Andria Remirez, a PhD Student at Vanderbilt University talks about a flexible robot for surgeries.
Interview conducted by Ivanhoe Broadcast News in December 2018.
Tell me your role in developing this device.
ANDRIA REMIREZ: So, the core technology, that a lot of the things we work on in the lab is based around, was invented by my advisor Bob Webster when he was in graduate school. And since he’s invented this design for these snake-like robots, we, as graduate students, have really taken on the task of developing that basic idea into a lot of different systems for specific surgeries. And so one of the things that I’m working on in the lab is developing a snake-like robot for transnasal surgery. Basically, we’re going in with these robots and operating on brain tumors through the nose.
And could you tell me why is there a need for this?
ANDRIA REMIREZ: Pituitary tumors actually are a really common type of tumor. In fact there are lots of other types of tumors that can happen in the same vicinity which is kind of in the center of your head. And it’s a really difficult region to access if you want to go in through a traditional approach. Basically, you’re having to go through a lot of healthy brain tissue to get to that central part of the head. What a lot of surgeons have started to work towards is this idea of doing more and more of these surgeries actually through the nose. When they do this, they’re using these straight, rigid tools, basically chopsticks, that they have to put through your nose and try to work with. They’re operating them from a distance because they’re trying to reach these surgical sites that are far inside your head by moving their hands outside of your nose. And that becomes a really challenging task with rigid tools because they’re not able to bend in any way. So our goal in developing this snake-like robot is to give those surgeons more dexterity at the sight of the tumor and allow them to reach through a small opening using a natural orifice to do procedures that would otherwise be potentially very invasive and dangerous.
And what do you think would be the maximum benefit to the patient using this technology?
ANDRIA REMIREZ: So a lot of people have tumors that can be really difficult to access through minimally invasive approaches using the current tools that surgeons have at their disposal. And because surgeons are stuck with these rigid tools, if the tumor is located in a place that would require them to bend around a corner they’re not going to be able to do it with this minimally invasive transnasal approach. So in the long term, we’d really like to enable surgeons to do more procedures in this minimally invasive way because there are huge benefits to the patient in terms of just saving the healthy brain tissue that you might have to go through otherwise if you aren’t able to use a transnasal approach. There’s also a much longer recovery time associated with open-brain surgeries. Whereas if you use the transnasal approach, the recovery time is pretty comparable to having sinus surgery which is one of the most common surgeries done in America.
Can you explain to me what this device looks like? What are the components?
ANDRIA REMIREZ: We call these devices concentric tube robots, and basically, what they look like is kind of an old antenna which is basically a series of metal tubes that are nested inside one another that you can kind of telescope in and out of each other. But the difference with our technology from this basic straight antenna is that all of our tubes are really flexible so they can bend and twist each other as they move. And they’re also pre-curved. So what happens when you translate and rotate these tubes is they create this kind of tentacle-like motion which is why they sometimes get compared to snakes. What’s really cool about this specific design for a snake-like robot is we can make them as small as one millimeter in diameter – just some of the – it’s one of the smallest designs out there.
And besides brain tumors, are there any other procedures that you guys are possibly looking into?
ANDRIA REMIREZ: Basically we see these devices as being useful anywhere that the surgeon wants to have dexterity and go through a small opening or bend around the corner. And so some of the other applications that we’ve looked at have been for prostate surgery for other types of brain surgery where you’re not going through the nose but you’re going through a really small burr hole. So again you’re still making it less invasive. We’re also looking into lung applications – so deploying a bronchoscope through your mouth basically, trying to access lung tumors but reaching farther than the bronchoscope can go on its own.
What impact do you believe this would have for someone who’s about to go to surgery compared to using other devices from the past?
ANDRIA REMIREZ: I think what’s really special about this technology is that it allows, in the future, it could allow surgeons to do procedures that would otherwise be really invasive through a natural orifice. And that means less incisions, less recovery time, less disturbance of kind of healthy tissue that doesn’t need to be disturbed if you can get into access your site with this flexible tool. The other thing that’s really cool about robotics is we can, as engineers, program a lot of intelligence into the systems to help the surgeons do their job better, so things like having the robot know where it is relative to the person’s anatomy. We can have a robot that’s programmed not to go and hit some critical blood vessel that the surgeon’s not intending to hit. And in that way, I think we can prevent a lot of surgical accidents too in the future.
And where would the doctor be in relation?
ANDRIA REMIREZ: Right. So most of the designs that we work on in the lab are designed to work with the doctor, they’re essentially a better tool for the surgeon to use to do his job. A lot of people think when we’re talking about surgical robots that the robot’s going to do the surgery all on its own. But the way we envision these things, for the most part, is to have a surgeon that’s controlling something like a video game controller, and the robot’s tracking the motions that he’s providing as an input.
And then most people hate this question but what’s the time frame do you see that this could be in clinicals?
ANDRIA REMIREZ: In the lab, we’ve done a lot of work on kind of answering the underlying theoretical questions about if this can be done. We’ve done a lot of proof of concept studies to show that these robots can benefit for specific procedures. But in terms of commercializing the robots and getting them, you know, through FDA approval and stuff, that’s where we really want to work with commercial partners to do that. We’d like to see these things being used in patients in the next few years. But it depends on how the whole commercialization process goes, and then of course, getting through all the regulatory processes.
END OF INTERVIEW
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