In an effort to provide endoscopists with a robotic “second hand” to assist in performing endoscopic submucosal dissection (ESD) for colorectal cancer, Hamid Marvi and his team at Arizona State University are developing a robotic endoscopic surgery platform.
With the current ESD approach, basically everything happens with the endoscope. The surgeons have the one hand, which is the camera, light, cutting tool, manipulation tool, everything, Marvi said.
“That's all they got,” added Marvi, Associate Professor, School for Engineering of Matter, Transport and Energy. “And then imagine you have a large, flat lesion, and you need to cut it out without damaging the muscles that are just a few millimeters underneath. That's a very difficult task when you only have one hand.”
So, what the team at the Bio-Inspired Robotics Technology and Healthcare (BIRTH) lab is doing is giving them a second hand: One hand is the scope, and the second hand is for manipulating the tissue. Now, instead of the endoscopist having to go under the tissue and cut under it without having much means of manipulating it besides the scope itself, they can grab the tissue and then pull it in any direction they like using the robotic hand.
“And we do that magnetically by introducing a magnetic clip through the scope and then manipulating it using an external magnet that's attached to a robotic arm,” Marvi said. “Through the interaction of these two magnets, they can pull the tissue in the desired direction. They gain much better visibility, allowing them to work precisely beneath the tissue and adjust its position as needed during removal.”
It works; the numbers don’t lie. Marvi said the technology has reduced the timing of the procedure significantly — by up to around 50 percent. Not only that, but it has reduced the muscle damage to zero. “We've not had any muscle damage in any of the procedures that we've done so far over the past couple years. It's been very promising,” he noted.
While everything has been going swimmingly with the project, Marvi has his sights set even higher: making the robotic arm autonomous. Currently, the second hand is being controlled by the endoscopist — either via joystick or verbal commands. They still need to think about it, pause what they're doing, and then it’s joystick or voice command time. Then they must wait for the system to perform it and then continue, he said.
“We don’t like that,” Marvi said. “The surgeons are OK with it; it’s still reducing the time by half. We, as roboticists, would like to minimize that disruption. We want them to just focus on the procedure without taking their hand off the scope for a second, without having to communicate with our system, or think about it. We want them to consistently proceed with the procedure, and our system is going to learn how to adapt to the procedure autonomously. As they're removing the lesion, the system will automatically manipulate the tissue in the direction that makes it easy for the surgeon to cut. That's what we're working on: The idea is the system operates seamlessly in the background, without distracting the physician during the procedure.,” he added.
The BIRTH lab is in the process of wasting no time: It has ex-vivo and in-vivo experiments happening this Spring as the next step with in-the-lab testing currently going on. The team even has mock-up setups in the lab with which they can test the entire procedure.
“We currently have the full prototype operational,” Marvi noted. “The manual mode of control is fully functional; it's been tested for almost two years now. Now we're putting on the finishing touches, especially focused on the autonomy, and we're hoping to be able to finish that by the end of this year and next year move on to the preclinical testing and apply for FDA approval.”
This article was written by Andrew Corselli, Digital Content Editor, SAE Media Group. For more information, visit here .
