the importance of context

Telesurgery has the potential to overcome geographical barriers in surgical care, encouraging its deployment in areas with sparse surgical expertise. Despite successful in-human experiments and substantial technological progress, the adoption of telesurgery remains slow. In this Review, we analyze the reasons for this slow adoption. First, we identify various contexts for telesurgery and highlight the vastly different requirements for their realization. We then discuss why procedures with high urgency and skill sparsity are particularly suitable for telesurgery. Last, we summarize key research areas essential for further progress. The goal of this Review is to provide the reader with a comprehensive analysis of the current state of telesurgery research and to provide guidance for faster adoption of this exciting technology.

Space surgery: a SAGES' white paper

BACKGROUND

Space travel is experiencing a renaissance with expanding commercial and international efforts. Space surgery will have growing relevance as mission frequency and distances increase beyond low Earth orbit.

METHODS

This white paper from the SAGES Space Surgery Task Force raises awareness among the SAGES membership regarding the challenges and opportunities surrounding this emerging field that anticipates surgical care in the most extreme, austere environments.

RESULTS

Innovation in technology and preventive medicine principles will enhance the effectiveness of space surgical care when the need arises. The impact of advancements in space and terrestrial medicine to support space exploration indicates the need for a surgeon to oversee medical/surgical invasive treatment to ensure astronaut health and mission success. Advanced technology, including semi- and autonomous robotic systems, may be a preferred way to deliver this care in the foreseeable future. There is currently a need to develop training curricula and flight-compatible supplies and technology for physicians that deliver surgical care to this special patient population. The protocols and technology developed to address the unique challenges of space travel will provide value for care in space as well as in extreme, austere terrestrial environments on Earth.

CONCLUSION

Space surgery will continue to evolve as commercial and government programs explore further into space. The SAGES Space Surgery Task Force is favorably positioned to significantly contribute to addressing some capability gaps in delivering surgical care in space.

Emerging Technologies in Hand Orthopedic Surgery: Current Trends and Future Directions

Emerging technologies are changing hand surgery by improving surgical precision, minimizing tissue disruption, and expediting patient recovery. These advancements have the potential to revolutionize surgical procedures, patient outcomes, and rehabilitation processes. However, there are still challenges that need to be addressed before these technologies can be widely adopted. These challenges include the learning curve for surgeons, high costs, and ethical considerations. Future research should focus on addressing the limitations of these technologies, exploring their long-term effects, and evaluating their cost-effectiveness. To successfully implement them, a collaborative approach involving clinicians, researchers, engineers, and policymakers is necessary. This review provides an overview of current and future trends in emerging technologies for hand orthopedic surgery.

Artificial intelligence meets medical robotics

Artificial intelligence (AI) applications in medical robots are bringing a new era to medicine. Advanced medical robots can perform diagnostic and surgical procedures, aid rehabilitation, and provide symbiotic prosthetics to replace limbs. The technology used in these devices, including computer vision, medical image analysis, haptics, navigation, precise manipulation, and machine learning (ML) , could allow autonomous robots to carry out diagnostic imaging, remote surgery, surgical subtasks, or even entire surgical procedures. Moreover, AI in rehabilitation devices and advanced prosthetics can provide individualized support, as well as improved functionality and mobility (see the figure). The combination of extraordinary advances in robotics, medicine, materials science, and computing could bring safer, more efficient, and more widely available patient care in the future. -Gemma K. Alderton.

Surgery in the Next Space Missions

In the coming years, missions to the Moon and Mars shall be the new goals of space flight. The complexity of these missions due to the great distance from Earth and the unforeseen obstacles to settle on another planet have given rise to great concerns for crew health and survival. The need for advanced crew autonomy and a different approach to surgical emergency require new protocols and devices to help future crew medical officers and other crew members in a task of unprecedented difficulty. Hence, the increasing variety of schedules, devices, and protocols being developed. A serious health problem, such as an emerging surgical disease or severe trauma, can jeopardize the mission and survival of the entire crew. Many other difficulties are present in deep-space missions or settlements on other planets, such as communication and supply, also medical, delays, and shortage, and the presence of radiation. Progress in advanced technologies as well as the evolution of robotic surgery and the use of artificial intelligence are other topics of this review. In this particular area of research, even if we are still very far from an "intelligent robot", this evolution must be evaluated in the light of legislative and ethical considerations. This topic was presented at the annual meeting of the American College of Surgeons-Italy Chapter in 2021.

Inducing Performance of Commercial Surgical Robots in Space

Pre-existing surgical robotic systems are sold with electronics (sensors and controllers) that can prove difficult to retroactively improve when newly developed methods are proposed. Improvements must be somehow "imposed" upon the original robotic systems. What options are available for imposing performance from pre-existing, common systems and how do the options compare? Optimization often assumes idealized systems leading to open-loop results (lacking feedback from sensors), and this manuscript investigates utility of prefiltering, such other modern methods applied to non-idealized systems, including fusion of noisy sensors and so-called "fictional forces" associated with measurement of displacements in rotating reference frames. A dozen modern approaches are compared as the main contribution of this work. Four methods are idealized cases establishing a valid theoretical comparative benchmark. Subsequently, eight modern methods are compared against the theoretical benchmark and against the pre-existing robotic systems. The two best performing methods included one modern application of a classical approach (velocity control) and one modern approach derived using Pontryagin's methods of systems theory, including Hamiltonian minimization, adjoint equations, and terminal transversality of the endpoint Lagrangian. The key novelty presented is the best performing method called prefiltered open-loop optimal + transport decoupling, achieving 1-3 percent attitude tracking performance of the robotic instrument with a two percent reduced computational burden and without increased costs (effort).

Human Health during Space Travel: State-of-the-Art Review

The field of human space travel is in the midst of a dramatic revolution. Upcoming missions are looking to push the boundaries of space travel, with plans to travel for longer distances and durations than ever before. Both the National Aeronautics and Space Administration (NASA) and several commercial space companies (e.g., Blue Origin, SpaceX, Virgin Galactic) have already started the process of preparing for long-distance, long-duration space exploration and currently plan to explore inner solar planets (e.g., Mars) by the 2030s. With the emergence of space tourism, space travel has materialized as a potential new, exciting frontier of business, hospitality, medicine, and technology in the coming years. However, current evidence regarding human health in space is very limited, particularly pertaining to short-term and long-term space travel. This review synthesizes developments across the continuum of space health including prior studies and unpublished data from NASA related to each individual organ system, and medical screening prior to space travel. We categorized the extraterrestrial environment into exogenous (e.g., space radiation and microgravity) and endogenous processes (e.g., alteration of humans' natural circadian rhythm and mental health due to confinement, isolation, immobilization, and lack of social interaction) and their various effects on human health. The aim of this review is to explore the potential health challenges associated with space travel and how they may be overcome in order to enable new paradigms for space health, as well as the use of emerging Artificial Intelligence based (AI) technology to propel future space health research.

Advances in the application of robotic surgical systems in gastric cancer: A narrative review

Gastric cancer is one of the common malignant tumors in the gastrointestinal tract, and surgery is currently an important treatment for progressive gastric cancer. With the development of technology, the simultaneous maturation of artificial intelligence (AI), fifth-generation (5G) telecommunication networks and the internet of things (IOT) has brought significant efficacy and new opportunities for the surgical treatment of gastric malignancies. The combination of 5G network and remote surgical robotic system is the future trend of radical gastric cancer surgery, and the "unmanned" treatment mode of fully automated robotic gastric cancer radical surgery will be realized soon.

Role of fibroblasts in wound healing and tissue remodeling on Earth and in space

Wound healing (WH) and the role fibroblasts play in the process, as well as healing impairment and fibroblast dysfunction, have been thoroughly reviewed by other authors. We treat these topics briefly, with the only aim of contextualizing the true focus of this review, namely, the microgravity-induced changes in fibroblast functions involved in WH. Microgravity is a condition typical of spaceflight. Studying its possible effects on fibroblasts and WH is useful not only for the safety of astronauts who will face future interplanetary space missions, but also to help improve the management of WH impairment on Earth. The interesting similarity between microgravity-induced alterations of fibroblast behavior and fibroblast dysfunction in WH impairment on Earth is highlighted. The possibility of using microgravity-exposed fibroblasts and WH in space as models of healing impairment on Earth is suggested. The gaps in knowledge on fibroblast functions in WH are analyzed. The contribution that studies on fibroblast behavior in weightlessness can make to fill these gaps and, consequently, improve therapeutic strategies is considered.

Anatomical Engineering and 3D Printing for Surgery and Medical Devices: International Review and Future Exponential Innovations

Three-dimensional printing (3DP) has recently gained importance in the medical industry, especially in surgical specialties. It uses different techniques and materials based on patients' needs, which allows bioprofessionals to design and develop unique pieces using medical imaging provided by computed tomography (CT) and magnetic resonance imaging (MRI). Therefore, the Department of Biology and Medicine and the Department of Physics and Engineering, at the Bioastronautics and Space Mechatronics Research Group, have managed and supervised an international cooperation study, in order to present a general review of the innovative surgical applications, focused on anatomical systems, such as the nervous and craniofacial system, cardiovascular system, digestive system, genitourinary system, and musculoskeletal system. Finally, the integration with augmented, mixed, virtual reality is analyzed to show the advantages of personalized treatments, taking into account the improvements for preoperative, intraoperative planning, and medical training. Also, this article explores the creation of devices and tools for space surgery to get better outcomes under changing gravity conditions.

The Epidermis in Microgravity and Unloading Conditions and Their Effects on Wound Healing

The future objectives of human space flight are changing from low-term permanence in the International Space Station to missions beyond low Earth orbit to explore other planets. This implies that astronauts would remain exposed for long time to a micro-gravity environment with limited medical support available. This has sparkled medical research to investigate how tissues may adapt to such conditions and how wound repair may be influenced. This mini-review is focused on the effects of microgravity and unloading conditions on the epidermis and its keratinocytes. Previous studies, originally aimed at improving the in vitro protocols to generate skin substitutes for plastic surgery purposes, showed that epidermal stem cells cultured in simulated microgravity underwent enhanced proliferation and viability and reduced terminal differentiation than under normal gravity. In the meantime, microgravity also triggered epithelial-mesenchymal transition of keratinocytes, promoting a migratory behavior. The molecular mechanisms, only partially understood, involve mechano-trasduction signals and pathways whereby specific target genes are activated, i.e., those presiding to circadian rhythms, migration, and immune suppression, or inhibited, i.e., those involved in stress responses. However, despite the above in vitro studies suggest that microgravity would accelerate keratinocyte growth rate and migration, in vivo findings on animals in experimental set-ups to simulate low gravity rather suggest that prolonged mechanical unloading contributes to delayed and impaired epidermal repair. This is in keeping with the finding that microgravity interferes at multiple levels with the regulatory signals which coordinate the different cell types involved in the repair process, thereby negatively influencing skin wound healing.