The medical industry is ripe for disruption. Already, Intuitive Surgical has been revolutionizing the operating room with its DaVinci-assisted device. If you are not familiar, robot-assisted surgery means a surgeon sits at a console and uses hand and foot controls to manipulate four interactive robotic arms, which are equipped with a high-definition vision system. The robot translates the surgeon’s hand, wrist, and finger movements into movements of the actual surgical instruments inside the patient. Surgeons can see the site of operation better because the “eyes” of the device—the camera—can go very close to the tissue and project a three-dimensional image that’s then magnified tenfold. In addition, the robot takes the surgeon’s motions and scales them down, allowing for enhanced precision.
As an example, when robotic surgery devices began to emerge around 2000, Memorial Sloan Kettering Cancer Center in New York quickly recognized the potential for expanding the number of minimally invasive procedures. Today, Sloan Kettering has the largest robotic surgery program in the United State and is only one of many worldwide institutions that consider robotic surgery as commonplace as laparoscopic. According to industry forecasts, the robotic surgical market is anticipated to grow from $3.2 billion in 2014 to $20 billion by 2021 as the next generation of devices, systems, and instruments are introduced to manage surgery through small ports in the body instead of large, open wounds. Already the market is an exhaustive list of large and startup companies, including: Intuitive Surgical, Accuray, Stryker / Mako, Hansen Medical, Medrobotics, Freehand 2010, Accel Spine, Accuray, Aesynt/Health Robotics, Alliance Spine, Alphatec Spine, Amedica, Apollo Spine, Ascendx Spine, AVRA Surgical, Back 2 Basics Spine, Captiva Spine, Centinel Spine, Corindus, Elekta AB, Freehand, Globus Medical, Hansen Medical, Healthcare Robotics Lab, Intuitive Surgical, Johnson and Johnson / DePuy Synthes, K2M, Lanx / EBI Holdings / BioMet /, LDR, Life Spine, Mazor Robotics, Medrobotics, Medtronic, NLT Spine, NuVasive, Otto Bock HealthCare, RTI Biologics / Pioneer Surgical Technology, Precision Spine, Restoration Robotics, SI-BONE 503, Spinal Elements, Spineart, SpineGuard, Spine Frontier, , Spineology, Spine Smith Partners, Spine Surgical Innovations, Spine View, Spine Wave, Stryker / MAKO Surgical, Think Surgical, Titan Medical, TranS1, UC Berkeley, Varian Medical Systems., Vecna Robotics, Victrex plc / Invibio, Vycor, Wenzel Spine, X-spine and Zyga Technology.
Assisting surgeons is only one aspect of how robots are fighting cancer and other terminally fatal diseases. In 2011, Given Imaging’s “PillCam” was cleared by the FDA for clinical use. This gave way to the concept of a digestible robot that could attack diseases at the point of contact. Last week at MIT, a team of researchers introduced the next wave of medical robots with an ingestible capsule that turns into an origami bot to remove tumors, repair tissue, and even medically treat organs internally.
The tiny robot is designed to unfold from a capsule, latching onto unwanted and potentially harmful objects stuck in the stomach, whisking them safely through the body. “It’s really exciting to see our small origami robots doing something with potential important applications to health care,” said Daniela Rus, director of MIT’s Computer Science and Artificial Intelligence Laboratory and creator of the tiny origami robot. “For applications inside the body, we need a small, controllable, untethered robot system. It’s really difficult to control and place a robot inside the body if the robot is attached to a tether.”
The origami pill can propel itself through the stomach and intestines through a “stick-slip” motion, using appendages to latch onto a surface through friction, but then flexes forward like an accordion to change its weight distribution. Also like its predecessor—and like several other origami robots designed by Rus, the new robot contains two layers of structural material sandwiching another material that shrinks when heated. A pattern of slits in the outer layers determines how the robot will fold when the middle layer contracts.
Unlike previous origami robots designed by Rus, the bio-version has to fit inside a capsule for swallowing; similarly, when the capsule dissolved, the forces acting on the robot had to be strong enough to cause it to fully unfold. In the center of one of the forward accordion folds is a permanent magnet that responds to changing magnetic fields outside of the body which control the robot’s motion. The forces applied to the robot are principally rotational. A quick rotation will make it spin in place, but a slower rotation will cause it to pivot around one of its fixed feet.
Today, the robot is targeting accidental digestion of batteries, as every year 3,500 button batteries are swallowed in the U.S. alone. Frequently, the batteries are digested normally, but if they come into prolonged contact with the tissue of the esophagus or stomach, they can cause an electric current that produces hydroxide, which burns the tissue. To counter this, Rus’ robot uses the same interior magnet to pick up the button battery and remove it out of the body like other forms of excrement. It is very imaginable that Rus’ origami robots can be used to remove a variety of other dangerous organic and inorganic matter from our bodies in the foreseeable future.
Origami-inspired ingestible robots are nothing novel. In fact, nanorobots use the same principal. According to Dr. Ido Bachelet, a leading figure in the field of DNA nanotechnology, “a nanometric robot” is created by using a selected DNA sequence and folding it using a “process called DNA origami” to enable a computer operator to unfold the DNA molecule at will. Bachelet declared earlier this year that human trials will be happening very soon with critically ill leukemia patients who have been given roughly six months to live. These patients will receive an injection of DNA nanobots to target and effectively destroy the leukemia cells, while causing zero collateral damage to healthy tissues.
Bachelet explains, “The result is that a DNA sequence can be made in the form of a clam, and contain a drug. For example, the clam can be designed to change its shape and release the drug only when it meets a cancer cell or the right tissue.”
A National Science Foundation report notes that the nanotechnology opportunity is not limited to disease control, but “has the potential to enhance human performance, to bring sustainable development for materials, water, energy, and food, to protect against unknown bacteria and viruses.” It has been forecasted that the global nanotechnology industry will grow to reach $76 billion by 2020.
While nanorobots and pillbots are clearly on the horizon, today most diseases are detected using external imaging that is viewed by a human. IBM has now developed an AI software application to become a radiologist’s assistant. The software is code-named Avicenna, after an 11th century philosopher who wrote an influential medical encyclopedia. It can identify anatomical features and abnormalities in medical images such as CT scans, and also draws on text and other data in a patient’s medical record to suggest possible diagnoses and treatments.
Avicenna is intended to be used by cardiologists and radiologists to speed up work and reduce errors, and is currently specialized to cardiology and breast radiology. It is currently being tested and tuned up using anonymized medical images and records. But Tanveer Syeda-Mahmood, a researcher at IBM’s Almaden research lab near San Jose, California, and chief scientist on the project, says that her team and others in the company are already getting ready to start testing the software outside the lab on large volumes of real patient data.
“We’re getting into preparations for commercialization,” says Syeda-Mahmood.
IBM has an advantage over others trying to build this kind of software. That’s because making a machine-learning system more accurate requires feeding it lots of example data to tune its abilities. IBM has already amassed a very large collection of medical images and records and is in the process of making it much larger. Last year, the company acquired a collection of billions of medical images when it purchased the company Merge Healthcare. Those images are not yet available to Avicenna, but when they are, they could help make the software more accurate, says Syeda-Mahmood. The project may also get a boost from 50 million anonymized electronic health records that IBM received in the acquisition last year of a startup called Explorys.
Is the concept of robotic doctors or treatments a scary proposition or a welcomed improvement to an overwhelmed, overworked, and under-appreciated industry?
The robot will see you now…
Image Credit: CC by Army Medicine