Artificial Intelligence & Robotics: What does

future hold for Medicine?

Dr Vaibhav Bagaria MBBS MS FCPS

Hip & knee Surgeon Sir HN Reliance Foundation Hospital

Mumbai

Bit Awkward!!!

Are we too elitist?

Gorakhpur Tragedy

Self Obsessed & Nonsense talk

• Intelligent Orthopedician is traditionally considered an oxymoron!!!

• Orthopaedician talking about intelligence and that too artificial intelligence would perhaps be called: *…..g Non sense!

Robots!

• Czech word Robota - Biosynthetic machine used for forced labor

• Da Vinci’s sketchbook of robot helped set up stage for innovation in this field

• AI describes science of engineering & medicine was officially born in 1956

ध्रुवम् लोकिवनाशाय पौलस्त्येनािस िनिमर् तः | तस्मात्त्वमद्यप्रभृित मृतकल्पः शियष्यसे || ६-६१-२४ (dhruvam loka vinaashaaya paulastyena asi nirmitaH | tasmaat tvam adya prabhR^iti mR^ita kalpaH shayiSyase || ) Translation : It is sure that you were created by visravasa for the destroyal of people. On that account, you will be sleeping apparently dead from now onwards.

Da Vinci Legacy• During the Renaissance, Leonardo da Vinci made a detailed

study of human anatomy to design humanoid robot.

• His sketches drawn in 1495, were only rediscovered in the 1950s.

• Leonardo's robot knight robot that was able to stand-up, sit-down, wave arms, move head and jaw. Operated by pulleys & cables.

• More important than his accomplishments in this area, da Vinci's sketchbooks were a source of inspiration for a generation of robotic researchers, some of whom worked at NASA

Neural Networks

AI In Medicine• The application of AI in medicine has two main

branches: virtual and physical.

• Virtual component represented by Machine Learning , (aka Deep Learning ) represented by mathematical algorithms that improve learning through experience.

• Physical component: physical objects, medical devices and increasingly sophisticated robots taking part in the delivery of care & in surgeries.

Learning Paradigms

• Unsupervised (ability to find patterns)

• Supervised (classification and prediction algorithms based on previous examples)

• Reinforcement learning (use sequences of rewards and punishments to form a strategy for operation in a specific problem space)

Improved patient Care

First taste of success in Medicine

• Protein–protein interaction algorithms that led to novel therapeutic target discoveries

• “Evolutionary enhanced Markov clustering”

• Permitted prediction of over 5000 protein complexes, of which over 70% were enriched by at least one gene ontology function term

EHR & AI integration

Future is closer than you think!!!Mercedes Factory Governed by Robots Video

Surgical Robots• Master Slave Manipulator

• Automated Machines

• Collaborative Robots (Cobots)

• Hand - Held Robots

• NOTES (natural orifice transluminal endoscopic surgery) Robots

Telemanipulator

Da Vinci• Estimated 200,000 surgeries conducted in 2016

• 4 interactive robotic arms controlled from console

• 3 arms are for tools that hold objects and can also act as scissors, scalpels, electrocautery

• 4th arm carries an endoscopic camera with dual lenses for stereotactic vision

• All controlled from a console which is operator dependant

Cobots

Hand Held Robots

NOTES Robots

Robots in Orthopaedics• Available clinically in some form for over 2 decades

• Claiming to improve total joint arthroplasty by enhancing the surgeon's ability to reproduce alignment and therefore better restore normal kinematics.

• Various current systems include a robotic arm, robotic- guided cutting jigs, and robotic milling systems with a diversity of different navigation strategies using active, semiactive, or passive control systems.

Aviation to Manufacturing• consideration of the industry as an “art” by

experts in the field

• development of “rules plus instruments”

• development of “standardized procedures and templates”

• automation

• computer integrationRoger Bohn

Semi active Robot• Semiactive systems require surgeon involvement, but

providing feedback, usually tactile, to augment the surgeon's control & theoretically, operative safety.

• These semiactive systems are also known as “haptic systems.”

• In contrast to computer-assisted surgery, which provides passive guidance and feedback, the robotic system provides passive haptic restraints for surgical resection.

Robot Autonomy

Orthopaedic Robots• Surgeon cannot, for eg, burr bone outside the preset

volumetric parameters, confining the treatment to only the planned level of resection in 3 D.

• Haptic sensation is provided to the surgeon through auditory (beeping), tactile (vibratory), and visual (color change on the computer screen).

• These alerts trigger and provide feedback to the surgeon as the defined resection parameters are approached; this prevents over resection and malpositioning during the procedure.

Robots in Orthopedics

Navio ( S& N)

Robotic Uni being performed using Navio

Makoplasty ( Stryker)

Robotic Hip Replacement using Mako

Mazor Spine Assist

Mazor Spine Assist• different attachment points on each mount (three

for the spinous process mount and nineteen with the Hover-T frame), three different drill guide lengths, and two extension bridges.

• The software can be used in conjunction with the preoperative plan and informs the surgeon about which position, drill guide, and if an extension bridge will be needed to place the implant.

Outcomes

Outcomes

For Whom the bell tolls?

Chess, Jeopardy & Joker

For whom the bell Tolls?

• Robots fall over opening doors

• Currently at 6th grader level

• Mistake yellow and black stripes for school bus

• Life is complex - There are vision, Illusion, confusion and rarely conclusion!!!

As a surgeon…

In a nutshell…• Over the long term, no industry has ever seen robotic

technology be introduced and ultimately not show an increase in production capacity, improved accuracy and precision, and lower cost.

• As in all development efforts, robotics in other industries generally undergoes a period of development and refinement before rapid adoption, which occurs after the benefits of the technology become clear.

• Robotics is now being introduced in the arena of arthroplasty in ways that seem likely to portend viable improvements over prior failed robotic technologies in the health care space.

Thank You!!!