# Review of Advanced Medical Telerobots
## 1 Introduction
### The Motivations for Telebotics in Medicine  
The above-mentioned efforts illustrate the high interest in telerobotic systems for revolutionizing the field of medicine. The ultimate goal of teleoperation, especially in medicine, is realizing the perfect \"telepresence\", a concept popularized in the robotic community by [PERSON] in 1995 [PERSON] (1995). Telepresence is the sense of being and acting at a location other than where one is. Even if this may be seen as an unreachable objective in a short time frame (especially due to the complexity of robotized perception), the research and development in this field have been actively followed by many researchers and industries to enhance the existing technology (knowing that robotics-mediated haptics sensation is far from the actual perfect direct touch, in terms of perception) [55]. One of the initial motivations for surgical teleoperation is the need for a long-distance medical operation. At the scale of a country, rural hospitals often lack equipment and experienced surgeons. To investigate the feasibility, in early 2000 some experiments have been performed. In this regard, in 2003, more than 20 telesurgeries were conducted at a distance of 400 km in Ontario, Canada, with a Zeus-TS surgical robot [56]. Two surgeons (one in each hospital) could take the local control of the robot when desired. This successful experience has shown the feasibility and potential to use telerobotic systems for telesurgery in rural and underprivileged areas. At a higher distance, since 2004, the National Aeronautics and Space Administration (NASA) has conducted experiments on remote laparoscopic surgery for astronauts in space conditions, initially with a Zeus robot [57]. The main difficulty, in this case, was a significant time latency. It has been shown that telesurgery performed by an experimented surgeon located on earth was more effective than an on-board surgery conducted by a less expert surgeon on board. Despite these motivating experiments, the current regular practice requires the patient and the surgeon to be in the same hospital (and in most cases the same room). Nonetheless, telesurgery has the potential to facilitate \"the exchange of medical expertise around the world without requiring physicians to travel.\" This saves time, money, and effort by bringing the remote operating room to the fingertips of the surgeon and vice versa [58]. Teleoperation is also required for medical manipulations in workspaces unreachable by the surgeons' hands. For instance, MRI-guided interventional robotics is an emerging field. MRI technology is a widespread high-quality imaging technology that has shown great potential to be used for real-time visualization of deep soft tissues [59]. However, MRI machines require fixation of the body region in a long and small tube which significantly limits the possibility of conducting a manual operation. Due to the electromagnetic nature of this machine many operational tools and other machines cannot be used. In 2012, [PERSON] et al. demonstrated the feasibility of MRI-guided prostate biopsy using an MRI-compatible teleoperated needle driver module based on piezoelectric motors [60]. In 2013, a solution combining pneumatic and piezoelectric actuation was introduced [61]. A recent review on this topic can be found in [62; 63]. Besides surgery, there are several other medical applications of telerobotic systems. In this regard, in Section 2.2, we will introduce telerobotic rehabilitation, which is an emerging field of medical telerobotics. Tele robotic rehabilitation has the potential to transform how remote patients with motor disabilities (such as post-stroke ones) can receive kinesthetic motor therapy over a communication network and possibly when they are at home interacting remotely with a clinician in a hospital [7; 64]. This technology provides an equal opportunity of accessing rehabilitation services, regardless of geographical limitations, and provides patients with an immersive experience of teletherapy and interpersonal interaction.