Talk given in SORC 2017 Mumbai about how the Artificial intelligence and Robotics are likely to shape the future of medicine. How and why the AI and Robots can be a curse and boon at the same time!!!

1. Artificial Intelligence &
Robotics: What does
future hold for Medicine?
Dr Vaibhav Bagaria
MBBS MS FCPS
Hip & knee Surgeon
Sir HN Reliance Foundation Hospital
Mumbai

2. Bit Awkward!!!

3. Are we too elitist?
Gorakhpur Tragedy

4. Self Obsessed & Nonsense
talk

5. • Intelligent Orthopedician is traditionally
considered an oxymoron!!!
• Orthopaedician talking about intelligence and
that too artificial intelligence would perhaps be
called: *…..g Non sense!

7. 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

8. 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.

9. 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

11. Neural Networks

12. 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.

13. 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)

14. Improved patient Care

15. 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

17. EHR & AI integration

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

19. Surgical Robots
• Master Slave Manipulator
• Automated Machines
• Collaborative Robots (Cobots)
• Hand - Held Robots
• NOTES (natural orifice transluminal endoscopic
surgery) Robots

20. Telemanipulator

21. 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

24. Cobots

25. Hand Held Robots

26. NOTES Robots

28. 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.

29. 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 integration
Roger Bohn

30. 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.

31. Robot Autonomy

32. 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.

33. Robots in Orthopedics

34. Navio ( S& N)
Robotic Uni being performed using Navio

35. Makoplasty ( Stryker)
Robotic Hip Replacement using Mako

36. Mazor Spine Assist

37. 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.

38. Outcomes

39. Outcomes

40. For Whom the bell tolls?

41. Chess, Jeopardy & Joker

42. 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!!!

44. As a surgeon…

47. 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.

48. Thank You!!!