A robot guided by images from a 3-D ultrasound scanner can go to the right spots in a simulated surgery and promises to give surgeons a better picture of organs they are operating on, according to a new study in an engineering journal.
Among other applications, surgeons could use the 3-D scanner to spot potential tumors in real time during biopsy procedures, making it easier to diagnose cancer. Currently, physicians use scans of patients organs taken prior to biopsy to locate lesions suspected to be cancer.
Minimally invasive or laparoscopic surgeries already use surgeon-operated robots to perform biopsies and other procedures. Rather than cutting through large flaps of skin and fat to expose underlying organs, laparoscopic surgeons work through tiny incisions, using tiny video cameras (endoscopes) and imaging technology to observe their progress. But these procedures use optical endoscopes, which look only at the outer surface of tissue.
Ultrasound has the advantage of showing objects in three dimensions, and its already used for imaging fetuses and beating hearts. In addition, optical endoscopes often require surgeons to inflate patients abdomens with carbon dioxide to give surgeons a better view. That procedure can cause intense pain and would be unnecessary with ultrasound.
However, most ultrasound devices used clinically have scanners that are outside rather than inside the body, said Steve Smith, professor of biomedical engineering at Dukes Pratt School of Engineering and lead author of the study, which appeared in the November issue of IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control. "The new work is the first use of an endoscope with 3-D ultrasound hooked up to a robot," he said.
Smith said that the ultrasound-guided scope came about when a former graduate student suggested that he collaborate with a surgeon from basketball rival University of North Carolina. The project took only nine months, said Smith, and is ready to move to the next step. The scanner is small enough to use for laparoscopic imaging of the gall bladder, spleen, liver, and other organs.
Richard Satava, a laparoscopic surgeon and professor at the University of Washington Medical Center, said that he had not yet read the paper, but that the work sounded similar to that pursued at other research institutions.
"People have been talking about this for a long time, and we havent seen it migrating out of laboratory and into clinical practice," he said, "It would be of great value if it did."
Though the Duke teams device has not yet been tested in people, Smith said that there were no technological barriers to doing so. The main barrier is simply the cost of creating a robot connected to an ultrasound scanner. He expects that to happen within the next three years. "The robot companies are aware of it, and the ultrasound companies are aware of it, and its just a matter of when they get together."
Ultimately, he said, the ultrasound-guided robot might be able to perform very simple surgeries even without a surgeon. For that, the system would need to hooked up to an artificial intelligence system that could allow the robot to recognize where, for example, it needed to excise a precancerous polyp.
Smith said he hasnt teamed up with any artificial intelligence experts yet.