Robotics in medicine. La robótica en medicina

In 1985, at the Long Beach Memorial Medical Centre, a PUMA 200 robot from the company UNIMATE performed what is considered the first ever use of a robot in surgery, accurately guiding a needle to its intended destination in a stereotactic brain biopsy.1 According to Kwoh et al.,1 the reasons justifying the use of a robot in the operating room was its submillimeter accuracy and the precise execution of the plan defined by a surgeon in the preoperative process based on a tomographic image. And indeed, robots can reach precisions of hundredths of a millimetre, countering the small oscillations associated with an inevitable human tremor. Some years after this pioneering experience of applying a robot in the surgical context, in 1993 the Food and Drug Administration (FDA) approved the use of a robotic system in an endoscopic surgical procedure (the Automated Endoscopic System for Optimal Positioning of Computer Motion Inc [AESOP]).2 The combination of the information obtained through a medical image, the computer programmes designed to help with preoperative planning and the ability of the robots to faithfully replicate the plan, are the basis of systems such as ROBODOC3 initially commercialised by CUREXO and currently by Thinsurgical – CASPAR – Ortho MAQUET – and the MAKOplasty® Robotic Arm, whose purpose is to intervene in Total Knee and Total Hip Arthroplasties (TKA and THA). With the same precision that they have when carrying out tasks in a workshop, these robots perform the preparation of bone tissue operations for the correct settlement of the prosthesis. Certain long-term clinical studies carried out on behalf of CUREXO found that robotic TKA and THA interventions show “small but potentially important clinical improvements in patients”4; however, other studies have shown that they generally require an undesirable increase in surgery time. But it is not this ability to accurately replicate a pre-established plan that has given rise to the expansion surgical roboti