The technology is still under development and part of the €4 million SMARTsurg project, funded by the European Union under the Horizon 2020 scheme.
Ten partners from four countries are working together on the project , led by the Bristol Robotics Laboratory and the University of the West of England Bristol.
The robotic exoskeleton could increase a surgeon’s dexterity and also give them an ability to ‘sense’, ‘see’, control and safely navigate the human body during operations, says the team working on the exoskeleton.
Keyhole surgery, referred to as minimally invasive surgery (MIS), is an attractive option for doctors as patients lose less blood during operations and recover faster. It also lowers the cost for hospitals as they need less after-care and are less likely to catch infections.
Sanja Dogramadzi, lead of the research project and robot specialist, told PE that robot-assisted MIS is growing in some surgical applications such as urology, which focuses on kidneys, ureters, bladder, prostate and male reproductive organs.
However, robotic systems are costly and so generally limited in other areas of surgery. “Success of the surgery depends on the available surgical tools and it is even more the case with MIS,” Dogramadzi said. “Enabling minimally invasive access in other surgical fields would be extremely beneficial for patients.”
A sense of touch
The main drawback for surgeons carrying out MIS is that when they insert instruments through small incisions, the surgeons typically loose dexterity and sense of touch.
The new technology hopes to overcome these drawbacks with the development of three key biomedical tools that mimic complex human dexterity and senses. These can be worn by the surgeon and transmit the surgeon's own movements to the very small incisions made in MIS.
It is hoped that this will also lessen the amount of mental and physical stress experienced by surgeons carrying out such precise movements, as well as the highly demanding training needed.
The first will be an exoskeleton that fit over the surgeon's hands, which will control the instruments inside the body – a surgical 'gripper' able to mimic the thumb and two fingers of the hand.
The instrument, which goes inside the body, will have haptic abilities, delivering feedback (typically in the form of small vibrations). This will allow the surgeon to ‘feel’ the tissues and organs inside the body, just like they do during conventional surgery. A prototype has been developed by researchers at Bristol Robotics Laboratory.
Exoskeleton prototype. Credit: UWE Bristol
The wearable exoskeleton on the surgeon’s hand will enable movement that is more intuitive as well as giving the surgeon the sense of touch.
The sense of touch will improve upon current haptic systems, which mainly focus on delivering feedback to the arm or forearm of the user. Instead, the system will also focus haptic feedback on the fingers of the surgeon.
Dogrmadzi says that the SMARTsurg exoskeleton and robotic surgical tools will offer much better dexterity to the human hand because of this ability to sense “fine finger motion,” which is translated into fine motion of the surgical instruments.
Researchers will also develop smart glasses to be worn during surgery that would give the doctor a real-time, 3D view of what is happening inside the body during the operation.
This could mean that the surgeon could be on the other side of the room, operating remotely using the exoskeleton gloves, and would be able to see exactly what is going on throughout the operation.
Dogramadzi told PE that the glasses could also provide extra information, such as biopsy results, during surgery.
Tests will be carried out on medical models, called laboratory phantoms, and non-invasive tests on animals, before moving on to more realistic models. Dogramadzi said it should be up to six years before the technology is used for real medical procedures in the operating theatre.
The project's collaborators include the Centre for Research and Technology Hellas (Greece), Politecnico di Milano (Italy), Bristol Urological Institute (UK), North Bristol National Health Service Trust, the University of Bristol, the European Institute of Oncology (Italy), TheMIS Orthopaedic Center (Greece), CYBERNETIX (France), Optinvent SA (France) and Hypertech Innovations (UK).