# Review of Advanced Medical Telerobots
## 4 Conclusions and Future Directions  
Telerobotic technologies have opened new doors to investigate the future of the modern healthcare system when smart and connected infrastructures can address several existing challenges. Tele robotic systems were initially designed to extend human access to remote environments and bypass physical barriers, such as deep water, space, and radiations. With the utilization of modern medical telerobotics, other potentials of this technology have been realized. With the use of this technology, currently, many clinical tasks are possible, which were not realizable before the use of telerobots. In this paper, we discussed several applications of telerobotic technologies, including telerobotic surgery and telerobotic rehabilitation. We have identified sensory augmentation and motor augmentation benefits of intelligent telerobotic systems; when using a sensorized tool, the awareness of the operator (e.g., a surgeon) about a particular task has reached a level beyond human competence, and the resolution of movement control has been significantly improved. These benefits are mainly discussed in the context of telerobotic surgery, for which a successful commercialized example is the da Vinci surgical system. We have also highlighted other medical applications of telerobotic systems, in particular, telerobotic rehabilitation for delivering physical therapy and assessment of patients with motor disabilities at remote locations when patients are at home and clinicians are located at far distances in clinics. We have explained how such technologies have attracted a great deal of interest, especially after the COVID-19 pandemic, due to their power in augmenting the current telemedicine, which relies only on visual and verbal interaction between the clinician and the patient. This paper also discusses the existing challenges about the use of telerobotic systems, including the lack of force feedback in several medical telerobotic technologies due to the challenges associated with instrumentation and stabilization. We have discussed that with the use of advanced instrumentation technologies and intelligent stabilizers, the next generation of medical telerobotic systems can be enabled with force feedback modality. In addition to the above, this paper also investigates other topologies of telerobotic systems when the number of robots involved is more than two resulting in a multilateral architecture. The multilateral architectures can allow for either collaboration between several operators to contact a joint task or can allow collaboration between several remote robotic arms to interact when and if the task cannot be conducted using one follower robotic systems. Another application of multilateral architectures is explained to be expert in the loop training of novice clinicians (such as novice surgeons). The paper highlighted that with the use of advanced architectures, the autonomy of task conduction can be shared between the human operator and the machine intelligence. The concept of autonomy and various levels of autonomy were explained in detail in this paper. Various examples of shared autonomy were introduced, such as when autonomous agents compensate for the natural tremor of the surgeon's hands, or compensate for organ motions, or provide virtual fixtures to generate either a forbidden region or guiding force field to help the surgeon enhance the quality of the outcome. We have also discussed the use of advanced machine learning methods for augmenting the intelligence of surgical robots and sharing various levels of autonomy between the operator and the machine. In the end, we have categorized and discussed more diverse applications of telerobots, which can form the future of telemedicine in modern healthcare. To summarize, this review paper provided and updated a comprehensive analysis of the literature and discussed the challenges and future directions of research and development of this technology.