Title: Surgical robotics of breast biopsy for ambulatory applications: reduction of risks of infections
Author: prof. Alberto Rovetta N. AF-1

Medicine Meets Virtual Reality, Proceedings of 1997, 1998, IOS Press

A methodology for breast biopsy for ambulatory applications. Robotic surgical systems, which now are almost 500 in the world, present some main positive characters. Robotic application may offer a large reduction of risks of infection, because of the standardization of the procedure. It also decreases the possibilities of contamination in the hospital, because all the parts of the robot may be sterilized and cleaned completely, avoiding the deposit of unhealthy material, and washing it away completely after every surgical act.
The infection due to contacts with the environment covers a percentage of 10% in regular hospital activities in highly technologically developed Countries. The presence of surgical robotics and of telerobotics may reduce the infection risk.

The robotic and telerobotic surgical system in Laboratory of Telerobotics, Politecnico di Milano has been developed to perform the operations of breast biopsy in an automated and mini-invasive way, acting under an ecographic guide. In the procedure followed, similar for the four operations, the physician characterises the target using the probe of the ecograph, and then a second operator starts the system confirming the target position on the PC monitor. The computer calculates the position of the point in the space and the ideal trajectory to follow, and then the robotic arm proceeds automatically to move and to insert the needle in the patient to take the desired tissue sample. The device consists of four main components: a robot with its control system, an ecograph, a tracking device and a supervising master PC.

The presence of surgical robotics and of telerobotics may reduce the infection risk. The robotic and telerobotic system increases the number of components in the surgical room. Because the robot must work as in clean room, the European Union and the Federal Drug Administration rules impose some restrictions, which are very strong for cleaning, for safety, for infection risk reduction. These rules provoke also a decrease of the elements to be carried in the surgical room, and reduce the time of biopsy.
The precision of surgical robotic act, which is only a part of the total surgical action, is very high. The time of action (biopsy, surgical operation) is reduced. Because in every case the act of the robot is not different in the results from the surgeon action, the pain of the patient (if some pain is) is not changed by the presence of the robot action.
The preliminary tests have shown:

  • great efficiency of the system,
  • high precision (the robot may present 0.02 mm in precision)
  • high speed in execution of the breast biopsy (1-2 minutes in front of 3-6 minutes);
  • high reduction of risks of infection due to the environment.

Future possible developments
The reduction of risks is very high because the person and the robot are completely insulated; the sample may be extracted by telerobotics and the barriers between the person and the environment may be checked every time and maintained continuously. The safety of the robotic system is the main aspect, which must be considered in parallel with the reduction of the risk of infection and contamination.