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Wanted: surgeon with gaming experience
When conducting eye surgery, a robotic assistant can provide additional damping, reducing the natural vibrations of the surgeon’s hand.
© KU Leuven

Wanted: surgeon with gaming experience

Robotic surgery appeals to the imagination: but in reality, it turns that it is mostly… very small.

5 minutes
01 March 2021

Would you like to become a surgeon? Some experience with videogames like Grand Theft Auto, Minecraft, or Among Us certainly won’t hurt. Indeed, in the future, the traditional scalpel will be a tiny, smart instrument full of robotics. And just like pilots practice in a flight simulator, surgeons in training will use an operation simulator.

In the past, surgeons would often make large incisions in their patients. This would enable them to see everything clearly and provide access to all the organs. But for the patient, a large wound would of course lead to a longer recovery. Nowadays, keyhole operations are used wherever possible. This means that the surgeon’s incision is as small as possible, or even that the operation is conducted using natural openings in the body, such as the navel. This is much better for the patient, but not necessarily for the surgeon: they have to use smaller instruments that are much more difficult to handle.

This evolution towards miniaturization developed in tandem with the rise of robotics in surgery, Professor Emmanuel Vander Poorten of Campus Groep T in Leuven tells us. He works in a multidisciplinary team of industrial and civil engineers that cooperates with a variety of departments at the Leuven University Hospitals, including the Smart Instrumentation Research Group. As the name suggests, these are not life-size operation robots, but smart instruments for the medical sector. You might describe them as minuscule operation robots.

A practice table for a keyhole operation in which the surgeon is assisted by two robotic arms.
A practice table for a keyhole operation in which the surgeon is assisted by two robotic arms.
© KU Leuven - RS

GPS for surgeons

Equipping existing instruments with the latest high-tech is already a major step forward, Vander Poorten continues. “You can integrate all kinds of sensors into existing instruments, such as a camera or a sensor that takes a constant echograph. This provides the surgeon with a better view of the area in which he is operating.” One example is foetal surgery, in which a foetus undergoes an operation in the womb: everything is of course very small and due to the tiny incision, the surgeon cannot see very much. A smart instrument can stick together all of the echo images to create a 2D or 3D map and thus provide the surgeon with a GPS navigation system.”

To solve some problems, new instruments must be developed from scratch. Think, for example, of flexible, almost snakelike tools that can be inserted into small openings and reach places that were previously difficult to access. These instruments are also equipped with a variety of sensors. One example of such a new high-tech device is a shape sensing sensor: a sensor that calculates the 3D shape of the instrument by emitting light and measuring the reflection. The sensor sounds an alarm if the instrument presses against the walls of the bloodstream with too much force. This enables the surgeon to work more precisely more safely.

Instead of building instruments directly, we first make a virtual dummy and let the surgeons test them in virtual reality

Catheter with muscle

Smart instruments that are able to move independently are currently being developed. For example, the researchers have designed a self-moving catheter – a tubular medical device. Cardiologists will be able to use it to implant heart valves. “Our catheter has artificial muscles so that it can move independently. The catheter uses shape sensing and echo probing to measure its position, aim directly at the centre of the bloodstream, and slide right to the heart. There is thus no risk of damaging the artery wall, and the surgeon is able to focus entirely on implanting the valve.”

Now that surgeons are increasingly working on a smaller scale, there is a growing demand for instruments that help to stabilize the surgeons’ movements. Indeed, the human hand always vibrates a little. For example, it is extremely difficult for eye surgeons to prick a blood vessel in the eye because these blood vessels are thinner than a human hair, let alone being able to maintain this position for minutes at a time with damaging the retina. Robotic assistants can provide additional damping, reducing the natural vibrations of the human hand. The system can also impose a perimeter to which the instrument is confined, so that the retina is not unnecessarily affected. “The results of the first operations with this system were very promising.”

MG 9510
© KU Leuven - RS

Surgeon simulator

Just like in the world of gaming, the surgeon of the future will increasingly work with a dashboard of smart tools that provide information and assistance. But the surgeon will also literally game more, or work digitally with virtual models and simulations. “You can compare it to the flight simulator of a pilot: flying hours are expensive, and mistakes are fatal, so pilots first practice in a virtual environment. In the same way, there is now a strong trend for surgeons to practice operations virtually, trying out new instruments and learning to use various devices.”

Using scans, it is already possible for instruction the patient virtually, enabling the surgeon to practice a difficult operation beforehand. “But virtual reality is now also being used to allow surgeons to train with their instruments safely. This may involve virtual sessions with existing instruments, because they are often very complex. Or it may be a question of testing new devices that are still under development. Instead of building these instruments directly, we first make a virtual dummy, often with various prototypes. We then let the surgeons test them with a console, and receive very useful feedback about their user friendliness, for example. If the tests are successful, we can continue to develop the instruments in a more target-oriented way.”

Will we ever see fully automatic robots in the operating theatre? Professor Vander Poorten does not think that robots will replace surgeons of flesh and blood any time soon. “This is related to the human body, which is extremely complex and different in every case. Constant measurement and adjustment are therefore required, which is very difficult. Fully automatic robotic operations will not be a reality in the near future.” The medical robots we will see in our lifetimes, will probably be tiny and remote controlled by a surgeon. Surgeons in training should therefore continue to practice with joysticks and pedals!