A team of American doctors and engineers has developed the first robotic surgery system to target bladder cancer, the sixth most common form of the disease and the most costly to treat.
The team, from Vanderbilt and Columbia Universities, said the advance is the biggest step forward in bladder cancer treatment in more than 70 years.
The system is designed to make it easier for surgeons to get a much better view of bladder tumors and remove them, regardless of their location, offering significant improvements to the current operation called a "transurethral resection."
Nabil Simaan, an associate professor of mechanical engineering at Vanderbilt who headed the team, said the group was inspired to develop the new system, using micro-robotics, after witnessing existing surgical procedures, which he found to be invasive and rudimentary.
"When I observed my first transurethral resection, I was amazed at how crude the instruments are and how much pushing and stretching of the patient's body is required," Simaan said.
The researchers detailed the system’s development in the journal IEEE Transactions on Biomedical Engineering.
S. Duke Herrell, an associate professor of urologic surgery and biomedical engineering at the Vanderbilt University Medical Center, said the robotic technique "doesn't take the judgment out of surgeons' hands, [but] it enhances their capabilities and hopefully gives them surgical superpowers."
The traditional method involves inserting a rigid tube called a resectoscope through the urethra and into the bladder to view tissues, take biopsies, and remove tumors. But surgeons must press and twist the scope or push on the patient's body to bring some areas into view or remove tumors from less accessible regions.
"Because you are working through a long, rigid tube, this can be a difficult procedure, especially in some areas of the bladder," said Herrell.
Bladder cancer is expensive to treat in part because the tumors in the bladder lining are persistent and so require continuing surveillance and repeated surgeries.
But the new telerobotic system is designed specifically to operate in this challenging environment. The machine itself is the size and shape of a large thermos bottle but its business end is only about one fifth of an inch and consists of a segmented robotic arm. The tiny arm can swivel 180 degrees, allowing it to point in every direction, and its tip contains a white light, an optical fiber laser for cauterization, a fiberscope for observation, and a tiny forceps for gripping tissue.
"Surgeons can typically identify the gross visual margin of a tumor within a millimeter, but a robot like this have the potential of doing so with sub-millimetric precision and additional technologies may actually be able to distinguish margins at the cellular level," said Herrell.
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