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18 September 2019
Smart Surgery: soft robotics, tele-surgery and advanced haptics
Dr Liu is designing a soft robotic endoscope to carry out medical interventions to provide access to diseases in the least invasive way possible.
Inserting a small flexible tube into the human body to examine its inner workings, can, understandably, be perceived as invasive. But such is the nature of the endoscopy – a procedure which has seen its overall demand double in many UK centers over the last five years.
While complications are generally minimal, Dr Hongbin Liu and team saw there was an opportunity to develop current endoscope technology to make it neater and ultimately safer for patients.
Dr Liu is designing a soft robotic endoscope to carry out medical interventions to provide access to diseases in the least invasive way possible. With Dr Liu’s technology, the robot is designed to pass through narrow spaces like the food pipe and in the future could even pass through blood vessels and the lung.
Such fantastical possibility exists because this robot was designed with a slim arm and is made from soft material. Inside there are optical fibers acting like nerves to pass through the tactile information from the tip of the arm to a processor located at the back side of the robot. Inside the arm there are some tendons to control the tip and the tendon is controlled through an actuation unit at the back side of the robot.
But where Dr Liu’s technology breaks from the pack is with the added capability to measure the contact force during the insertion stage and therapy.
Dr Liu describes it as feeling like your arm is interacting inside the body of a patient, as endoscopists can now feel the sensations that happen at the tip of the endoscope.
This added haptic capability means that Dr Liu’s endoscope can prevent accidental damage to internal organs or perforations as it is equipped with a haptic capability -- providing a sense of touch which reverberates back to the clinicians who feel the endoscope as an extension of their arm so they can carry out the procedure safely and confidently.
“In terms of safety because we are able to measure the instantaneous contact force during the whole procedure we will be able to avoid some potential accidents,” Dr Liu said.
When endoscopists operate the conventional endoscope they can potentially cause internal bleeding of the tissue because they apply excessive force to the internal surface or they can perforate or punch a hole.
“With the haptic sensation we are able to avoid that,” Dr Liu said. “The clinician can also be more confident. This makes it quite elegant because this system is dexterous and intuitive, so it reduces the complexity of a clinician to perform certain tasks.”
Currently surgeons train themselves to get used to the position and control during such surgical procedures but with the pending development of Dr Liu’s technology, it will be much easier for them to operate the tool so they can put more focus on the diagnosis and treatment aspect.
But what does this mean for the patient? Quite simply, it means less pain, and less trauma to internal organs as the clinician is far more aware of what is happening inside between the endoscope and the internal organ in terms of the contact and the force.
“Risks from the procedure will be significantly reduced – that's the most expected clinical benefit,” Dr Liu said.
“It will potentially enable more sophisticated integration and complicated procedures to be carried out in a less invasive manner. We could anticipate that for patients who undergo open surgery, could be replaced using this non-invasive approach.”
Will robots perform the endoscopies?
Unfortunately, the truth about robots performing surgery and replacing surgeons has been lost in translation. At this stage, fully automating robots – especially ones that would exert significant ethical computations – is simply not possible.
“To fully automate the robot is still very challenging because there is a lot of decision making that humans are very good at but still challenging to develop the technology for a robot to have equal capabilities,” Dr Liu said.
Rather, his philosophy is to make systems that robots are good at – like dexterity and precision – and leave the more sophisticated tasks like decision making or dealing with complex scenarios to the surgeons.
“Robots are working with clinicians. What we want to do is make a smart system which can be an extension of a surgeon’s capability,” Dr Liu said.
“The brain is still with the surgeon but our device allows the surgeon to go places that they simply cannot reach, or provide them with the capability to operate with greater precision in terms of the location or level of force they can apply to the tissue which is beyond what the human being can do.”
These systems, explains Dr Liu, are augmenting the capabilities of the surgeon rather than replacing them. This is how he sees medical robotics going forward in the next five to ten years.
So should we fear the robotic invasion in healthcare? Probably not.
“I want [people] to understand that the robot we are developing is an intelligent tool to assist the clinician and we want to them to feel that this tool suddenly opens many possibilities which currently are not possible,” Dr Liu said.
“The robot can reach locations that are not currently accessible by other means, and once the robot has reached [various locations] with the clinician as the commander, more complex procedures can be carried out.”
Perhaps one of the most obvious benefits of technological advances in healthcare is that it can ensure equality of access – take for example earlier this year, the tele-surgery performed by a surgeon in Fujian, China, who removed the liver of a lab test animal over the 5G network.
Working in collaboration with industry partners, Dr Liu and his team are aiming to further develop the platform for future 5G remote tele-operation. In the future, a skilled clinician will operate this system which will be located rurally to basically make the best treatment available for everyone. It will democratize the healthcare system, making it more accessible.
But these early systems are only able to transmit images and sounds so procedures that can be done are rather limited simply due to the inherent limitation of what kind of information can be provided. Dr Liu’s system includes one vital feature: touch.
“Beside the vision, we are also able to measure and transmit the haptic information. We are able to measure how much force is generated during the intervention and we are able to relay this back to the clinician, unleashing more uses for future remote operations,” Dr Liu said.
Will it be safe? Dr Liu says yes. But safety is determined by many factors: safety related to the robot itself and to communications. Dr Liu and team chose endoscopy, however as in this scenario it allows more of a delay and because the robot is made with soft materials and has a safety cushion, he expects it will indeed be safe.
While the soft endoscope is still a research prototype, Dr Liu and team are in the process of preparing for a pre-clinical trial to test the capability to eventually see the endoscope used in hospitals. Will it translate easily? With a similar burst of optimism, Dr Liu is confident it will push through to the clinical trial stage.
“Ultimately we want to create technology to extend surgeons' capability, to make surgery simpler, safer and also improve the patient care pathway,” Dr Liu said.
“This system contains several advancements from our lab, in terms of soft robotics and in terms of haptic sensing and combining this all together we will enable the system to do more challenging tasks which cannot be done by other systems.”