With the flick of a tiny mechanical wrist, a team of engineers and doctors at Vanderbilt University’s Medical Engineering and Discovery Laboratory hope to give needlescopic surgery a whole new degree of dexterity.
Needlescopic surgery, which uses surgical instruments shrunk to sinvasive surgery. The needle-sized incisions it requires are so small that they can be sealed with surgical tape and usually heal without leaving a scar.
A research team headed by Associate Professor of Mechanical Engineering Robert Webster has developed a surgical robot with steerable needles equipped with wrists that are less than 1/16th of an inch (2 mm) thick. The achievement is described in a paper titled “A wrist for needle-sized surgical robots” presented last month at the International Conference on Robotics and Automation in Seattle.
The new device is designed to provide needlescopic tools with a degree of dexterity that they have previously lacked. Not only will this allow surgeon-operators to perform a number of procedures such as precise resections and suturing that haven’t been possible before, but it will also allow the use of needles in places that have been beyond its reach, such as the nose, throat, ears and brain.
“The smaller you can make surgical instruments the better...as long as you can maintain an adequate degree of dexterity,” said Professor of Urological Surgery S. Duke Herrell who is consulting on the project. “In my experience, the smaller the instruments, the less post-operative pain patients experience and the faster they recover.”
For the last six years, Webster and his colleagues have been developing a surgical robot that uses “steerable needles.” This is a system of telescoping tubes that are made out of nitinol, a “memory metal” that retains it shape. Each tube has a different intrinsic curvature. By precisely rotating, extending and retracting the tubes, an operator can steer the tip in different directions, allowing it to follow a curving path through the body.
Vanderbilt University applied for a provisional patent on the design in May.
Team members would like to test the system by using it for “transnasal” surgery: operations to remove tumors in the pituitary gland and at the skull base that traditionally involve cutting large openings in a patient’s skull and/or face. Studies have shown that using an endoscope to go through the nasal cavity is less traumatic, but the procedure is so difficult that only a handful of surgeons have mastered it.
“It should be useful for a number of other operations as well,” said Webster. “We think once we give this tool to surgeons they will find all kinds of applications we haven’t thought of.”
By the end of the summer, they hope to have completed the control software and the interface that allows the surgeons to operate the device. They are actively looking for a commercial partner who will take the new instrument through the FDA approval process including initial clinical trials. “Our best case scenario is that the system could be available to surgeons in four to five years,” Webster said.
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