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The World’s Smallest Surgical Robot

A powerful creative collaboration between researchers in South Korea and the United States has positioned both countries at a new frontier of medicine: tele-robotic microsurgery.

April Enewsletter robot“Imagine a world in which minimally invasive single-port surgery is available anywhere at any time,” says Daniel H. Kim, M.D., FACS, FAANS, a professor in the Vivian L. Smith Department of Neurosurgery at McGovern Medical School at UTHealth and director of spinal and peripheral nerve surgery at Mischer Neuroscience Institute. “In this new world, spina bifida and other fetal defects could be treated safely before birth, and stroke patients living in remote locations would have fast access to the same care available in large cities. That world is within our reach.”

Researchers in Houston, at the Mischer Neuroscience Institute and McGovern Medical School at UTHealth, and at KAIST in South Korea are the frontrunners in an international race to develop the first tele-robotic microsurgical tool – the world’s smallest surgical robot. The new system will make robotic surgery possible in any location, performed by surgeons in medical hubs in the United States, South Korea and other countries. The end result: a global healthcare model for advanced care delivered tele-robotically to rural locations and less-developed countries.

The Limitations of the Current Technology

The limitations of open surgery led to the development of laparoscopic surgery through four small incisions. From there, physicians developed single-incision surgery, operating through one entry point. The domain of the future is single-port tele-robotic surgery enabling microscopic manipulation beyond the surgeon’s skill – anywhere in the world.

“Current medical robot technology is expensive and bulky,” Dr. Kim says. “Designed for access through four small incisions, it lacks the small scale and flexibility needed to operate through a single port. Our new miniaturized tele-robotic system for microsurgery, designed in collaboration with KAIST, is small, mobile, versatile and agile – a model for the future of surgery.”

The new miniaturized tele-robot allows physicians to move the system’s four arms to accommodate the patient and the procedure. Its frame fits on an existing operating table. Instrumentation is jointed – with wrists and elbows that allow additional degrees of motion – and miniaturized to allow for the use of four surgical instruments through a single incision. Unlike current robotic technology, which requires frequent replacement of expensive parts, each instrument may be removed for sterilization and reused. Dr. Kim and his team expect the robot to outperform currently technology in cost, stability and dexterity.

Developing a Steerable Micro-Robot

The researchers have taken the miniaturization of technology a step further and developed a steerable micro-robot that can maneuver through small spaces between organs in a snake-like motion. Only 10 millimeters in diameter, this “snake robot” has two tiny graspers, one microsurgical instrument and the world’s smallest lighted camera. The mirco-snake has novel robotic clinical applications for fetal surgery, as well as for spine and cranial surgery.

“Since the 1930s, the first step in the treatment of newborns with spina bifida has been surgery to close the incompletely developed portion of the spinal cord a few days after birth,” Dr. Kim says. “In-utero open and minimally invasive repair are now possible, but both procedures have high morbidity and mortality rates for mother and baby. The microsurgical robot enables precise fetal surgery through a single incision, lowering risk during procedures to repair heart defects, esophageal atresia, spina bifida and other abnormalities.”

Also under development is a steerable tele-robotic microcatheter with life-changing potential for stroke patients worldwide. For those living in remote locations, access to fast care may not be possible. With telerobotics, an emergency physician in a rural community can access the femoral artery, and a skilled endovascular neurosurgeon working in a tele-robotic hub can manipulate the microcatheter via computer to retrieve the clot.

“Stroke is a time-sensitive emergency,” says Mark Dannenbaum, M.D., a fellowship-trained neurosurgeon with expertise in vascular and endovascular neurosurgery. “Our goal is to design a highly specialized microcatheter – the first of its kind – that can overcome the anatomic limitations of traditional embolectomy and retrieve the clot with precision. We hope to change the landscape of stroke treatment worldwide through tele-robotics.”

The novel microcatheter uses smart materials – an electroactive polymer that can bend to accommodate anatomy. That same technology can be adapted for minimally invasive spine procedures, brain surgery and other intricate operations.

The researchers have refined their first prototype.  Preclinical animal studies began in late 2015, with the first human studies expected by the summer of 2016.

At the heart of this new technology is a desire to improve quality of life and outcomes that connects researchers on two continents. “Through our collaboration with innovative scientists in South Korea, we’re leading the future of surgery,” Dr. Kim says. “Our miniaturized robot will access sites deep in the body unreachable with other robotic devices. Tele-robotics will enable physicians to treat patients anywhere in the world. This new technology is cost-effective and high impact. When tele-robotic hubs are completed, we’ll bring the world something entirely new – a model for truly global health care.”