Page last updated at 09:12 GMT, Wednesday, 9 September 2009 10:12 UK

Robots 'to revolutionise surgery'

By Jane Elliott
BBC News health reporter

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See the latest medical robots - Sarah Pearson, curator of the Hunterian Museum, takes a tour

Within ten years some doctors and scientists are predicting that all surgery could be scarless.

They say by using the natural orifices of the body and the body's own natural scar the belly-button (or umbilicus), it will be possible to insert robots into the body which can help perform every surgical procedure.

It sounds fantastical, but prototypes are already in existence that can crawl and swim inside the body taking pictures of difficult to access areas.

There are particularly big hopes for Ares (Assembling Reconfigurable Endoluminal Surgical System), developed by Scuola Superiore Sant'Anna, Italy, with the support of the European Commission.

This is a robot that will self assemble inside the body, after the patient has swallowed up to 15 separate parts, and then aid the surgeon to carry out procedures.

It is almost inconceivable as surgeons that in 10 years time we will be putting our hands in patients
Mr Justin Vale
Urological surgeon

By operating from inside the body, surgeons could avoid external incisions, minimising pain and shortening recovery time for the patient.

In many areas surgeons are already using robots for their daily surgical work.

Head movements

Robots such as 'FreeHand', a robotic camera controller for minimally invasive surgery.

Traditionally the laparoscopic (keyhole) camera has been moved by an assistant, but the 'FreeHand' allows the surgeon to control the camera themselves using head movements and a foot pedal.

Da Vinci robot
The Da Vinci robot offers surgeons great precision

Another example is the 'Da Vinci Robot' which is mainly used to carry out prostatectomies (removal of all or part of the prostate), tumour removals, gastro and neurological operations.

Its robotic arms rotate 360 degrees allowing surgeons more precision than they would have using their own hands.

Mr Justin Vale, a urological surgeon from Imperial College Healthcare NHS Trust said robots already feature heavily in his daily work.

He uses the Da Vinci robot for all his prostatectomies and half his kidney tumour removals.

"I say to all my trainees and NHS managers that it is almost inconceivable as surgeons that in 10 years time we will be putting our hands in patients," he said.

"As long as they can bring the price down and make them smaller it is almost inevitable they will take off."

But he said there were training issues and that learning to use the computers required a new approach.

Sense of touch

"It does have limitations. One that surgeons will talk about is that there is no sense of touch.

"When you use your hands or standard keyhole instruments you do get a feeling of tension and pressure and whether something is soft or hard, but you can't do that to the same degree with a robot.

Many mini and micro-robots have biologically inspired designs which emulate the crawling and wriggling motion of worms and insects
Dr Arianna Menciassi
Scuola Superiore Sant'Anna

"It is difficult when you are learning as you have lost one of your senses, but when you are a skilled robotic surgeon you develop to overcome that minor loss."

The growth of interest in this area has led the Royal College of Surgeons (RCS) to hold a special exhibition to mark the work of robots.

'Sci-Fi Surgery: Medical Robots' at the Hunterian Museum, London, will run from 8 September to 23 December.

Dr Arianna Menciassi, is one of the experts in biomedical robotics leading work at Scuola Superiore Sant'Anna.

She said nature had been their inspiration for much of their work.

"Many mini and micro-robots have biologically inspired designs which emulate the crawling and wriggling motion of worms and insects, or the swimming motion of bacteria," she said.

"We turned to biological inspiration because worms have locomotion systems suited to unstructured, slippery environments and are ideally suited for use in the human body.

"The dream for us is that in the future no more incisions will be necessary for operations because we can exploit the natural orifices of the human body.

"We are also working on the real possibility of building a robot inside the person (Ares), inside their abdomen or stomach and there would be several module which are very small like pills and that can combine together inside and the idea is to introduce these robots from the mouth or anus or the umbilical

"This is the dream, but at the moment it is not so advanced to satisfy the dream but this is the direction."

The idea of the exhibition is to put before the public the idea that surgeons can be assisted by robots - they are not competition to the profession
Mike Larvin
Royal College of Surgeons

The London exhibition will also feature some famous medical robots from the world of science fiction, including the Pyschophonic Nurse, dreamed up in the 1920s.

As a 10-year-old Mike Larvin, Director of Education at the RCS said he had been inspired by the film 'Fantastic Voyage' in which a miniaturised medical team is injected into the bloodstream of an ailing diplomat to try to make him better.

That might remain a far-fetched fantasy, but Mike said medical robotics was a branch of science that was advancing at phenomenal speed.

"The idea of the exhibition is to put before the public the idea that surgeons can be assisted by robots - they are not competition to the profession," he said.

"They are something that helps make operations safer and better."



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