# Development of Robot-Assisted Untact Swab Sampling System for Upper Respiratory Disease
## 1 Introduction  
Due to the global epidemic of respiratory diseases such as Coronavirus Disease 2019 (COVID-19), interest in so-called \"untact technology\" is on the rise. As one type of untact technology, a master-slave medical robotic system can be utilized in telemedical operations for noncontact diagnosis and treatment. Telerobotic systems for use in the medical field have mainly been studied for application in minimally invasive surgery (MIS) and natural orifice transluminal endoscopic surgery (NOTES) [1]. In comparison to conventional laparoscopic/endoscopic surgery, these robotic systems enable more accurate and precise manipulations by scaling or filtering the operator's motions during a surgical procedure [2; 3]. Telerobotic operation procedures have also been exploited to avoid the exposure of medical staff to radiation during _X_-ray or computed tomography (CT) imaging. In particular, studies using master-slave robotic systems have been actively conducted in the context of surgeries performed under fluoroscopic guidance, such as catheter driving for vascular interventional procedures [4; 5]. A remote needle insertion robot inside a CT scanner has also been developed for spinal intervention [6]. Robot-assisted tele-echography is a representative class of master-slave medical robotic systems. Ultrasound (US) imaging has many advantages, such as being noninvasive and harmless to the human body and enabling immediate diagnosis. However, different medical experts are needed for each area of diagnosis, and the diagnostic results are highly dependent on the medical staff's experience and skill [7]. Robotic tele-echography systems enable US experts in urban hospitals to control the motion of US probes through robotic manipulation and diagnose patients in remote areas without the need to travel long distances [8; 9]. We are currently attempting to apply a master-slave robotic system for remote sample collection for the diagnosis of respiratory disease. To date, respiratory specimen collection has been performed only offline, meaning that medical staff are required to be in close contact with the patient for such an examination. For sampling for the high infective diseases, basic personal protective equipment (PPE) including mask, goggle, full-body protective clothing, and gloves should be worn to protect the medical staff from cross-infection. However, PPE poses a number of troubles for medical staff, such as the risk of infection when replacing it for each patient, heat stress, time consuming about 20 to 30 min for wearing and taking off, and restricted movement, etc. Therefore, the necessity for non-face-to-face sampling is becoming urgent as these contact sampling issues and the rapid spread and highly infectious nature of respiratory diseases. Viral transmission is known to occur through close contact and via respiratory droplets produced by people who are suspected to be infected [10]. Since coughing or sneezing of a patient during sample collection can directly result in the infection of an examiner working in front of the patient, high-level PPE (higher than Level D) is strongly recommended for protection during such a procedure. However, wearing PPE can impair visibility by face shields, reduce dexterity due to multiple thick glove layers, and cause heat stress and dehydration [11]. Moreover, in a pandemic situation where a large number of suspected patients need to be screened for infection, during frequent changing of the disposable PPE, or if PPE is lacking, medical staff may be at a greater risk of infection. Especially in the case of COVID-19, since many patients without any symptoms nevertheless have a high potential for transmission [12], the accuracy of the initial diagnosis is very important. In this regard, robot-assisted sample collection is expected to play an important role in realizing \"untact\" and \"accurate\" respiratory specimen sampling.