Robotic arm with scalpel.

    Keyhole surgery needs to be faster and less expensive – and for that we need better tools

    16 March 2018

    More than a century ago the first keyhole surgery procedure was conducted, paving the way for a vast revolution in the way surgery is conducted, reducing risk for patients and increasing precision for surgeons.

    Things have changed immeasurably during that period. Yet whilst the benefits of such approaches are well known – reduced hospital stay time, less pain and bleeding, reduced scarring and a faster recovery time, amongst many others – we cannot rest on our laurels and must continue to drive innovation.

    That revolution has led from the classical robots used in hip replacements and prostatectomy to sophisticated macroscale surgical robots and microscale flexible robots for minimally invasive laparoscopic surgery.

    However, whilst the devices used daily across the globe are a significant improvement on earlier models, there is room for improvement. Current structures are substantial in size (most are large, fixed devices), costly (averaging $1m), rigid and less manoeuvrable than they should be due to the reduced Degrees of Freedom (DoF) for their intraoperative probe.

    Those in the field globally would concede more can, and should, be done to develop products which are even smaller and safer for patients and the medical professionals who use them on a daily basis. In short, the industry is ripe for another revolution.

    We are currently developing a surgical robotic arm as part of research at NYU Abu Dhabi, where our engineering faculty are currently in the process of refining a snakelike, downsized version of the traditional fixed option.

    The intraoperative arm, measuring 10mm in diameter and 12cm in length with 12 DoF (one fourth of the DoF of the existing systems) operates by making a single cut to enter the patient’s body. Historically MIS-systems use three cuts, opening larger areas and with it increasing the risk of infection and likelihood of scarring. Once inside, the arm has immense manoeuvrability due to its ability to move like a snake, meaning enhanced precision and, with it, projected success rates of surgery. The overall system weighs less than 15kg, making it portable for robotic surgeries in long-distance emergency situations.

    We believe the arm has mass surgical potential, making procedures quicker, less invasive, more effective and straightforward for both the patient and the practitioner. Looking ahead, it is possible that within the next five years, robotics technology could allow surgeons to offer minimally invasive heart surgeries to patients.

    Surgical revolution continues at speed. But in such a critical field, it must. As we move towards smaller, more manoeuvrable surgical devices, it’s worth considering that the ultimate end goal could look like a simple extension of the surgeon’s arm with a robotic probe capable of performing high precision with haptic feedback and reduced tremor surgical operations.

    Through doing so, we can improve success rates, patient comfort and the experience of medical practitioners, all whilst increasing the efficiency of surgery, and reducing the strain on health services globally. A perfect example of a win-win situation.

    Antonios Tzes is Professor of Electrical and Computer Engineering at NYU Abu Dhabi