Mon, July 6, 2015The Pirates Will See You Now: Open Source Surgery Bot Built to Drive Down Medical Costs

Ultimately, the open source revolution and digital fabrication have the potential to give just about anyone the ability to make anything, regardless of background or experience.? Even robotic surgeons, according to a recent Heise article.? In order to bring down the cost of surgical robots, like laparoscopic machines, Frank Kolkman launched Open Surgery, an open source project to create a low-cost, open source, surgical robot.

On the Open Surgery site, Kolkman describes the development process behind the Surgery Pirate, his open source, laparoscopic robot.? Taking a cue from the US military’s own open source device, the $200k RAVEN II Surgical robot, Kolkman sought to bring down this price significantly.? Thinking that the biggest cost issue would be the actual surgical equipment, Kolkman turned to Alibaba, ordering sterile laparoscopic instruments, as well as peripheral components like camera modules and CO2 insufflation pumps, from Chinese manufacturers, all of which could, he reasons, be sterilized in a home oven or microwave.? Then, it came time to design the mechanics of the bot itself, which he describes as the most difficult part of the process.

Kolkman relied on designs from the RepRap community to nail down the electronics for the Surgery Pirate, designing “four 3D printed parts controlled by two DC servo motors that rotate around a central pivotal point” and programming it with Processing’s open source platform. By using such designs, he believes that the community will, in turn, be able to improve the bot even further and help Kolkman along the way.

And, after five months, he achieved a rough prototype for a surgical robot, though he warns “I wouldn’t recommend to attempt surgery with it just yet,” adding, “The biggest limitation is that you would still require a trained surgeon, or someone with extensive knowledge of the human anatomy and knowledge of surgery, to perform the operation. However I don’t think it is to hard to imagine that there would be surgeons who share in the same ideology and become part of such communities. The legality of that however remains questionable and it’s preferability off course debatable.”

A quick visit to Open Surgery and you immediately see that Kolkman’s robot is clearly framed not as a device for actually performing surgeries, but is meant to be an act of sociopolitical commentary.? Think Cody Wilson and the 3D printed Liberator gun, but with a constructive message.? He eloquently laments the sometimes $2M cost of surgical robots, which have the ability to perform minute procedures with precision and reduce the trauma experienced by patients.? Not only is this not cost effective for hospitals, which have to use the robots constantly to see a return, but such robots, Kolkman says, “ the range of treatment options available to patients… by replacing lower cost options with higher-cost services.”?He goes on to describe step-by-step tutorials on YouTube on how to perform some medical procedures at home, “Driven by the lack of affordable alternatives to the professional healthcare system, communities of mainly uninsured Americans use Youtube to share videos showing them performing medical hacks on themselves…”

In a separate post, he also draws attention to the issue of patents in the medical industry, which are notorious for driving up the costs of life-saving medications and technology.? After pointing out the valid uses for patents, Kolkman explains, “However where intellectual property law begins to fail in my opinion is where large companies are monopolizing over extensive patent portfolios with very broadly defined patents on concepts and mechanisms. Especially within the medical sector this is painful, firstly because your are directly preventing certain groups of people from getting access to care that might save their life and secondly because a lot of healthcare related research is publicly funded. Meaning the government, and the tax payer, is initially taking most of the risk, for little return of the profit later on as companies have bought back their intellectual property and become privatized. Besides that the cost associated with patents means that it is difficult for startups who don’t have the capital yet to enter the medical market with revolutionary ideas, because even if they only marginally seem to infringe on often very broadly defined patents it becomes hard to get investment. So the challenge for innovation policy is to come up with a system that only pays for innovations that are worth it, but without shutting down the potential for disruptive new ideas to have a long-term effect. “

As much as Open Surgery is meant as a sociopolitical message, it is also clear that the Surgery Pirate is a sincere experiment by Kolkman, who really does believe that advanced medical equipment could be made open source in order to improve the technology and bring down its cost.? And his argument is definitely an appealing one, as we’ve seen e-NABLE’s 3D printed prosthetics and Open Bionics’ bionic arms drive the cost of prosthetic limbs down by orders of magnitude.? Why shouldn’t the same happen for surgical robots?

I guess the question may seem absurd at first, given the dangers of DIY surgery (the fatalities caused by DIY butt injections come to mind), as 3D printed prosthetics are far less likely to cause anyone harm.? At the same time, one can begin to imagine a middle ground between anyone building surgical robots at home without safety regulations enforced and the closed model we have now, in which people are driven to such DIY procedures because of the high cost of medical care.? Open source designs could bring down the cost of medical equipment and a new framework for regulating such devices might be enacted to also control their safety.? And, in countries and legitimate clinics that can’t afford such high-cost equipment, these devices could be built and run by trained professionals in lieu of anything higher quality. Otherwise, we might be living in an even more dystopian world in which we really are turning to DIY robots in back alleys to get our medical needs met.? Unless we’re already living in that world.

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The Pirates Will See You Now- Open Source Surgery Bot Built to Drive Down Medical Costs

最终，开源革命和数字化制造具有不论背景或经验的潜力，给几乎任何人做任何事情的能力，。？即使机器人外科医生，根据最近的海泽文章？为了减低手术机器人的成本，如腹腔镜机，弗兰克Kolkman推出了开放手术，一个开源项目，以创建一个低成本的，开放源码的，外科手术机器人。

在开放手术部位，Kolkman介绍了发展过程中的手术海盗，他的开源，腹腔镜机器人的背后？以一个线索，从美军自己的开源设备时，$200K RAVEN II手术机器人，Kolkman试图推翻这个价格显著？思考，最大的成本问题将是实际的手术设备，Kolkman转向阿里巴巴，订购无菌腹腔镜手术器械，以及像摄像头模块和CO2气腹泵外围元件，从中国制造商，所有这些都可能，他的理由，进行消毒在家庭烤箱或微波炉？然后，是时候来设计机器人本身，他描述的过程中最困难的部分的机制。

Kolkman依赖于设计的的RepRap社区明确电子的手术海盗，设计和它处理的开源平台编程“由两个直流伺服电机，围绕一个中心枢纽点旋转控制四款3D打印的部件”。通过采用这样的设计，他认为，社会将反过来，能够进一步提高机器人，帮助Kolkman前进的道路。

而五个月后，他的手术机器人实现了粗略的原型，但他警告说，“我不会建议尝试手术只是还没有，”他补充，“最大的限制是，你仍然需要一个训练有素的外科医生，或有人与人体解剖学和手术知识的广泛的知识，来执行该操作。不过，我不认为这是很难想象会有谁的外科医生在同一个思想交流，并成为这些社区的一部分。那合法性但仍值得怀疑，它的优选性偏离航向值得商榷。“

快速访问开放手术，你立即看到Kolkman的机器人显然是诬陷不作为设备实际进行手术，但意思是社会政治评论的行为？想想科迪·威尔逊和印刷解放者枪3D，而是以建设性的消息？他意味深长地感叹手术机器人有时$ 2M成本，这必须执行分钟的程序，精确度和降低所经历的患者的创伤的能力？这不仅是不符合成本效益的医院，其中必须使用机器人经常看到的返回，但这样的机器人，Kolkman说，“提供给患者......通过用更高成本服务替换较低成本选项的治疗方案的范围内。 “？他接着描述一步一步的教程，YouTube上关于如何在家里进行一些医疗程序，”创佳由于缺乏负担得起的替代品，以专业的医疗系统，主要是没有保险的美国人的社区使用YouTube分享视频展示他们执行医疗黑客在自己身上......“

在一个单独的帖子中，他还提请注意专利，在医疗行业的问题，这是臭名昭著的哄抬救命的药物和技术的成本？指出了有效的用途专利后，Kolkman解释说，“但是，若知识产权法开始在我看来，失败的地方是大公司垄断了广泛的专利组合和对概念和机制的定义非常宽泛的专利。特别是在医疗领域内，这是痛苦的，首先是因为你是直接阻止某些群体的人从获得获得医疗保健，可能挽救他们的生命，其次是因为很多医疗相关研究的是政府资助。这意味着政府和纳税人，最初承担大部分的风险，对利润的回报很少后来因为公司已经回购了自己的知识产权，并成为私有化。此外，与专利相关的成本意味着它是困难的谁没有资本尚未进入医疗市场的革命思想新创公司，因为即使他们似乎只有轻微侵犯往往定义非常广泛的专利变得难以获得投资。因此，对于创新政策所面临的挑战是要拿出一个系统，只需支付创新，是值得的，但没有关闭了颠覆性的新思路的潜力有一个长期的影响。 “

多达开放手术是指作为一个社会政治的消息，也很清楚，手术海盗是一个真诚的实验由Kolkman，谁真的相信，先进的医疗设备可以作出开源，以提高技术，带来了它的成本？而他的说法绝对是一个十分吸引人的，因为我们已经看到电子NABLE的3D打印假肢和开放式仿生“仿生臂驱动假肢的成本降低几个数量级。？为什么不应该一样发生手术机器人？

我想这个问题看似荒谬首先，给DIY手术的危险性（由DIY屁股打针死亡人数浮现在脑海中），作为3D打印的假肢是不太可能造成任何的伤害。？与此同时，人们可以开始想象有人在家里没有强制执行安全规章和封闭模式，我们现在有，在其中的人都被驱动到，因为医疗费用高的这种DIY的程序建立的手术机器人之间的中间地带。 ？开源的设计可以减低医疗设备和调节这种设备的新框架的成本可能会颁布也控制他们的安全？而且，在国家和无法承受如此高性价比的设备合法诊所，这些设备可以建立并代替任何质量更高训练有素的专业人员运行。否则，我们可能会生活在一个更加反乌托邦世界中，我们真的正在转向DIY机器人在后巷，让我们的医疗需求得到满足？除非我们已经生活在那个世界。

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