Robotic+Operation+2

Robotic Technology in SOCIAL IMPACTS in our Society.... //Research by David Torrefiel//

= = = = = = = = = = = = toc = = = = =**Introduction:**=
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Prostate cancer robotic operation:
Robotic surgery is a growing trend in treating prostate cancer. The number of cases has increased sevenfold in the past four years, from 10,000 in 2004 to a projected 70,000 in 2008, according to Intuitive Surgical Inc., the creators of the robotic device. The advantages of robotics -- fewer side effects and quicker recovery times in many patients -- have led to increased use for other surgeries, including hysterectomy, kidney cancer and some heart procedures. **ATLANTA, Georgia (CNN)** -- As 3D images illuminate the viewfinder, a joystick delicately maneuvers a pair of robotic arms. It may sound like a video game, but Dr. Nikhil Shah is actually performing cancer surgery. "At first, men think we hook up a robot and then go get some coffee, but the reality is the robot arms are a tool that I control, just like a scalpel, " said Shah, who has performed more than 600 robotic prostatectomies at St. Joseph Hospital in Atlanta, Georgia.

In the June, 2001 issue of the //Annals of Surgery//, encouraging results have been reported from the first pilot study in the United States aimed at evaluating robotically-assisted coronary artery bypass surgery. One year after having the robotic bypass performed, all 19 patients included in the study remained free of complications and of angina.
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What is robotic heart surgery?
Robotically-assisted heart surgery is the latest advance in trying to move open heart surgical procedures to the category of minimally invasive surgery - that is, to minimize the extent and the trauma of cardiac surgery as much as possible. Most minimally invasive surgery is performed by passing an endoscope (a small tube containing an advanced optical system) through a tiny incision. Surgical instruments are then passed either through the endoscope tube itself, or through an additional tiny incision. While visualizing the surgical area through the endoscope, the surgeon manipulates the surgical instruments to complete the operation. || Such endoscopic surgery works well for several types of operations (such as gallbladder removal and knee repairs,) where the part of the body to be operated upon is motionless, and the surgical maneuvers that need to be performed are relatively simple. But moving the surgical instruments manually during endoscopic surgery can be difficult - the length of the instruments is far longer than normal, and the "feel" of these long instruments is non-intuitive to the surgeon. Long instruments also exaggerate normal hand tremors. Thus, endoscopic surgery has achieved only limited success in more complicated operations such as heart surgery, where the heart is beating and the necessary surgical maneuvers tend to be complex. //Robotically-assisted endoscopic heart surgery// is aimed at making endoscopic heart operations feasible. With this technology, the surgeon manipulates the surgical instruments with the help of a computer. An endoscope is passed through a tiny incision in the chest wall, and two surgical instruments are passed through additional tiny incisions. The surgeon views the image provided by the endoscope on a computer screen. Instead of manipulating the surgical instruments directly, the surgeon manipulates them via a computer console - similar to manipulating a gamepad to play Ninetendo. The computer interprets the surgeon's hand movements and causes the surgical instruments to respond accordingly. This system addresses the major disadvantages to moving the long surgical instruments manually - computer control of the surgical instruments essentially eliminates the tremor effect, and also the non-intuitive feel of maneuvering such instruments. While it takes special training to become adept at using robotically-assisted instruments, most surgeons who have had such training report that they feel quite comfortable maneuvering surgical instruments via a console instead of directly.

How is robotic heart surgery being used?
Much of the early work with robotically-assisted heart surgery has been with bypass surgery. So far, this technique has been limited to single bypass grafts in the left anterior descending coronary artery (the LAD). The LAD is located on the front of the heart, and therefore is relatively accessible. It is predicted that with advances in technology, multiple grafts with robotic assistance will be possible, at virtually any location on the heart. Early efforts have been made at extending robotically assisted surgery to other kinds of heart surgery. Robotic procedures have been successfully performed, for instance, in mitral valve repair, in repairing atrial septal defects (ASD,) and in repairing patent ductus arteriosus (PDA.) It is expected that as experience and technology advance, robotic procedures will be applied to most other forms of heart surgery. Two robotic surgical systems are currently available, both developed and manufactured in the U.S. However, while both robotic systems have been approved for use in Europe, both remain experimental in the United States. It is not likely they will be approved in the U.S. until randomized clinical trials are completed that convincingly demonstrate their safety and efficacy.

What are the advantages of robotic heart surgery?
The chief advantage of such surgery is that the incisions that are made are tiny, and therefore recovery from surgery is extremely quick. Rapid recovery from cardiac surgery is not only better for the patient, but it is less expensive for society.

What are the disadvantages of robotic heart surgery?
The chief disadvantage at this point is that the technology is new, and (despite early encouraging reports) is still evolving. Its efficacy and safety have not yet been proven sufficiently to allow the FDA to approve it for widespread use. Another disadvantage is the expense of the robotic systems. They cost between $750,000 and $1,000,000, and it is unlikely that most hospitals will be able to afford purchasing the robotic systems for operations they are performing "just fine" today without the robotic equipment. The bottom line: it is likely to be several years before robotic heart surgery is widely available.

What controversies surround robotic heart surgery?
There are at least two that come to mind. 1) Not all surgeons think robotic surgery is a great idea. While most agree that robotic surgery is feasible, many question whether it should be pursued at all. They cite the expense of the equipment, and the success they are currently having with today's methods of doing surgery. Such arguments against new technology date back at least to Gutenberg, of course, and are easy to counter. One suspects that those surgeons betraying a Luddite opinion might have other fears in mind - such as a complete disruption of the practice of surgery. It is easy to ask why, for instance, if a surgeon can perform a heart operation while sitting at a console 15 feet away from the patient, then why couldn't that surgeon perform the same operation while sitting 1500 miles away from the patient? In other words, competition for patients would occur on a global scale instead of a local scale. (And //everyone// could be operated upon by only the very best surgeons.) If such a notion does not disrupt the practice of surgery, DrRich doesn't know what does. 2) Insurers and the government (the two entities that pay for most of health care) understand something that most of the public does not, to wit: the introduction of any successful minimally invasive procedure - while it may reduce the expense of caring for an individual - //always// increases the total expenditures within the health care system. This is because when a minimally invasive procedure is available, suddenly the number of patients who "need" to have that procedure expands exponentially. A good example is endoscopic gallbladder surgery. In the past, it was extremely difficult to recover from gallbladder surgery. Such surgery required extensive hospital stays, and resulted in significant and protracted misery on the part of the patient. But with minimally invasive gallbladder surgery recovery is rapid and suffering is minimized. Most people go home the same day or the next day (and as a result the expense of the procedure for each individual is far less than it used to be.) //But// precisely because the surgery is now so benign, far more people (people who, in the old days, would reasonably conclude that suffering in relative silence was the wisest course of action) are choosing surgery. The total cost to the health care system has exploded. The same, of course, can be predicted to happen when robotic heart surgery becomes widely available. As a result, there will be a tension between innovative companies and surgeons on one hand, and insurers, regulators, and Luddite surgeons on the other. Robotic heart surgery will not be accepted with open arms by everybody, even if its efficacy and safety are proven beyond a shadow of a doubt.

Studies:
Studies have shown some benefits of robotically performed prostatectomy over a traditional open prostatectomy -- but the data aren't overwhelming. One clear advantage, Shah said, is the reduced blood loss. Also, robotic surgeries are considered minimally invasive. Instead of a 4½-inch incision, robotics patients have six dime-sized incisions in the abdomen. Some patients experience only minimal pain and are in the hospital less than 24 hours. The surgeon sits about 10 feet away from the patient and can view the procedure either through a three-dimensional viewer in the control console or on large, color monitors in the operating room. An articulating robotic wrist re-creates movements made by the surgeon sitting at the control console. The device, known as the da Vinci robot, initially was developed for doing heart bypass surgery but now is being used much more for prostate surgery.

The findings come as robotic surgery devices:
//Which cost about **$1.5 million each**, are popping up in small and large hospitals around the state and nation.//


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Testimonial
Patients are requesting it like never before," he said. "The fact that less blood is lost and a short hospital stay is appealing for some patients." Tony Pouncey, 60, is one of those patients. His prostate cancer was diagnosed earlier this year. "I freaked out a bit, got on the Internet, and called around to find out what was out there for me," he said. For Pouncey, the size of the incision was the deciding factor. "I do a lot of exercise. I wanted to be back on my feet as quick as possible." He had a robotic prostatectomy last month and is now cancer free. "I feel great," he said. "I was amazed at what little pain I had. I was at home and even walked my dog the very next day." Shah said Pouncey's experience is more the norm than the exception, but points out not everyone qualifies for robotic surgery. Patients with excess abdominal fat and those with cancer that is not localized would not be ideal candidates. "It's important to talk to your doctor to figure out what is the best way to treat your individual case. **The surgery can cost up to $15,000.** It's also not always covered by insurance. Medicare leaves it up to regional offices to determine coverage case by case.

Touting experience
Matthew Johnson, the St. Luke's urologist who performed the first procedure, said a doctor needs to perform at least 150 robotic procedures before getting off the learning curve. Had the study looked at surgeons who had done at least that many cases, he said, the impotence and incontinence rates would be similar or better for robotic. He said he believed St. Luke's claim of fewer side effects was a fair statement. "We have a dedicated team of robotic surgeons and two robots working all the time," he said. However, he warned that several hospitals in smaller cities around the state now have robots and do not have a lot of experience with the devices. "You better know who your surgeon is," he said. Other centers, such as UW Hospital in Madison, don't claim that robotic surgery is superior in reducing erectile dysfunction and incontinence, instead stressing more proven benefits such as less pain, less blood loss and a shorter hospital stay. Cancer control, continence and sexual potency are roughly equivalent between the two techniques at UW, said David Jarrard, a professor of urology and head of urologic oncology. One big benefit with robotic surgery is that it provides a much better view for the surgeon because there is less bleeding and the magnification is 10X, compared with 4X for open surgery, said Jarrard, who has done about 600 open procedures and 500 robotic ones. "It allows you to zoom in very closely on the tissue," he said. What is needed, he said, is a large, rigorous clinical trial comparing the two procedures. However, because most men would not agree to be randomized into an open surgery arm of a trial, such a study likely will never be done, he said.

Impact of Robotic Surgery
Robots often must achieve high speed to improve functionality and productivity. Such speed may, however, cause higher internal or impact forces upon contact, thus increasing the risk of damage to motors, gears, and other parts. Furthermore, robots are composed of various mechanisms depending on their applications, and their structural strengths will vary from moment to moment according to the robot’s changing configurations or postures. Parts damaged by external force will vary depending on construction, configuration, and movement. There is always a possibility that some unexpected parts are damaged due to stress concentration or the propagation of impact waves during robotic motion. To prevent such damage, it is important to detect and mitigate impact forces that propagate among structural components. In most cases, sensors are used to detect impact forces, and thus the risk of structural damage. Sensors, however, are limited in detecting impact only to parts they measure. Accelerometers are often used in measuring shock waves, but acceleration data cannot be used directly to evaluate structural risk since the relationship between acceleration and impact force differs for different materials. Although some methods employ force sensors, the measured data is not reliable since calibration methods against dynamic loads remain unestablished. Dynamic loads can only be measured precisely using momentum change of the impacting body. Sensors and amplifiers have measurement limitations against response periods, so robot may undergo high-frequency shock that is undetected. Given these considerations, we propose a sensorfree robot having a numerical model of its own mechanism and thus capable of predicting impact forces upon contact with another body based on rapid finite element analysis.

We investigated the possibility of constructing an impact force prediction system for robotic mechanisms, by developing a scheme to analyze shock waves occurring during robotic motion at low computational cost. We also tested its validity by comparing the results with experiments. To stabilize time integration and lower computational cost, we used linear Timoshenko beam elements, which have a low number of dimensions and few degrees of freedom (DOF), to model robots. Although linear Timoshenko beam elements use linear interpolation as a displacement function and thus have low accuracy, highly accurate elastic solutions are obtained by a minimum number of finite elements by treating two elements as a single subset element and placing its stress evaluation point at a location corresponding to the numerical integration point of a Bernoulli-Euler beam element. Finite elements generally place the mass at nodes, causing the mass at constrained points to be neglected. We coped with this problem by concentrating the mass of subset elements at nodes at centers of gravity. To treat contact with another object, we used gap elements. Integrating these techniques, we constructed an internal force distribution analysis scheme for a robotic mechanism, including its contact with another object, and studied the validity of impact force analysis by comparison with experimental results. We then applied the scheme to analyze impact forces occurring during “bipedal motion” in a leg consisting of stiffness varying members.

=Economic growth:= If you have read the articles entitled Robotic Nation, Robots in 2015 and Manna, and if you have looked at the many robotic news items on this page, then you may be coming to a new realization. We are standing right now on the threshold of the robotic era. Once robots start arriving in the job market in significant numbers -- something that we will see happening within a decade or so -- they have the potential to dramatically change the world economy. At least 50 percent of the people working in the American job market today are working in people-powered industries like fast-food restaurants (McDonald's, Burger King, Wendy's, etc.), retail stores (Wal-Mart, Home Depot, Target, Toys "R" Us, etc.), delivery companies (the post office, Fedex, UPS, etc.), construction, airlines, amusement parks, hotels and motels, warehousing and so on. All of these jobs are prime targets for robotic replacement. In 2003 we are seeing the deployment of automated checkout lines in stores all across the U.S. This is the leading edge of the robotic revolution in retail. By 2015 we will start to see voice-recognizing robots helping customers in these stores, inventory-shelving robots putting the products out, cleaning robots sweeping the floors and the parking lots, cart robots bringing the shopping carts back into the store.... Robots will be moving in to make the completely automated retail store a reality in a 2020 time frame. Companies like Wal-mart, K-Mart, Target, Home Depot, Lowes, BJ's, Sam's Club, Toys R Us, Sears, J.C. Penny's, Barnes and Noble, Borders, Best Buy, Circuit City, Office Max, Staples, Office Depot, Kroger's, Winn-Dixie, Pet Depot, etc. will all switch to robots at approximately the same time. They will dump 10 million or so workers onto the unemployment rolls at approximately the same time. Other industries like fast food, construction, transportation, warehousing, etc. will be automating as well, dumping millions more. The unemployment rate during this period of time could be remarkable. Even if you assume that the economy reconfigures rapidly and creates new jobs for all of these displaced workers, it will not do so instantaneously. There will be a year or more of turmoil for each employee as the economy invents the job and the employee retrains to fill it. More likely, the economy will not be able to absorb all of these displaced workers. The economy has been creating millions and millions of low-paying, no-benefits, service-sector jobs for the last 40 years. These jobs are perfect for robotic replacement. There is no reason to expect that the economy will suddenly figure out a way to create high-paying, exciting, fulfilling jobs for these tens of millions of people displaced by robots. If the economy could do that, it would be doing it now. In other words, The first wave of robots has the potential to make things very uncomfortable for the American economy. In the 2020 time frame, the rate of economic change will be startling. At the very least it will be a time of intense flux and employment turmoil. The question that I would like to pose in this article is a simple one: How are we, as a society, going to respond to this robotic revolution? If we handle it properly, the arrival of robots could be an incredibly beneficial event for human beings. If we do not handle it properly, we will end up with millions of unemployed people and a severe economic downturn that will benefit no one. Can we modify the American economy now to prevent this downturn? Are there things that we can do today to smooth the transition to the robotic nation?

The thing that you notice in this diagram is how important people are to this system. People are where all the money comes from and where all the money goes. When money comes into a corporation, its original source (even if it has passed through several corporations along the way) is a person who spent money. When money leaves a corporation, eventually it pays a person in the form of a wage, a dividend or a benefit. One thing that has been happening in the economy for quite some time is a __ concentration of wealth __. To put the concentration of wealth into perspective, you can look at a report like the Census Bureau's //Money Income in the United States//. This report shows that: In other words, the richest 20% of the people in the United States get half the income. The other 80% get the other half. In the 1960s, the split was closer to 60/40, with 80% of the population making 60% of the income, and the richest 20% of the population making 40%. Between 1960 and 2000, the income split has gone from 60/40 to 50/50.
 * 80 percent of the households in America make 50.6 percent of all the income in America.
 * The richest 20 percent of the households, on the other hand, make 49.4% of the income.



**In 1960, the wealthiest 20 percent of the U.S. population took home 40 percent of the nation's income. By 2000 the wealthiest 20 percent took home 50 percent. In the future the process accelerates.** We see the reason for this trend regularly in the news. CEO and executive salaries are rising at a startling pace. The average CEO of a large corporation now makes between $10 million and $20 million per year. Since 1980, CEO salaries have risen by a factor of 10, and that same trend is increasing all executive compensation. William McDonough, president of the New York Federal Reserve Bank, notes: "I find nothing in economic theory that justifies this development... I can assure you that we CEOs of today are not 10 times better than those of 20 years ago. At the same time, employee wages are stagnant. The minimum wage has not risen __ since 1997 __. Since the minimum wage acts as a foundation on which most other wage scales are based, we are all affected. As a result, sixty percent of Americans make less than $14 per hour today. In her book //The Divine Right of Capital//, Marjorie Kelly describes the situation this way: The wealthiest 10 percent of households own about half of all stock -- so that minority has a virtual economic majority.... Because corporate revenues represent a bulk of GDP, and the wealthiest own the bulk of corporate equity, running corporations to serve stockholders means running the economy to benefit the wealthy. You can see the level of economic power held by the wealthy in today's society, and the reasons for wage stagnation for workers, in this brief excerpt from the book __ Fast Food Nation __ by Eric Schlosser: The fast food industry pays the minimum wage to a higher proportion of its workers than any other American industry. Consequently, a low minimum wage has long been a crucial part the fast food industry's business plan. Between 1968 and 1990, the years when the fast food chains expanded at their fastest rate, the real value of the U.S. minimum wage fell by almost 40 percent. In the late 1990s, the real value of the U.S. minimum wage still remained about 27 percent lower than it was in the late 1960s. Nevertheless, the National Restaurant Association (NRA) has vehemently opposed any rise in the minimum wage at the federal, state or local level [minimum wage has been $5.15 __ since 1997 __]. About 60 large fast food companies -- including Jack in the Box, Wendy's, Chevy's, and Red Lobster -- have backed Congressional legislation that would essentially eliminate the federal minimum wage by allowing states to disregard it. Pete Meersman, the president of the Colorado Restaurant Association, advocates creating a federal guest worker program to import low-wage foodservice workers from overseas. While the real value of the wages paid to restaurant workers has declined for the past three decades, the earnings of restaurant company executives have risen considerably. According to a 1997 survey in Nation's Restaurant News, the average corporate executive bonus was $131,000, an increase of 20 percent over the previous year. With executive pay rising at a rapid rate and the wages of everyone else stagnant, you can see where we are heading. The wealth will continue concentrating, moving toward 40/60 -- the richest 20% will make 60% of the income. The people in the richest 20% will get more and more of the income, while rank and file employees get less and less. Then it will move toward 30/70. Robots will turbocharge the concentration of wealth. Let's take America's largest corporation -- Wal-Mart -- as an example. Wal-Mart currently employs over 1.3 million people. Imagine that Wal-Mart is able to __ deploy robots __ over a relatively short period of time and eliminate one million of those employees. = =

Market Share
- Between 2001 and 2008, robotically assisted minimally invasive prostate surgery jumped from 1% of all procedures to up to 60%, largely because of direct-to-consumer marketing suggesting that men were less likely to develop erectile dysfunction and incontinence, as well as have a quicker recovery and less blood loss. - But what patients aren't being told is that it could take as many as 250 operations with the robot before a surgeon is fully proficient. - Yet to start scheduling cases, a surgeon needs only to attend a two-day course and get some assistance from another surgeon, who himself might have used the device only 20 times, according to the study published in the Journal of the American Medical Association. - The findings come as robotic surgery devices, which cost about $1.5 million each, are popping up in small and large hospitals around the state and nation. - "Often technology gets ahead of science and it's hard to get the genie back in the bottle," said William See, chief of urology at Froedtert Hospital in Wauwatosa. - The study's results add to some already confusing issues surrounding prostate cancer, including the controversial PSA blood test and whether surgery is the best option for some men diagnosed with the disease. Each year, 192,000 new cases of prostate cancer are diagnosed in the U.S. and 27,000 men will die from the disease.

Sales growth

 * Intuitive Surgical (ISRG)**, maker of the da Vinci surgical robot, had a wild ride over the 24 hours surrounding their earnings release last week. They released market-beating earnings after the market close on Thursday, which brought an immediate bump up by about 20%. Then Friday morning the shares fell from the previous closing by about 10% after an analyst downgrade -- a swing from about $112 at closing yesterday, up over $120 in the after hours, then back down to about $100 ... and they opened lower today, hovering just under a hundred dollars a share.

Gross profit margin declined to 66% from 69.2% as a result of writeoff of inventory, and increased overhead with manufacturing expansion. They expect margins to improve by 100 basis points in the fourth quarter, which is promising. The expansion of their manufacturing capacity is complete, and they're now expanding engineering and product development space.

Non-cash stock options expenses are still pretty high, 7 million this quarter -- much of that is credited to their sales force, which has been expanded over the past year, and as long as they're in hyper growth mode and pushing sales of the systems to expand their footprint, I'll consider that to be reasonable. Right now, stock options reduce their gross margin by about one percentage point (still in the high 60s, so it doesn't bite too much yet). 52 hospitals now have multiple robots -- the biggest news this quarter was that Penn purchased three new systems, in addition to their first, to be the first hospital with four robots as they build out a "center of excellence" in robotic surgery. Nine other customers now have three systems. (As I've written before, the goal is to have three robots each in all 1,500 of the largest US hospitals, which would bring the installed total to roughly ten times today's number ... and make a lot of people very rich.)

So far, system sales (the sale of the actual da Vinci surgical robots) still make up the majority of revenue -- about 55% -- but utilization is growing so quickly that the installed base is beginning to require a significant number of new instruments and significantly more doctor training. Instrument and accessory sales are already growing slightly faster than system sales. There were 42 new da Vinci surgical robots added to the worldwide installed base in this last quarter, three more than in the quarter before. So there are now 509 systems installed worldwide (there were also four "trade-ins", so you may see totals of 46 for the quarter in some places, but those also removed four older machines from the market). It seems likely that their ability to forecast system sales is going to suffer further, as the sales cycle is getting a bit shorter. Their cycle is down to six months or even less in some cases, and some sales have less than a quarter lead time ||
 * [[image:6.jpg]] || ===**Long Term da Vinci Growth:**===

Each procedure done with a da Vinci generates somewhere between $1,500 and $2,000 in sales, primarily for instruments that are only usable for a limited number of procedures (and that doesn't count the instrument and accessory sales that accompany new installations). And while there is a huge range of utilization rates across different hospitals, procedure growth continues to be dramatic, and more and more hospitals are adding second, third or (in one case) fourth robots (12 of the sales this quarter were to hospitals with multiple machines) -- which leads me to believe that this recurring revenue stream should soon eclipse the systems sale revenue. But it really seems to me that investors are conditioned to focus only on the "units sold" number and on sequential growth. In that light, Intuitive didn't look that spectacular this quarter. They sold 39 robots last quarter, and 40 in the fourth quarter last year, so the 42 sold this quarter don't jump out as a dramatic growth indicator. Since the summer quarter is a pretty soft one for sales, according to management, and year over year growth was dramatic, I don't see anything significant to be concerned with at this time. That strong and steady procedure growth noted by the CFO is much more significant than the quarter to quarter system sales. Major technological advances have furnished the clinical ability to help patients cope with diabetes, heart disease, cancer, HIV-AIDS. Specialists were trained to use new technologies to provide better diagnosis, make fast and more complete cures, increase safety of medical treatments, and minimize side effects. To ensure that drugs and medical technologies are safe and effective for their intended usage, they need to be approved by the Food and Drug Administration (FDA) by law. For example, better anesthetic agents and practices have reduced the burden of surgery on patients, producing faster patient recoveries, shorter hospital stays, and fewer medical errors.
 * Quality Improvement of Health Care**

**Promotion of Economic Growth**
Because consumers demand for better health, advanced medical technology are perceived as ways to promote these goals. Direct care providers incorporate new technology because they want to improve the services they offer to their patients, but they also may feel the need to offer the “latest and best” as they compete with other providers for patients. Health care professionals, like people in other occupations, are also motivated by professional goals (e.g., peer recognition, tenure, prestige) to find ways to improve practice. Commercial interests (such as pharmaceutical companies and medical device makers) are willing to invest large amounts in research and development because they have found strong consumer interest in, and financial reimbursement for, many of the new products they produce. In addition, public and private investments in basic science research lead directly and indirectly to advancements in medical practice. Thus, these investments then promote the growth in the nation economy.

=Conclusion:= Robotic Operation is one of most in demand instrument in the field of Medical technology. In fact, growth of sales in the market is rapidly increasing and most of hospitals having interest to have this equipment. The sales growth, is projecting to 58-60% overall sales growth, with all segments growing. 62-64% expected growth for instrument revenue leads the pack, as procedure growth continues to build this recurring revenue stream. They could easily sell 50 systems and post blowout numbers in the fourth quarter and see their share price rocket ... or they might sell 35 systems, miss the numbers, and see the price halved. In the long run, though, I think their monopoly position in their niche and their growing installed base will drive them to many years of strong growth.

Robots in 2015
Imagine that you have a time machine and you are able to travel back in time to the year 1950: Industries like these are, by and large, completely untouched by automation today. These people-powered industries represent at least half of the jobs in the American job pool. Now imagine the __ near-term future __. In just a decade or two we begin to approach a point where CPU power rivals that of the human brain. This CPU power drives the creation of robots that take over all of these jobs. The unemployment rate in the United States skyrockets as cheap robots push expensive humans out of half the jobs that we see in our economy today. The automated checkout lines and kiosks that are popping up in places like Home Depot and McDonald's are the first messengers of this robotic takeover. When the robots start arriving in massive numbers to take half the jobs in America, the effects will be profound. At this moment in history, we are standing right on the edge of the transformation to a __ robotic nation __. It is fascinating to stand on this edge and think about what the robots will mean to us as citizens of the United States.
 * If you walk into a restaurant, hotel or store in 1950, it would be nearly identical to a restaurant, hotel or store today. People do everything in both cases -- people stock the shelves, prepare the food, serve the food, help customers, man the cash registers and sweep the floors in 2003 just like they did in 1950.
 * It's the same on any construction site. In 1950, guys with circular saws and hammers built houses. Today it is guys with circular saws and nail guns. No big difference.
 * An airport in 1950 and an airport today are nearly identical. People take your tickets, handle the baggage, maintain the planes and pilot them in both cases.
 * Coney island in 1950 looks like any amusement park today, with people operating the rides, selling the concessions and keeping the park clean.

**Replacing all the Pilots**
Robots in the workplace will be a very popular idea because they will eliminate labor costs. Pilots will be the first to go because pilots are incredibly expensive and their jobs are largely automated already. Let's say that, in 2015, one airline decides to completely automate the cockpit and eliminate its pilots. Since pilots are expensive, that airline will have a real price advantage over its competitors. That airline will also have far more scheduling flexibility because it will not have to worry about crew availability. After that first airline makes the leap to the robotic cockpit, every airline will do the same thing. Competitive pressure will leave the other airlines with no choice. Southwest Airlines has shown us just how sensitive the airline industry is to lower prices. The complete elimination of pilots from the airline industry will take just a few years. The 66,000 pilots in the Air Line Pilots Association will be out of work. These pilots are people who have spent thousands and thousands of hours training in their chosen profession. They have high salaries as well -- up to $250,000 per year is not uncommon for a senior pilot flying commercial aircraft. The economy could weather the loss of those 66,000 jobs. With an American workforce of over 100 million employees, 66,000 people is a drop in the bucket. We will all feel sorry for the pilots for a few minutes, but then we will get over it because ticket prices will go down. The pilots will all adapt by getting jobs at Wal-Mart or Target or McDonald's. This sort of thing happens all the time in any capitalistic society. The question is, will all the unemployed pilots be able to get jobs at Wal-Mart or Target or McDonald's? The answer to that question is where things get uncomfortable.

**Robots in Retailers**
In 2015, at about the same time that the airlines are laying off all of their pilots, Wal-Mart or Target or some other large retailer will be introducing a totally automated inventory management system. Every shelf will be fitted with RFID tags and bar codes, allowing a mobile pick-and-place robot to find the exact shelf location of every product in the store. Every individual product in the warehouse will also be fitted with an RFID tag and bar code, so the robot will be able to pick up and identify every product that it needs to shelve. A relatively simple computer vision system will allow the robot to stack items on the shelves. These inventory management robots will operate 24-hours-a-day shuttling merchandise from the back of the store onto the shelves as items are sold. The robots will also constantly straighten the shelves and re-shelve merchandise. All of the technology needed to do this is nearly in place today.

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