OR without surgeon: science fiction or realistic scenario?

The same holds true, Professor Stallkamp points out, fordisinfection robotswhose potential is being explored due to新冠肺炎：“有一个机器人消毒医院的想法呈现在当前的情况下。移动机器人确实存在，并且在没有人类的封闭空间中，它们确实可以用喷雾或UV-C辐射消毒空间。但是当机器人必须谈判障碍时会发生什么 - 例如患者 - 在消毒门把手，手轨或电话等临界细节时？

For mobile robots lifts, automatic doors and staircases have to be built in a certain way so they can handle them. Or the robots themselves have to be constructed so they can overcome hurdles. You very quickly reach the limits of feasibility or financing. The precondition for safe applications is a holistic concept. While currentroboticssolutions might be able to reduce the infection risk considerably, no cost-benefit analysis is available and indeed such a calculation appears to be difficult.”

For Professor Stallkamp, a mechanical engineer by training, clinical logistics is an area with great potential to decrease operating costs. Whether a tissue sample is taken from the OR topathology, a blood sample to clinical chemistry or medication to a ward – all these tasks involve a staff member running the errand. Often enough that person receives an emergency call or is waylaid by a patient en route and delays ensue.

“With hundreds of such tasks on a daily basis, transport and the interruptions of the transport are quickly turning into a cost factor. I can image all these tasks being performed by robots in the future. But this also requires a spatial infrastructure that is suitable for robotic applications," says Professor Stallkamp. "And the entire process would have to be automated since often partial automation does not seem to reduce the human or financial resources needed. Moreover, when we are dealing with critical transport tasks such as pain killers or radioactive materials we have to consider all possible scenarios, for example what should happen to the blood sample when a technical failure occurs, when the robot breaks down mid-journey?”

Patient transport by robots?

机器人，Stallkamp教授建议，不仅可以运输样品和药丸，而且患者也是如此：“由于安全原因，许多床上患者必须伴有工作人员”，因此简单的运输机器人不承认，因为它们不承认unexpected events such as the sudden deterioration of the patient’s health. However, he says, “it should be possible to develop robots that can recognize these events and take the necessary actions such as calling a physician and taking the patient straight to the right department. Unfortunately, there is a big gap between what’s feasible and what’s possible.”

Professor Stallkamp is well aware of the fact that the hospitals don’t have the financial means do implement such complex solutions. Nevertheless he suggests building each new hospital in a way that robots can be easily accommodated. Technology, he says, is only the smaller problem. It’s the organizational barriers that are more difficult to overcome: “In healthcare it seems that new solutions are only implemented when there is evidence of their practical benefits. The moment we can prove that a robotic system outperforms the conventional approach the hospitals will jump on the bandwagon.”

Overall, the general public is prepared to accept robots and we should build upon this positive attitude. But money remains the linchpin: “Establishing these complex structures requires a lot of money and we have to take more risks. We need teams of financers, industry, clinical users and engineers that have the courage to implement such a project.”

他说，研究人员必须在医院的每一天运营中融入，并在GO上开发结构。在研究学院的走廊中的考验不会做。机器人技术，Stallkamp强调的教授，并不是“有许多好公司和解决方案”的问题。但是，留给自己的设备，他们无法满足成功的临床机器人必须满足的所有要求。他们需要跨学科合作。

回到Stallkamp教授的愿景全自动或不再需要外科医生的干预：“操作可以更快地进行，更加迫切，对患者的压力较小，以及医院的更高效率。但无论是一项技术和临床观点，仍然是一种仍然是一种方式。“

The key to this kind of fully automated technology is artificial intelligence which has to replace the one immeasurable factor: the physician’s intuition. “Why does a physician hesitate when performing a biopsy? Why doesn’t she push the needle deeper? That’s expertise and experience, gathered over the years“, says Professor Stallkamp and adds that “we would need a technical solution to measure intuition. If we had that we wouldn’t even need AI anymore.”

Profile:
In 2014, Professor Dr Jan Stallkamp was appointed Professor for Automation in Medicine and Biotechnology at the University Medical Center Mannheim which is part of the University of Heidelberg. After completing his mechanical engineering studies at the Rheinisch-Westfälische Technische Hochschule RWTH Aachen he joined the Fraunhofer Institute for Manufacturing Engineering and Automation (IPA) in Stuttgart as post-graduate.

In 2005, he received his doctorate in medical technology at the University of Stuttgart. At Fraunhofer IPA he headed the Competence Center Medical Technology and later led both the group and the department of Automation in Medicine and LifeSciences. He was co-founder of the Fraunhofer project Automation in Medicine and Biotechnology PAMB in Mannheim which he has been heading since 2011.

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