146 members and guests packed out the Turing Lecture Theatre at Savoy Place for the first IET Central London Evening Lecture of 2018 to hear from Christos Bergeles from the UCL’s Wellcome EPSRC Centre for Interventional and Surgical sciences.
What's at the cutting, even bleeding, edge of technology... and yet isn't?
The answer to that riddle is Christos' robotic microsurgery, as it doesn't cut (currently) and doesn't cause (much) bleeding.
Christos introduced his research group approach as building on the three themes of: Navigation, Clinician experience and Precision Instruments.
Fundamentally, surgery is "an assault to the human body"; it's unnatural and mostly very invasive, something we want to minimise.
Taking a look at how surgery has evolved, there has been little change. Similar to Rembrandt's painting of The Anatomy Lesson, we still have a ton of people gathered around a body on a table, hopefully anaesthetised. The tools are much the same as in Roman or mediaeval ages, just finer and cleaner.
There has been great progress in reducing invasiveness. From
- Open surgery - Large incisions
- To the 1950's when the endoscope was a breakthrough.
- Minimally invasive surgery - laparoscopy
- 1990's Robotic surgery - Da Vinci surgical robotic tools. High dexterity, minimal invasion. Surgeon sits at a console, sees inside the body, controls with joysticks, as if operating inside the body. Minimal pressure, high precision. Currently in use.
- 2000's Flexible access surgery - 1 to 2 cm incision. Stereo vision, Triangulation; single port access for a group of robotic tools
- 2010's Robotic microsurgery - Flexible Snake robots for vascular, cardiac, optical, vocal chords (through the throat)
Christos' group works on concentric tube robots, where the tube can be manipulated to take up virtually any shape (global dexterity). This could be particularly useful for removing a brain tumour in a ventrical without damaging healthy tissue, or in a child's small brain, as it provides access from many different angles, but all though one very small hole. Similarly, it can reach to the heart via the jugular vein.
I can't claim that I fully understood the construction - it was along the lines of: Three concentric super-elastic tubes of different diameter and rigidity that conform to a mutual shape. Moving one will adjust the shape of the tube.
There is then some complex mathematics (inverse kinematics) needed for iterative convergence to the optimal design, working out how to get the tool to the destinations needed. There is an infinite number of solutions to reach a specific point, although collision avoidance is important. They use multiple computers, each trying to find a solution; the chance is that one will succeed.
Christos is now 'focusing' on Age-related Macular Degeneration (AMD) (600,000 sufferers in UK). The aim is to deliver healthy cells (that have been grown from stem cells in a petri dish) to the diseased retina within the patient's eye. They have a prototype, having had to overcome several tough challenges, and are making a simulation for an optician to practice on.
Indicating the interest aroused in the audience, there was an enthusiastic Q & A session, covering: Cross infection; Proprietary systems issues; Adding scissors and a camera; What if control is lost?
Many thanks to our speaker for enlightening us so enthusiastically, to Steven Mulvenna for organising the event and to the IET & Savoy Place staff for their customary, friendly support.
