Transforming Surgery With Japan's First Surgical Robot

Join us as we explore, Medical Frontiers.

Robot assisted surgery allows doctors to perform complex procedures with greater precision, and it's beginning to play a larger role in medicine.

A market research firm in the United States forecasts that a global market for surgical robots will quadruple in value in the next decade to $21 billion dollars.

And here in Japan, the long awaited first surgical robot was put to practical use in 2020.

We'll be speaking to the doctor and others who developed the robot and look at the new possibilities it's bringing about in the operating room.

A medical device is being prepared for use in an operating room.

It's the first surgical robot developed in Japan, using cutting-edge technology.

Specialized staff set it up over a patient.

The device will support the surgical team during a roughly four-hour-long operation.

The robot is equipped with an endoscope, two pairs of forceps and a pair of scissors.

These four arms serve as the surgeon's hands during the operation.

The robot is named "hinotori," or "phoenix" in Japanese.

It reduces the burden on surgeons and increases precision and safety.

It also enables remote operations, and could change the future of surgery.

The robot is being used in a laparoscopy.

This procedure allows doctors to operate on organs internally while viewing them on a screen.

The surgeon controls the robot from a console called the cockpit, which is two meters away.

The surgeon looks at the console's monitor as he moves the controller.

The movements of the controller and the robot's arms are synchronized.

Kobe University Professor Fujisawa Masato, an expert in urology, helped to develop the robot.

Professor, Fujisawa, thank you so much for your time today.

It's great pleasure to meet virtually.

Welcome to the show.

Thank you.

So this is amazing robot here I see just to your left, Japan-made incredible surgical robot.

This is where the patient lies during a surgery.

Today, I’ll use this model to
explain how the system works.

This is the surgeon cockpit.

This is a controller.

Yes.

So you're using foot pedal and also the arms well?

Both hands and both feet are used
to control the operation unit.

The surgeon uses the controller and foot pedals to switch between the four arms and manipulate them freely.

The forceps on the robot's arms are about 50 centimeters long.

They can be replaced according to the operation.

The forceps and scissors are controlled by the thumb and the forefinger.

They can also be rotated.

The surgeon's movements are reflected in real time.

Looking at these movement, so smooth well.

This is what the surgeon sees on the monitor.

The rubber bands on the protrusions are around eight millimeters in diameter.

Even such small rubber bands can be picked up and moved easily.

The robot automatically cancels out hand tremors, enabling smooth movements.

The surgeon can easily hold two rubber bands and tie them together.

And it's amazing.

It just looks so smooth when you're doing it.

If you were to manually use such
long forceps, the tip would shake a lot.

But the robot automatically
prevents any shaking.

Despite hand tremors, the tip
remains stable during surgery.

Laparoscopies are usually done manually.

The operating surgeon handles a pair of forceps and a pair of scissors.

Another doctor operates the endoscope.

Yet another doctor controls a second pair of forceps.

The three doctors must limit their arm movements to avoid getting in each other's way.

The robot, however, is able to prevent its arms from bumping into each other.

This was made possible by technology that is used to assemble automobiles.

At this auto factory, 20 robotic arms move in harmony, avoiding collisions.

This was a basis of the technology that was used to build the surgical robot.

It also implements technology used to remotely apply coatings.

Such Japanese technical expertise has contributed to the smoothness of the surgical robot's movements.

A patient is on his way to a prostate cancer surgery using the surgical robot.

I’m not worried. With a machine,
there’s probably a lower chance of errors.

The prostate is a roughly walnut-sized gland that is part of the male reproductive system.

Located next to the bladder, it wraps around the urethra.

Prostate cancer is usually treated by removing the entire gland.

This must be done without damaging the bladder.

After the prostate is removed, the urethra must be stitched to the bladder.

The operation requires advanced surgical skills and vast experience.

Ready? Good.

Let’s get started.

This footage shows just how useful the surgical robot is in prostate cancer surgery.

In the red circle is the bladder.

The urethra, in the back, is just five millimeters thick.

The surgeon must take care not to damage it.

Even such small organs can remain unharmed with the support of the robot.

The device significantly eases the burden on doctors.

An hour and a half into the operation, the surgeon is ready to remove the prostate.

He carefully separates the prostate from the bladder.

Three hours into the surgery, the prostate is successfully removed.

Next is what's considered the most important part of a prostate-cancer surgery.

The bladder and the urethra must be connected.

When this is done manually, surgeons may have difficulty reaching some spots.

But the robot's forceps can rotate, making it easier to suture.

Free of complications, the patient is discharged nine days later.

So, Professor, so when you compare, for example, conventional surgery to robotic surgery, how is the brain changes in terms of, for example, surgeon fatigue and also the performance level?

Has this changed?

For patients, laparoscopies are
more beneficial than open surgeries.

But for surgeons, laparoscopies are
very tiring. The robot has changed that.

The device facilitates operations,
significantly reducing the surgeons’ fatigue.

The surgical robot has been approved by Japan's health ministry for use not just on prostate cancer, but also on stomach and colorectal cancers.

It can also be used in gynecological procedures.

It is now being introduced into various hospitals around the country.

Twenty years before this robot was developed, Japanese hospitals began using American surgical robots.

These robots have been used in various types of operations from those for prostate cancer to heart surgeries.

But doctors in Japan started expressing an interest in developing their own robot.

Given Japan’s sophisticated robotics technology,
we assumed we could develop a new robot.

There was a high-tech company with
a large global share in industrial robots.

We worked with the company
to develop the surgical robot.

A company with over 50 years of experience in making industrial robots started developing Japan's first surgical robot.

But as soon as the development effort began, a major communication gap arose between the doctors and the engineers.

The doctors would say the robot’s arms
didn’t feel sturdy, or that they vibrated.

They’d also say it felt like they were
operating the robot on a boat.

We found it difficult to
understand what they meant.

We made measurements and gathered data
so we could analyze what was happening.

The engineers observed many surgeries to better understand what the doctors needed.

In industry, if one robot malfunctions,
all other units will be halted.

It’s the opposite with the surgical robot.

Even if one arm stops,
the other three must keep working.

This is necessary in order to ensure safety.

After five years of close communication between the doctors and the engineers, the surgical robot was finally complete.

It was made compact enough to fit into Japanese operating rooms.

Japanese technology allowed the developers to minimize the size of the robot without sacrificing its functions.

We wanted to create a robot that’s
easy for Japanese doctors to use.

We also wanted to build it based on the ideas of
Japanese doctors and engineers.

Since the robot is made domestically, it’s easy to tell the developers when we
want improvements. They respond quickly.

That’s another big advantage.

Fujita Health University Professor Uyama Ichiro has been at the forefront of promoting robot-assisted surgery in Japan.

He's leading a new project using the surgical robot.

The project aims to improve the level of surgery around the country.

In order to provide surgeries that results in
few scars and have a low risk of complications, we need to keep promoting robotic surgery.

Generational changes take place,
and novice surgeons must learn new skills.

But they may not always have
capable instructors close by.

Remote learning is therefore very important.

A recent study by the Japan Surgical Society showed that the number of surgeons in the country is declining.

It also found that novice doctors tend to avoid becoming surgeons.

The reasons the novice doctors gave included grueling working conditions and the risk of getting sued over difficult surgeries.

Uyama says he is also concerned about regional inequalities in healthcare access, caused by the concentration of surgeons in urban areas.

This is partly because the latest training
is not available in small towns.

But with a remote learning system,
novice doctors in such places can gain new skills.

Uyama aims to help educate novice doctors and to support them during actual operations through the remote use of the surgical robot.

In order to show that remote surgeries are possible, he decided to do a demonstration.

The team sets up a high-speed connection dedicated to the surgery through which Uyama can control a surgical robot located 30 kilometers away.

Uyama attempts to remove an organ model at the remote location.

The time lag is only 0.025 seconds.

Uyama completes the sutures and other necessary surgical tasks without any problem.

I’m convinced I was able to
do the surgery as if I were on site.

In December 2022, Uyama instructed surgeons by conducting a remote operation during an academic conference.

Surgeons from regional communities eager to gain expertise through remote learning, also tried out the system.

It felt like a usual operation.

The robot has major potential.

Novice doctors can learn
directly from Japan’s top surgeons.

I think that’s the biggest advantage.

Research is also underway on the possibility of wirelessly conducting remote surgery.

This is just like the 5G antennas
installed around the city.

The Kobe University team is working with Japanese companies in an aim to use the expanding 5G network for remote surgery.

A 5G connection will make dedicated lines unnecessary, enabling hospitals to connect to each other at a low cost.

Most technological issues have been resolved.

We still need to improve safety measures,
such as how to respond when connections are lost.

We aim to do remote surgeries
on patients on islands or ships.

We hope to enable that using
the robot and communication technology.

How do you think that the surgical robot, how do you think it will be used in the future and what other possibilities do you see for it?

Doctors who do operations
must learn to do robotic surgery.

I think robots will be playing
a bigger role in healthcare.

We’ll probably see more new robots
and medical devices becoming available.

They will continue to expand
the capabilities of humans.

It's just been such a great pleasure...Thank you so much.

The surgical robots development encompasses many years of experience and wisdom of both surgeons and engineers.

And as a technology advances, enabling more surgeries to be assisted or done remotely, it's likely that many more patients will be able to receive high quality health care.

And we are gradually getting close to a future where that's possible.

Today on the program, we have one of the most popular trainers here in Japan, Dr. Tanimoto.

And he's going to show us some easy, simple bodyweight exercises.

Thank you for having me.

Tanimoto appears regularly on Japanese TV shows, offering tips for building the muscles.

He will show us three quick and easy exercises.

Let's start with a stretch.

Let’s first loosen the shoulders and back.

This exercise will make you feel lighter.

Clasp your hands together
and push them out in front of you.

Good. Your shoulders will come forward,
helping to round your back.

This even feels great like this.

Now, flip your hands and
bring your arms up above your head.

Reach higher so that your back is arched.

Next, lower your arms while
reaching as far back as possible.

Fantastic.

This feels good. Let’s do it again.

This is my favorite exercise.

Round your back, flip your hands,
then reach up high.

Reach back as you lower your arms.

So amazing. It's like I'm having a massage.

This feels almost like I'm releasing that whole area.

It’s relaxing, isn’t it?

There’s a type of animal that uses its
back muscles a lot and is very flexible.

This animal makes a movement
that is similar to what we just did.

Which animal is that?

Can you tell meow?

I have a cat.

Cats stretch their backs like this.

Exactly exactly.

That’s basically the same as this.

I noticed that my cats do it all the time.

1.

Flip, and 2.

And 3. Feels good meow!

And down from the outside.

Then let it down. Okay. That's fantastic.

Next is a work out that uses furniture for support.

To avoid falling, support your body
by putting your hands on a table.

Step as far forward as you can, keeping your shin vertical
so that your knee doesn’t stick out.

Then kneel on the floor.

Now, stand up, using your
back leg for support as well.

If it’s hard, come closer to the table and
use your hands to support and push yourself up.

Use a form that feels manageable.

When you step forward, try to stretch your back leg as well.

Step firmly, and back. Isn’t this fun?

No, It's becoming harder and harder.

You’re enjoying this, right?

Lots of positive burning pain is going on.

I know because it's really it's amazing how many different muscles you're using also with this one as well.

Finally, an aerobic exercise.

It can be done in your living room.

Walk in place, exaggerating your
leg and arm movements.

This is easy.
It’s the kind of exercise you like, Erica.

Much easier than lunge.

If you want to make it harder, walk faster.

To make it even harder,
keep at least one foot in the air.

In other words, run in place.

You can adjust the difficulty depending on your physical condition.

Even at walking speed, this exercise can help to refresh you.

So how long would you recommend we do this?

As much as you want, whenever you like.

You can make it hard or easy,
while doing it at a comfortable pace.

You don’t have to set aside time
especially for this.

You can do it while waiting for the
dishwasher or microwave to finish.

Or you can do it for 10 or
20 seconds while watching TV.

You can effectively use little chunks
of extra time that you have.

Thank you so much, Dr. Tanimoto.

Please try them!

Thank you very much.