Robotic assistants in operating theaters promise safer operations

Sophisticated robotics can help surgeons perform procedures where there is little margin for error. © Microsure BV, 2022

During surgery in India, a robot scans a patient’s knee to find out how best to perform a joint replacement. Meanwhile, in an operating room in the Netherlands, another robot performs highly challenging microsurgery under the control of a doctor using a joystick.

Such scenarios are likely to become more common. Today, some manual operations are so difficult that they can only be performed by a small number of surgeons worldwide, while others are invasive and rely on the surgeon’s special skills.

Advanced robotics provides tools that have the potential to enable more surgeons to perform such operations and perform them with higher success rates.

“We are entering the next revolution in medicine,” said Sophie Cahen, chief executive officer and co-founder of Ganymed Robotics in Paris.

New knee

Cahen presides over the funded European Union Ganymede project, which is developing compact robots to make joint replacement surgery more precise, less invasive, and – by extension – safer.

The focus initially is on a type of surgery called total knee arthroplasty (TKA), though Ganymed wants to expand to other joints including the shoulder, ankle, and hip.

An aging population and changing lifestyles are accelerating the demand for such surgeries, according to Cahen. Interest in the Ganymed robot has been expressed in many places, including distributors in developing countries like India.

“Demand is very high because arthroplasty is driven by patient age and weight, which is increasing worldwide,” says Cahen.

Arms with eyes

The Ganymed robot will aim to perform two main functions: contactless localization of bone and collaboration with surgeons to support joint replacement procedures.

It consists of an attached arm with an ‘eye’, which uses sophisticated computer vision-driven intelligence to check the correct position and orientation of the patient’s anatomical structures. This avoids the need to insert invasive rods and optical tracers into the body.

“We are entering the next revolution in medicine.”

-Sophie Cahen, Ganymede

The surgeon can then perform the operation using a tool such as a sagittal saw – used for orthopedic procedures – in collaboration with a robotic arm.

The ‘eyes’ assist with precision by providing what is called haptic feedback, which prevents instrument movement beyond a set virtual boundary. Robots also collect data that can be processed in real time and used to further hone procedures.

Ganymed has conducted clinical studies on 100 patients of the bone localization technology and Cahen says it achieves the desired precision.

‘We are very pleased with the results – they exceeded our expectations,’ he said.

Now the company is conducting studies on TKA procedures, with the hope that the robot will become commercially available by the end of 2025 and become the main tool used globally.

“We want to make it affordable and accessible, to democratize access to quality care and surgery,” said Cahen.

Microscopic thing

Robots are being explored not only for orthopedics but also for very complex surgeries at the microscopic level.

Funded by the European Union MEETING the project has further developed what it describes as the world’s first surgical robot for microsurgery certified under the EU ‘CE’ regulatory regime.

Called MUSA, this small and light robot is mounted on a platform equipped with arms capable of holding and manipulating microsurgical instruments with high precision. The platform is suspended above the patient during surgery and is controlled by the surgeon via a specially adapted joystick.

In a 2020 study, surgeons reported using MUSA to treat lymphedema associated with breast cancer – a chronic condition that usually occurs as a side effect of cancer treatment and is characterized by swelling of body tissues due to fluid buildup. .

MUSA robotic arm. Microsure BV, 2022

To perform the operation, the robot successfully sutures – or connects – small lymph vessels measuring 0.3 to 0.8 millimeters in diameter to the nearest blood vessels in the affected area.

‘Lymphatic vessels are under 1 mm in diameter, so it requires a lot of skill to perform,’ says Tom Konert, who leads MEETMUSA and is a clinical field specialist at robotic-assisted medical technology company Microsure in Eindhoven, The Netherlands. ‘But with a robot, you can do it much easier. So far, with respect to clinical results, we are seeing very good results.’

Steady hand

When such delicate surgeries are performed manually, they are affected by slight shaking in the hands, even by highly skilled surgeons, according to Konert. With robots, this problem can be avoided.

MUSA can also significantly reduce the surgeon’s common hand movements instead of simply repeating them one at a time, thereby enabling greater accuracy compared to conventional surgery.

“When a signal is generated with the joystick, we have an algorithm that will filter out the vibrations,” says Konert. ‘It lowers the movement scale as well. This can happen by a factor of 10 or 20 and gives the surgeon a lot of precision.’

As well as treating lymphedema, the current version of the MUSA – the second, after the previous prototype – has been used for other procedures including nerve repair and soft tissue reconstruction of the lower leg.

Next generation

Microsure is now developing a third version of the robot, the MUSA-3, which Konert hopes will be the first to become widely commercially available.

“When a signal is generated with the joystick, we have an algorithm that will filter out the vibrations.”

—Tom Konert, MEETMUSA

The new version will have various improvements, such as better sensors for increased precision and increased maneuverability of the robotic arm. It will also be mounted on a trolley with wheels rather than a fixed table to allow for easy transportation within and between operating rooms.

Next, the robot will be used with exoscopes – a new high-definition digital camera system. This would allow surgeons to view a three-dimensional screen through glasses to perform ‘head-up microsurgery’ instead of the inconvenient process of looking through a microscope.

Konert believes the MUSA-3 will be widely used across Europe and the US before the 2029 target date.

“Currently we are completing product development and preparing for clinical trials of MUSA-3,” he said. ‘The study will commence in 2024, with approval and commencement of commercialization slated for 2025 to 2026.’

MEETMUSA also sees the potential of artificial intelligence (AI) to further enhance robots. However, Konert believes that the goal of AI solutions may be to guide surgeons towards their goals and support them in excellence rather than achieving fully autonomous surgery.

“I think surgeons will always be in the feedback loop, but this tool will definitely help surgeons perform at the highest level going forward,” he says.

The research in this article was funded through the European Union’s European Innovation Council (EIC).

This article was originally published on Horizon, EU Research and Innovation magazine.

Horizon magazine delivers the latest news and features on thought-provoking science and innovative EU-funded research projects.

Horizon magazine delivers the latest news and features on thought-provoking science and innovative EU-funded research projects.

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