Robotics in Gastroenterology

Dr Louis Phee Associate Professor Head, Division of Mechatronics & Design School of Mechanical & Aerospace Engineering

Why Medical Robotics? The use of robotic and mechatronics technologies to aid the clinician in performing difficult and technically demanding surgical procedures.

Strengths of the Clinician: Good judgement. Strong hand eye co-ordination. Integrate extensive and diverse information. Very flexible and adaptable. Very dextrous at “human” level. Highly evolved. Easy to instruct. Easy to get verbal feedback.

Strengths of the Robot: Excellent geometric accuracy and repeatability. Untiring and stable. Immune to infection and radiation. Potentially high variety in size, shape and configuration to suit need. Can incorporate many sensors for information feedback and precise application (eg. of force). Creates better accessibility

Surgeon + Robot = •Enhances non invasive or minimally invasive surgical procedures •Eliminates or decreases technical difficulties faced by clinicians •Less pain and discomfort for patients •Lower surgical and hospitalization costs

Why Medical Robotics?

The Evolution of Surgery TRADITIONAL

SURGERY MINIMALLY INVASIVE SURGERY

Da Vinci CAS system

ENDOLUMINAL SURGERY

Endoscopic capsule Reconfigurable surgical system

Micro-endoscope for spinal cord

FETAL SURGERY

Force-feedback scissor for fetal surgery

CELL SURGERY

Artificial virus for cell therapy

The “Da Vinci” system

• Same hospitalization time

• Similar blood loss

• Same cauterization time

• Patient reported mean pain scores were almost identical

• Robotic surgery is expensive

• Robotic surgery has higher operative duration time

Robotic Surgery Vs Traditional Laparoscopy

The new challenge for surgeons and engineers

The real challenge for the future of robotics in surgery (and perhaps for surgery in general) is

to go beyond the mere imitation and substitution by a robot of conventional procedures and surgical gestures,

and rather to explore completely novel procedures that are possible only by means of robotic/mechatronic tools together with human surgeons.

Previous Projects: Colonoscopy Robot

•Colon cancers are one of the deadliest but most preventable malignancies •Kills 437 000 people worldwide each year •Curable 90% of the time, if detected and treated in the earlier stages •Death toll could drop by 50 to 75% with mass screening of the population •1 million colonoscopies performed in France each year, resulting in 52% of colorectal cancers cured •Colonoscopy tops the list of recommendations because the entire colon can be inspected and therapeutically treated as soon as ailments are discovered

Endoscopic View of fungating colon cancer

Mass screening of population for colon ailments would be desirable

Colon cancer is the one of the most common form of cancer in Singapore

Motivations

•Pain & discomfort for the patient

•Technical complexity for the surgeon

•Expensive; deters patient from examination

Previous Projects: Colonoscopy Robot

Objective: To develop a robot which can propel itself autonomously into the colon (anus to caecum) for inspection purposes

Understanding the Environment

2γε=σγ ≈ 5.0 MPa

Previous Projects: Colonoscopy Robot

Thermostatic support

Clamp

Controlled weight

Active surface

T

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DC MotorLoad cell

Tissue

Controlled Speed Motor

Thermocouple

Known Weight

Tissue

Controlled Temperature Plate

The INCHWORM locomotion mechanism…

…”never let go of what you are holding until you are holding something else”

Analysis of the Solutions – The Inchworm

Understanding the Environment

Previous Projects: Colonoscopy Robot

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∆=η

σ = stress ε = strain

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Prototyping

Previous Projects: Colonoscopy Robot

Previous Projects: Colonoscopy Robot

The future of colonoscopy?

Disposable

Current Gastroscopy

Master And Slave Transluminal Endoscopic Robot (MASTER)

Objectives

Nintendo Wii for Surgery

Master And Slave Transluminal Endoscopic Robot (MASTER)

Design: Overview

17

Conventional endoscopy system

Slave Robotic SystemPatient

Surgeon

Endoscopist

Master Console System

Microprocessor/ Motion Controller

Send signals

Assist

Stabilisedposition

Attend to

Control

Actuators housing

Control

Actuate

Perform treatment

Inside GI tract

Attach together

Provide visionfeedback

Distal endParameters changes

Changes proximalload cell readings

Control actuatortorque

Benefits for Clinicians •Enable endoscopist to perform intricate procedures otherwise normal performed by surgeons •Intuitive, easy to use, very short learning curve

Master And Slave Transluminal Endoscopic Robot (MASTER)

Benefits for Patients •Minimally invasive •No holes = no scars •Shorter hospitalization stays, if any •Lower costs

Master And Slave Transluminal Endoscopic Robot (MASTER)

Surgical Navigation System for NOTES

22

Force Feedback

Envisaged NOTES Platform

23

State-of-the-Art of Wireless Capsule Endoscopy

PillCam Colon 2

Inventors: Given Imaging Capability: Bi-directional communication, adaptive frame rate adjustment Specifications: 1.1cm in diameter and 3.1cm long; 4-35 frames per second

MiRo capsule

Inventors: Intelligent Microsystems Centre Capability: uses the human body as a conductive medium for data transmission Specifications: 10.8 mm in diameter and 24mm long; 2 frames per second

Magnetic Maneuverable Capsule

Inventors: University of Hamburg Capability: Controlled locomotion by using a handheld external magnet (magnetic disks are inserted inside one of the capsule's domes) Specifications: 1.1cm in diameter and 3.1cm long; 4 frames per second

Maneuverable Pill (Research)

Inventors: CRIM Lab at Scuola Superiore Sant’Anna and Katholieke Universiteit Leuven Capability: Controlled swimming using BLDC motors, Wireless power supply Specifications: 1cm in diameter and 4.5cm long; 2 frames per second

Magnetic Internal Mechanism capsule (Research)

Inventors: CRIM Lab, Scuola Superiore Sant’Anna Capability: gross positioning and precise control of the capsule orientation, tethered Specifications: 1.5cm in diameter and 4.8cm long

Hybrid locomotion (Research)

Inventors: CRIM Lab, Scuola Superiore Sant’Anna Capability: Hybrid locomotion (external magnetic dragging and internal actuating legged mechanism) Specifications: 1.4cm in diameter and 4.4cm long

‘Mermaid’ Pill

Inventors: Ryukoku University and Osaka Medical College Capability: Controlled swimming using fins in GI tract Specifications: 1cm in diameter and 4.5cm long; 2 frames per second

Innovative Imaging System

Rotatable camera (by using a micro-motor)

Self-focusing lenses with variable view angle

-Clearer images -Steerable vision -Longer operation duration

Tagging Device

Principle: - The capsule will inject a pre-determined volume of a solution into a desired

location of the small intestine/stomach sub-mucosal layer using a fine needle

- The tagged location could be recognized by X-Ray or by the physician during an open-surgery operation

Monitoring of Gastric Bleeding

Enabling Technologies: - Blood Sensor - Stop Mechanism (inflating balloon)

Weight Management

• Strong market for the clinical treatment of overweight and obesity

• Market forecast $6.4 billion globally by 2015

(c) Balloon inflates

(d) Balloon deflates (e) Removal (natural discharge)

(a) Capsule enters the stomach

(b) Resides in stomach

The Future Robots in your Body

Self Configurable Robot

… able to adapt its configuration to the specific site of intervention and to the task that must be executed

A customizable self assembled and self reconfigurable robot…

Learning from nature

Studying social insect colonies, e.g. ants and bees, to inspire solutions for collective behavior, mechanics and sensing systems of microrobots I-SWARM project: 1000 cooperating bio-inspired microrobots Technological challenges (*):

• size (3 3 3 mm3) • extremely low power limits onboard (< 1mW) • mass-fabrication and assembly through microtechnologies • swarm behavior algorithms on the base of the developed HW

(*) P. Valdastri, P. Corradi, A. Menciassi, T. Schmickl, K. Crailsheim, J. Seyfried, P. Dario, “Micromanipulation, Communication, Swarm Intelligence Issues in a Swarm Microrobotic Platform”

J. of Robotic and Autonomous Systems, Elsevier 2005)

http://www.i-swarm.org/

Micro/Nano Self Configurable Robots

Screening

Biopsy, surgery and other therapies

Thank You

Louis Phee Email: msjphee@ntu.edu.sg Tel: +65-67904959