Kapelica gallery presents the Open Hardware surgical robot in a potential environment for its use on the operating table. © Miha Fras
Are you ready for Open Surgery? Robot designer Frank Kolkman is presenting his surgery DIY robot at the Art&Science Kapelica gallery in Ljubljana, Slovenia, sparking the debate on opening up the extremely regulated medical world.
For many years, communities of mainly uninsured Americans have been using YouTube to share videos showing them performing medical or dental hacks on themselves. This phenomenon inspired Dutch designer Frank Kolkman, who in 2015 started to build a DIY surgical robot. Kolkman bought surgical pieces in China, hacked some parts, transformed his kitchen into a DIY surgery lab and customized an Open Surgery robot with laser-cut and 3D printed pieces.
Jurij Krpan, curator at Galerija Kapelica, explains his interest in presenting Frank Kolkman’s robot:
“Considering the medicine industry and pharmaceutical corporations that build their wealth by exploiting sick people and widen the gap between those who can afford health care and those who cannot, I found Frank Kolkman’s Open Surgery to be an intelligent speculative project, which raises the question of a possible alternative to the biopolitics of capitalist governance.”
Jurij Krpan, Galerija Kapelica
Kolkman says that during the starting phase of the project, he “somewhat naively intended the project to become open source”, taking great care to avoid using any parts that were recognizable in commercial medical robots and developing his own mechanisms. He then realized that the world of surgical machines was extremely regulated. He decided to remain cautious and dedicate more time to investigating the legal aspects. Meanwhile, surgeons welcome his initiative.
“I’ve met various professional surgeons, mainly through doing exhibitions and talks, and so far all of their responses have been quite positive (after the initial skepticism, of course), Frank Kolkman explains. Most of them have expressed interest to be updated about the project’s progress, and some have offered their assistance when needed. Already very early in the project, after reaching out to many different professionals in the field, I found that doctors and surgeons are actually much easier to talk to about these uncommon ideas than engineers or designers of medical devices. When it comes to medical devices, approvals, regulations and certificates, surgeons are much less restricted in their thinking than engineers. I’m not sure why, but my theory is that because surgeons are already used to being directly responsible for their patients (whereas a designer, engineer or even a hospital director, has at most a secondary responsibility), they are more willing to accept means-to-an-end solutions if they will get the job done under particular circumstances.”
The surgical robot in motion:
Telesurgery and open science
One early motivation for Kolkman was the fascinating development of robotic surgery. Another big inspiration was a 2014 Wired article explaining the medical potential of the da Vinci Surgical System, in which a robot performs long and complicated procedures with super human precision and dexterity—all the while decreasing patient trauma and providing a more comfortable experience for the surgeon.
With a price tag of up to $2 million, however, surgical robots also represent large capital investments for hospitals. And while new technologies are expanding the range of treatment options available to patients, they do so by replacing lower-cost options with higher-cost services. It goes against the logic of reducing costs and initiating the shift from manual to robotic precision, while also reducing opportunities for democratization in countries where health care systems have few resources.
Kolkman’s objective in developing DIY robots was simply pragmatic. Many surgeons dream of surgical robots for outreach surgery, in conflict zones or health care deserts. Kolkman says one machine is worth mentioning, the RAVEN II Surgical Robot, developed with funding from the U.S. military to create a portable telesurgery device for battlefield operations or in space.
All the software used to control the RAVEN II has been made open source and became very useful to researchers in universities to test new ideas and software approaches to robotic surgery. But its $200,000 price is out of reach for most medical hacker communities. By attempting to build a DIY surgical robot for around $5000, Kolkman is now entirely committed to this disruptive technology.
Open hardware approach
The challenge was to design a surgical robot that would theoretically be capable of performing laparoscopic surgery (a minimally invasive surgery done through small incisions) as witnessed in the da Vinci system. The key element in laparoscopic surgery is the laparoscope, a long fiber optic cable system which allows viewing of the affected area by snaking the cable from a more distant, but more easily accessible location. In this procedure, the surgeon can insert 5–10 mm diameter instruments (pliers, scissors, clip applier) into the abdomen through trocars (hollow tubes with a seal to prevent CO2 leakage).
Kolkman ordered a large part of the necessary specialized equipment directly from the Chinese manufacturers on Alibaba, as well as peripheral devices required for surgery, such as monitoring equipment, camera modules and CO2 insufflation pumps. A household kitchen oven preset to 160ºC for 4 hours was his simple alternative to an autoclave, and for some plastic parts he used a microwave. Designing the mechanical system, with its multiple iterations, was the most complicated part of the process. Kolkman ended up with a design that uses four 3D printed parts controlled by two DC servomotors rotating around a central pivot. The electronics used to control the robots are sourced from designs used in the usual 3D printer communities, developed in Processing.
Although the system is currently operational, no human surgical operations have been tested. Moreover, its designer recommends to not engage in surgery too lightly with this type of DIY machine! Much more research and development, not to mention serious training, is required before it will be ready for practical use.
“The main goal of the project was not to develop an immediately ‘operational’ machine. It was meant more as an experiment to see how plausible the idea of creating a DIY surgical robot would be.»
Frank Kolkman, designer
But according to Kolkman, a community of makers who bring the same amount of attention and dedication to building surgical tools as they do to designing 3D printers and CNC machines these days, could eventually make DIY surgery equipment accessible to everyone.
For Jurij Krpan, “the functional prototype of the laparoscopic surgical robot in this current phase is still somewhat clumsy, but I strongly believe that its political potential can attract other open source activists to engage in developing other possible scenarios. Since the contemporary medicine industry and pharmaceutical companies are primarily interested in making money, we can no longer ignore the ethical issue. It is all the more urgent for them to rethink their social responsibility! Thinking and speculating about the future of the Open Surgery project can be the perfect trigger for public debate.”
“Open Surgery” exhibition at Galerija Kapelica (Ljubljana, Slovenia), March 1-15