Devices & Diagnostics

Another kind of personalized medicine: Custom-made surgical robots built for one patient

Three experts in robotic surgery techniques discuss the state of the industry and how researchers are working to improve it.

By on March 12, 2014

In addition to the standard visual craziness at SXSW — bizarro mascots and Grumpy Cat on the Game of Thrones set — I saw a very welcome visual statement: three women speaking about robots in the OR. Katherine Kuchenbecker, Allison Okamura and Catherine Mohr talked about robots in the OR, how they are used now and how they are being adapted and revised and improved. Mohr is the senior director of medical research for Intuitive Surgical. Kuchenbecker is an associate professor of mechanical engineering and applied mechanics at the University of Pennsylvania. Her research centers on the design and control of haptic interfaces.

Okamura has a BS, MS and PhD in mechanical engineering. She is a associate professor in the mechanical engineering department at Stanford University. A medical robotic researcher, she is working on the challenge of pediatric surgery and looking for an answer to the question: How do you get robots deep in the body in a dexterous way?

Most robots used for surgery are too big to use during surgery on children. A better tool has to be:

  • As small as possible
  • Able to move in a curved path
  • Able to deliver therapy
  • Able to be used for a specific procedure with a specific patient

Okamura said that current examples of this kind of tool include devices used to do cochlear implants and capsule robots used to take pictures or polyp samples in the colon.

“These use existing channels or fluid spaces in the body. What we need is to get inside solid organs with minimal trauma to the patient,” she said.

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Okamura then described steerable needles – a new tool that fits all the criteria. The needles are highly flexible and can be steered in lots of ways. A robot pushes it inside the patient.

“A robot can spin the needle and curve it to fit a target,” Okamura said. “For a human to do that would be like parallel parking a tractor trailer.”

She went on to explain the second tool needed to see into opaque tissue: ultrasound combined with a vibrating needle. Attaching a piezo buzzer to the needle cuts through the noise of the ultrasound and lets the doctor see the target.

“Vibrating the needle gives you X-ray vision to see the instrument as well as what’s going on inside the body,” Okamura said.

By combining this imaging and the robot-guided needle, that gives a doctor a specific plan to hit targets in the body. This technique could help make ablation more precise and kill only the cancer cells, not healthy ones.

Pre-op images also would allow the doctor to create a patient specific model with a 3D printer to practice the surgery. The final piece of the personalized robot is an active cannula. These can work in free space and are the same diameter as a needle. An active cannula is a series of concentric tubes that are highly flexible and pre-bent.

“It’s a tentacle-like device whose geometry can be changed depending on the orientation of the tubes,” Okamura said. A surgeon could control the flexing of the needle with a hand controller like the Leap Motion.

“This would be patient-specific robot production when the surgeon picks the tubes that go in and even prints 3D parts on site for the patient,” she said.