Robotic technology - enhancing medical practice

Antonia Tzemanaki and the anthropomorphic MIS (minimal invasive surgery) instruments

From a tiny pill-sized robot you swallow to a robotic system that helps surgeons to reset broken bones, researchers at Bristol Robotics Laboratory (BRL) are developing robotic technology that can enhance medical practice.

Direct application to the real world

Researchers work closely with industry experts and doctors who have first-hand knowledge of patient needs and medical practices, and are able to gather feedback from patients on the new technology. This close working relationship fosters robot development that has direct application to the real world in which doctors and medical professionals work, ultimately benefiting patient care.

Fixing broken bones

A robotic system being developed by Dr Sanja Dogramadzi with Professor Roger Atkins, an orthopaedic surgeon at UH (University Hospitals) Bristol, could help surgeons put joint fractures back together using minimally invasive surgery (MIS). It will be the first robot-assisted system designed to deal with the problem of complex joint fractures.

The robotic system will use CT (computerised tomography) scans to locate the bone fragments, and find the best way of putting these back together using a robot under the direction of the surgeon.

Professor Roger Atkins says, “Surgeons have highly specialised skills and expertise, but robotic technology can enhance those skills for the benefit of patients. Complex joint fractures frequently require a deep incision and this has consequences for the patient. A system that allows fracture reduction (fixing the pieces of broken bone back together) without the need for open surgery would have huge benefits for patients and potential economic benefits.”

In safe hands

The amazing qualities of the human hand are the inspiration for robotic tools that could enhance the effectiveness of surgery.

Laparoscopy is a surgical method where the surgeon makes small incisions on the abdomen and carries out the surgery in a minimally invasive way. The surgeon uses a camera tool to see inside the abdomen and surgical tools with long rigid handles and a small gripper on the end that rotates in three directions. The tools are similar in both manual and robotic laparoscopy and perform a similar range of functions.

Mimicking the movements of surgeons' hands

Antonia Tzemanaki is rethinking these tools, taking the human hand as her starting point.

Anthropomorphic MIS (minimal invasive surgery) instruments“The hands are the most dexterous part of the human body. The fingers have incredible possibilities in terms of movements, dexterity, and sensing. So we thought, why not make a robotic instrument with three miniature fingers that would behave like the thumb, index and middle fingers of our hands?

“These three robotic ‘fingers’ would be at the end of the instrument which is inside the patient's body, and the surgeon would wear a sensory exoskeleton which would transmit the movements of his/her own fingers to the ‘fingers’ inside the body.

"The exoskeleton would be a structure fixed onto the hand, like a glove, but not made of fabric, with sensors at the side of each joint of the surgeon’s thumb, index and middle finger. This structure would help replicate the complexity and functions of the surgeon’s fingers so that the instruments can move in the same way as his/her hands."

The key to Antonia’s approach is developing robots that adapt to surgeons not the other way around.

Pill-sized robots to aid diagnosis

The need for improved methods of diagnosis in the gastro intestinal (GI) tract is the driver behind Ben Winstone’s research with radiologist Mark Callaway at UH Bristol. Traditional methods using endoscopy can be uncomfortable and have limited reach in to the GI tract. The small intestine is particularly hard to reach, making accurate and earlier diagnosis difficult.

A new approach of capsule endoscopy uses a camera housed inside a small pill like capsule that you swallow for diagnosis. This passes through the body whilst taking images, however, it is entirely passive so cannot be directed at specific areas by the radiologist.

Mubot furthers non-invasive exploration

Ben Winstone, Researcher at Bristol Robotics Laboratory (BRL), testing micro induction coils as part of the Mubot project

The Mubot project, led by Ben Winstone, aims to create a small robotic vessel in the shape of a capsule swallowed by the patient which will use wireless power transfer (WPT) technology based on magnetic induction.

It won’t depend on batteries, so the power to the capsule will last as long as the radiologist wants it to, and the payload, such as a camera, will be directed to places in the body that the radiologist sees as important for diagnosis or treatment.

Ben explains, “The Mubot vessel would be remotely operated so that it can be moved around the body under direction from the radiologist. Through the use of miniature actuation methods, the vessel can focus onto specific areas to inspect different tissues and organs that are relevant to the examination.

"The ultimate goal is that Mubot will work in conjunction with other medical imaging technologies, producing better quality images to further its diagnostic and treatment capabilities. Essentially, the project aims to create a vessel that will provide more options of what can be done inside the body in a non-invasive way."

A sense of touch

Dr Adam Spiers is passionate about bringing a sense of ‘touch’, known as haptics, to the development of medical robotics.

Robotic fingertip (the TACTIP) which mimics the sensing properties of the human fingerWorking with PhD candidate Calum Roke, the team developed a prototype system which allows surgeons to remotely feel and locate tumours.

The technology involves several elements including a robotic fingertip, the TACTIP, which mimics the sensing properties of the human finger and tactile display, which recreates tactile sensations onto a human finger.

These are linked to a robotic arm, which is remotely controlled by a haptic interface with force feedback.

Taking robotic surgery to the next level 

Adam says, “We humans have an amazing ability to process information from our sense of touch, yet the robotic tools surgeons are increasingly using for keyhole surgery do not include this sense. These robots are remotely controlled by the surgeon, usually in a console in the same room as the robot and patient. Despite the enhanced dexterity and vision provided by these robots, surgeons can no longer ‘feel’ the tissue that they are working with.

"This means that surgeons find it harder to use appropriate levels of force or identify tissue types, especially those hidden from view, like tumours. Some evidence suggests that sutures performed robotically can often be too tight or loose, as the surgeon can no longer feel tension in the thread. A goal of our haptics research is to enhance performance in robotic surgery, by enabling remote touch."

Tumour detection using remote touch technology

“Experiments with our system have allowed us to investigate the potential of this remote touch technology for tumour detection. We ran extensive tests, with 240 separate trials and found that participants found the tumour (a stiff lump embedded in soft tissue) in 99.16% of trials. As the tumours could not be detected visually, this result shows that there could be real health benefits to developing robotic technology which has tactile sensing properties.”

Medical robotics - hot topic for conference delegates

Leading clinicians, academics and researchers from across the UK will discuss the latest advances in Medical Robotics, Simulation and Telemedicine at a one day conference on 12 November at the UWE Exhibition and Conference Centre. The conference is organised jointly by Bristol Robotics Laboratory, Health Education South West, and the Royal Society of Medicine.

Medical robotics gallery

Did you know?

It currently takes around 3,000 hours for a surgeon to train to use a complex robot, but intuitive robotic tools require considerably less training time.

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