Moving robot surgery from labs to hospitals

Resources are becoming a more pressing concern every year for hospitals across Europe, while an ageing population, and higher expectations, are increasing the demands on healthcare services. Technology is one of the ways that we can hope to "square the circle" of improving the quality of care during surgery, while ensuring that such services remain accessible for patients.

In this context, investment in robotic surgery has become a growing trend in EU research. Soon, researchers expect to bring to market technologies that could perform surgical interventions automatically, or even robotic arms performing such interventions under the supervision of an actual surgeon located thousands of kilometres away. But while this all sounds very exciting, there is still a long way to go before such technologies reach your nearest city hospital.

Paolo Fiorini, a former scientist at NASA, has spent more than 20 years bridging gaps between research institutions and pushing for the commercialisation of newly developed technologies. His latest project goes by the name of EUROSURGE, which aims to build a pan-European community of researchers, simplify software development, and create an online platform that would act as the voice of scientists in this sector.

In an exclusive interview with the research*eu results magazine, Dr Fiorini explains the difficulties currently faced by EU scientists and his hopes for the future of this promising area of research.

What are the main objectives of EUROSURGE?

EUROSURGE is a Coordination Action (CA) that has the goal of forming a community of research laboratories and companies active in the field of robot-assisted surgery - often referred to as robotic surgery. While working on community building, I also felt that this was a good area to address the issues related to 'cognitive robotics' which was one of the main focuses of robotics in FP7.

What is new or innovative about the project and how it addresses this topic?

To build a community of researchers, I thought that it was necessary to develop methods to ensure that they could cooperate, perhaps on some common hardware/software platform. Although a CA does not have the money to develop hardware platforms, we addressed a number of issues that are related to the project's objectives.

As a first step we carried out an investigation on 'who is doing what' in Europe in the field of robotic surgery. We came up with a map that links all centres performing research in robotic surgery and identifies their main research topic. The map is already used by stakeholders to identify possible partners and reviewers of European projects.

The second step was to develop a technology that would simplify the development of software for robotic surgery. The focus here is on modularity, so that different groups can write components that are compatible with the software developed in other laboratories. We suggested guidelines both for the design and the implementation of software packages.

To satisfy the strict regulation of medical devices, all software needs to undergo severe validation and benchmark phases. In our vision, the design should be 'ontology-based', i.e. based on a formal description of the functions and connections of the components of a surgical robotic system, coupled with the description of the tasks the system will perform. The implementation should then be 'component-based' with specifications that can be automatically derived from the ontology description. We based our work on the ROS and OROCOS packages, already well known and used in the robotics community, and enhanced them with the concept of 'component supervisor' which allows each software package to identify itself and its function among other components and to let a test script verify whether all components are compatible with each other.

The last topic addressed by EUROSURGE is the analysis of the 'non-technical' road blocks, i.e. the issues related to common language, patents, regulations, ethics and laws in different European countries. Here we have developed a new website, called SurgiPedia, which publishes white papers and position statements on robotic surgery, and has a dedicated web search engine to collect information about patents related to robotic surgery.

What first drew you to research in this area?

From 1985 to 2000, I worked on teleoperation for space applications at NASA's Jet Propulsion Laboratory in Pasadena (CA-USA). When I returned to Italy in 2001, I found that space research was not too popular, and after a few attempts to work with the Italian Space Agency I decided to use my background in teleoperation for robotic surgery. It was a good idea since I was able to participate in and coordinate a number of projects in this area, develop new technologies and train students. I also started a couple of companies developing technologies for robot-assisted surgery.

What were the main difficulties you faced in advancing robotic surgery?

Of course, the main difficulties are not the technical problems. The main difficulty is the lack of a sustained stream of resources to reach a good level of maturity with a technology. The example is one of my start-up companies: after the good results of the European project ACCUROBAS, I decided to apply the experience acquired to make a new surgical robot that could address some of the problems identified during the project. I was also able to get some significant venture capital for the company, but it was not sufficient to reach the market. We succeeded in developing a new product, in carrying out animal tests and in certifying the technology. But then the money ran out and we could not find other investors ready to support the human clinical trials. This is a common problem for all European projects. We develop great technologies that have no impact on the economy because they never reach the market. Hopefully, this problem will be addressed in Horizon 2020, but there is no easy solution, given the lack of risk investments in Europe.

The second problem is the difficulty to find surgeons interested in cooperating 'seriously' on an engineering project. They are all interested in the beginning, but when we need their time to test the devices, to give us advice and to propose new features, somehow they disappear. I guess because a prototype is still too far away from the application that they lose interest during the development process.

How do you expect EUROSURGE to help in this regard?

I think that, besides the points listed above, we have been very successful in creating a community of researchers in robotic surgery. I do not want to say that everybody is involved and participates in the project activities, but a good number of researchers do. We had a successful workshop in Verona, in September, attended by about 70 researchers, and now we have a booth at the iREX International Robot Exhibition in Tokyo, where I will present the main results of all EU programmes developing robotic surgery technologies to the visitors. Thus, we have been able to involve in our activities even researchers who did not participate in the EUROSURGE project and we have established very good relations with all of them.

In the future, we certainly hope that the workshop, the Surgipedia website and patent search engine, the software design and implementation approaches, as well as the validation methods will continue to be developed by the project partners - even after the end of the project. We all hope that we will be able to get another project funded by the EU and therefore keep this initiative alive.

What are the next topics for your research?

My other active project in the field is about automation in robotic surgery. The name of this project is I-SUR. We are developing technologies for the automatic execution of simple surgical actions, such as puncturing, cutting and suturing. In this case, too, we have just scratched the surface of the problem and next year we will try to get funds to continue the research. Another project recently ended, SAFROS, pointed out the need for better training in robotic surgery. Therefore, we started a new company to commercialise the training software XRON (http//:metropolis.scienze.univr.it/xron) which can help reduce the risk of accidents during robot-assisted interventions. Finally, the most difficult goal is to continue developing the surgical robot, since there is a great need for new products, but there are no new offerings on the market.