With its Soloassist II robotic arm, Regensburg-based AKTORmed GmbH is making it easier for surgeons in hospitals to work with endoscopes. During minimally invasive procedures, the surgical camera can now be guided using voice recognition. This is a considerable improvement for the surgeon, but the underlying software places similarly high demands on the hardware, i.e. the processor, memory and interfaces. A Kontron motherboard, i.e. a full-value embedded industrial computer, is used for this purpose.
In 2017, more than seven million people were operated on in Germany, according to the Federal Statistical Office (in October 2018). Many operations have been minimally invasive since the 1980s, such as the majority of the approximately 200,000 hernia operations performed on men in Germany. Minimally invasive procedures are also known as “keyhole surgery”. In these procedures, the instruments and the endoscope, a miniature camera with a diameter of 5 to 10 millimetres, are guided to the surgical site via two tiny incisions. The image is displayed on an external monitor and shows the surgeon the surgical site. In the clinic, this means that for many operations, a second doctor must be present alongside the surgeon to guide the camera during surgery. Only for very simple operations is it sufficient for one doctor to adjust the camera himself.
THE GREAT TREMOR: THE HAND-HELD ENDOSCOPIC GUIDE
In the majority of minimally invasive procedures, the endoscope is still guided completely handheld. In practice, this has serious downsides, which are exacerbated by technological developments: High-resolution cameras produce images in 4K or even 8K quality, and even 3D images are now possible. For many applications based on this, however, people do not have the steady hand required to hold the endoscope, which can weigh up to 600 grams, for several minutes in uncomfortable positions. The smallest trembling movements are amplified in the magnified reproduction on high-resolution screens to such an extent that they make precise work more difficult than easier. In addition, movements of the entire body, for example to make it easier for a colleague to access the operating table, also cause the hand holding the endoscope to move despite all efforts. In addition, communication problems often make it difficult to work effectively and precisely with the endoscope if, for example, it is not entirely clear between the surgeon and his colleague at the camera how far or in which direction the camera should be moved.
STEADY IN EVERY OPERATING POSITION: THE ROBOTIC ARM
The robotic arm developed by AKTORmed, which guides the endoscope, has already made things much easier: it can be flexibly and manually guided with three different degrees of freedom and fixed in the correct position. This made it possible to work with an absolutely steady image, at least in a fixed position. The joystick also simplified guidance, so that in some cases a second doctor guiding the endoscope could be dispensed with completely. Given the chronic shortage of surgeons in many clinics, this is an advantage that should not be underestimated. AKTORmed’s customers now include hospitals in Germany as well as clinics all over the world. AKTORmed is a manufacturer for the development and distribution of medical devices, which was founded in Regensburg in 2005. With 16 employees, mainly engineers, electrical technicians and mechatronics engineers, the SOLOASSIST robotic arm is manufactured and distributed and new products are developed.
RELIABLE VOICE CONTROL REQUIRES HIGH COMPUTING POWER
The robotic arm can be used even more flexibly if it can respond directly to the surgeon’s voice commands. This allows the operating surgeon to steer the camera in the required direction with just a few simple commands, leaving both hands free for the procedure. In contrast to the joystick, however, speech recognition and processing requires significantly more computing and memory power. The developers at AKTORmed therefore decided to use an industrial PC that meets these requirements and also fulfills the strict criteria for devices used in operating theatres. In addition to the purely technical features, there were other reasons for AKTORmed to choose Kontron: Since innovation cycles in medical technology are long and procurement projects can take several years, the components of the Soloassist must have a long-term availability of at least seven to ten years, as offered by Kontron for its industrial boards. This requirement alone eliminated numerous board manufacturers at an early stage of the selection process. Furthermore, there was a need to be able to access a USB bus on the board; this feature was also not available from many of Kontron’s competitors, so the decision process in 2015 was based on Kontron. AKTORmed was also impressed by the commitment of Kontron’s partner Aaronn, who, together with Kontron, can meet all requirements in terms of service and support.
KONTRON INDUSTRIAL COMPUTER MOTHERBOARD AS THE CENTERPIECE
Image: AKTORmed relies on a proven industrial PC from Kontron, the Mini-ITX motherboard E38, for its Soloassist II.
The motherboard deployed is the Kontron Mini-ITX Board E38 with Intel Atom® processor of the E3800 series, which has sufficient memory and numerous interfaces required in the industry. A bootable flash memory is available for the operating system, while application data is stored via SSD storage. By mid-2019, after three years in clinical use, AKTORmed had not recorded any single motherboard failure. This is one of the reasons why the board stands out from the wide range of boards available for consumer products.
The high level of reliability also guarantees patient safety: The robotic arm is safeguarded against uncontrolled movements via algorithms. This guarantees that the endoscope does not injure the patient under any circumstances.
Robert Geiger, Managing Director, AKTORmed: “Availability, safety and reliability play a particularly important role in medical technology; if a component does not work as it should, the consequences can be fatal. Our decision to choose Kontron, an experienced supplier of industrial computers, was therefore absolutely right. The Soloassist runs absolutely reliable and error-free with Kontron’s industrial computers. Thanks to the configuration services provided by Kontron and its partner Aaronn, we can concentrate fully on the development of our robot arm. In international sales, Kontron’s experience in the global markets helps us to quickly pass the necessary, often complex approval procedures for medical devices. With Kontron, we also see ourselves well equipped for the future, when topics such as natural language recognition or artificial intelligence find their way into the control of our robotic arm.” Kontron’s experience with demanding customers around the world is also proving to be an advantage for AKTORmed. As approvals for medical devices are generally complex, lengthy and different in every country, AKTORmed already has access to many of the necessary certifications, such as CE, and confirmations and tests for electromagnetic compatibility (EMC), electrical safety and the radio-specific requirements of the US Federal Communications Commission (FCC). Long-term availability also pays off here, because if something changes in the approved component, a costly re-certification would be necessary for the next delivery.
KONTRON PARTNER AARONN ENSURES PRECISE DELIVERY
The complete software for the voice control of the Soloassist II now runs smoothly on the Kontron motherboard under Windows 7 Embedded. Kontron partner Aaronn adds its services to the reliable, secure, and long-term available Kontron product: Boards are delivered by Aaronn to AKTORmed ready for installation. Beforehand, Aaronn adds RAM, a fan, and the SSD memory, then the software image is installed and functional tests are carried out. Stefan Lobmeier, Product Manager Motherboards & SBC at Kontron: “Kontron specializes in industrial computers that meet the requirements of our demanding customers regarding reliability, security, and availability, especially in the healthcare sector. With our partner Aaronn, we can provide customers with individual support and meet their specific requirements.”
KONTRON ALSO THE RIGHT PARTNER FOR AI TECHNOLOGY
Soloassist II – Kontron is always there in the background. Kontron will also play a role in the further development of the robotic arm. AKTORmed is already thinking about artificial intelligence applications, for example: The endoscope could independently find the surgical area to be treated, for example an organ, and position itself. It is also conceivable that certain surgical procedures could be saved using machine learning and the robotic arm could reposition the endoscope itself accordingly.
With motherboards from Kontron, AKTORMed is well-prepared for the future and patients and doctors alike will benefit from advances in embedded computer technology.
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