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Robotics Revolution

Schools of Engineering and Medicine Lead the Charge

By David Salisbury
August 2013

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In the foreseeable future, robots will be sticking steerable needles in your brain to remove blood clots; capsule robots will be crawling up your colon as a painless replacement for the colonoscopy; and ultra-miniaturized snake robots will remove tumors from your bladder and other body cavities.

“Bionic” prosthetic devices will help amputees regain the mobility that they have lost, and humanoid robots will help therapists working with autistic children to give them the skills they need to live productive lives.

These aren’t futuristic flights of fancy, but some of the research projects currently under way at Vanderbilt that are blazing the trail toward increased use of “smart” devices and robotics in surgery and a variety of other medical applications.

In recent years Vanderbilt has emerged as one of the primary centers in the country for basic research in medical robotics along with Johns Hopkins, Carleton University in Canada and Stanford.

“Today, we have a total of 25 investigators with $25 million in research grants and robotics is an important part of our effort,” said Benoit Dawant, Ph.D., the Cornelius Vanderbilt Professor in Engineering who directs the Vanderbilt Initiative in Surgery and Engineering (ViSE) that was established in 2011 to foster collaborative research between doctors and engineers on campus.

In addition to creating new opportunities by the growing computational power and decreasing cost and size of microelectronic devices, the gradual shift toward minimally invasive surgery is also paving the way for the introduction of medical robots. Although minimally invasive procedures frequently take longer than open surgery, patients tend to have quicker recovery times and less discomfort than with conventional surgery.

“Surgery is moving from the knife to the needle,” observed S. Duke Herrell III, M.D., a member of the ViSE steering committee and associate professor of Urologic Surgery.

As a result surgeons are becoming increasingly accustomed to relying on the images from miniature cameras and remotely controlled manipulators and this has made them more receptive to efforts to add robotics to the mix.

Making smart medical devices requires more than brilliant engineers and doctors. It also requires a culture of collaboration between the two groups which has become one of Vanderbilt’s hidden advantages.

“People here want to cooperate and want to integrate. Most schools that have both engineering and medicine don’t have the proximity that we have geographically or the willingness to go through artificial barriers,” said Ron Eavey, M.D., the Guy M. Maness Professor and chair of Otolaryngology.

“Colleagues from other universities are amazed at the amount of access we have to the operating room,” added Robert Galloway, Ph.D., professor of Biomedical Engineering, Neurological Surgery and Surgery.

Collaboration key to commercialization
The unique culture of cooperation, integration and accessibility that exists at Vanderbilt today between the Schools of Engineering and Medicine has been built up over the last 20 years by a cadre of physicians and engineers who saw the value of working together.

Michael Fitzpatrick, Ph.D., professor emeritus of Computer Science, is a senior member of this core group. After coming to Vanderbilt in 1982, he was approached by neurosurgeons George Allen, M.D., Ph.D., and the late Robert Maciunas, M.D. They had an idea for an improved method for properly matching the CT scans taken before an operation which show the location of tumors that are invisible to the naked eye with the features of a patient’s brain revealed during surgery. The process is called registration. Allen’s idea was to replace the cumbersome cage, or frame, that was bolted onto the patient’s head for this purpose with a set of small markers implanted directly into the skull.

Allen, now professor emeritus, convinced the Johnson & Johnson Company to bankroll the effort. They also recruited Galloway, who was a post-doc at the time. It took them seven years, 102 patents and about $1.4 million of the company’s money, but they finally developed a frameless system that could display the precise position of a surgical probe on the image of a brain scan shown on a computer screen.

At the last minute, however, there was a change in leadership at Johnson & Johnson and it dropped the project. “If they hadn’t pulled out, the company could have been the leader in what is now a multibillion dollar a year industry,” said Fitzpatrick.

Although he didn’t make any money from his contributions, Fitzpatrick said that he is content. “It provided me with material for a number of papers. I got promoted to full tenure and the students who contributed have all gotten their degrees and gone on to successful careers.”

Galloway continued working on the technology, but his research took an unexpected turn after he developed a hernia. Following his operation, the surgeon, William Chapman, M.D., who is now at Washington University School of Medicine, asked, “Aren’t you that brain guy?” When Galloway admitted that he was, Chapman explained that they didn’t have a satisfactory way to register CT or MRI scans of the liver.

Galloway realized that the methods they developed for the brain wouldn’t work with the liver so he came up with an alternative technique, called surface-based registration, that would work and modified a laser scanner so that it could map the surface of the liver when inserted through a trocar, a hollow cylinder that surgeons insert through the skin to provide access to internal organs.

Benoit Dawant, Ph.D., left, and Michael Fitzpatrick, Ph.D. Photos by John Russell.

Benoit Dawant, Ph.D., left, and Michael Fitzpatrick, Ph.D. Photos by John Russell.

To commercialize the technology Galloway and Chapman teamed up with Dawant, Alan Herline, M.D., Michael Miga, Ph.D., and Jim Stefansic, Ph.D., to set up the company Pathfinder Technologies. The techniques they developed have since become the state of care for liver surgery and they are now adapting it for the kidney.

Dawant, who is an expert in medical image processing, also struck up a collaboration with Pete Konrad, M.D., Ph.D., associate professor of Neurosurgery and Biomedical Engineering, to improve a new treatment for movement disorders called deep brain stimulation (DBS) that is used when drug therapies fail.

Pete Konrad, M.D., Ph.D., places electrodes deep in the brain to treat movement  disorders when drug therapies fail. Photo by Anne Rayner.

Pete Konrad, M.D., Ph.D., places electrodes deep in the brain to treat movement disorders when drug therapies fail. Photo by Anne Rayner.

DBS involves inserting electrodes deep in the brain that can be highly effective at treating a number of movement disorders including dystonia and Parkinson’s disease and obsessive-compulsive disease as well as neurological diseases such as depression.

Over the last 10 years, Dawant and Konrad successfully developed a new guidance system that uses computerized brain-mapping techniques to direct the implantation of the electrodes, which substantially reduces the time and cost of the operation.

Dawant and Konrad partnered with Pierre-Francoise D’Haese, research assistant professor of Electrical Engineering, to set up the company Neurotargeting LLC to license and commercialize their system, which has now been used in more than 400 operations.

A reverence for robotics
Meanwhile, in mechanical engineering, Michael Goldfarb, Ph.D., established the Center for Intelligent Mechatronics. Although his passion was the design of prosthetic devices, it wasn’t until after the fighting began in Iraq and Afghanistan that federal funding became available so he could pursue his interest.

He has used this support to successfully develop a bionic arm powered by hydrogen peroxide, the first lower limb prosthetic with powered knee and ankle joints, an exceptionally dexterous artificial hand and a powered exoskeleton that allows people with paraplegia to stand and walk.

Michael Goldfarb, Ph.D. Photo by John Russell.

Michael Goldfarb, Ph.D. Photo by John Russell.

Goldfarb, the H. Fort Flowers Professor of Mechanical Engineering, also acted as a departmental champion for recruiting new members interested in medical robotics. In the last few years, the department has added three: Robert Webster, Ph.D., whose expertise involves surgical robotics and related devices that make surgery less invasive and more accurate; Nabil Simaan, Ph.D., who focuses on developing enabling robotic technologies for safe and intelligent surgical interventions including natural orifice surgery; and Pietro Valdastri, Ph.D., whose goal is to turn the science fiction vision of miniature capsule robots working inside the human body into reality.

At the same time, another center of activity emerged in otolaryngology where Robert Labadie, M.D., Ph.D., has been doing pioneering work in using robotics for ear surgery since 2001. In collaboration with Goldfarb, he performed the world’s first mastoidectomy using an industrial robot on a cadaver skull.

“I got the idea when we were remodeling our house. When my contractor told me that he needed the exact dimensions of our new sink because the cut-out in the countertop was made by a robot, I realized that it was crazy for surgeons to still be cutting openings in the skull by hand,” he said.

Robert Labadie, M.D., Ph.D. Photo by Susan Urmy.

Robert Labadie, M.D., Ph.D. Photo by Susan Urmy.

Since then Labadie has collaborated with Fitzpatrick and Dawant on developing a method for semi-automating the delicate surgery of placing electrodes into the cochlea of profoundly deaf patients to restore their hearing. Instead of completely removing the mastoid bone, their approach involves drilling through the mastoid. The procedure is currently undergoing clinical trials.

The collaboration between Vanderbilt engineers and doctors has now spread throughout three engineering departments —biomedical, electrical and computer science and mechanical—and 10 Medical Center departments—surgery, surgical oncology, neurosurgery, gastroenterology, otolaryngology, otology, cardiology, ophthalmology, urology and pathology. 




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