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Toward a miniaturized mechanical surgeon

26 October 2009
Rohan Fernandes, David H. Gracias

Recent advances in sub-millimeter scale engineering suggest the possibility for constructing miniaturized tetherless medical tools for in vivo diagnostics and therapeutics. We review the challenges associated with the design and implementation of small, remotely controlled or autonomous surgical devices. Two key milestones are the creation of tiny mimics of macroscopic surgical devices with chemical, mechanical and electronic functionalities; and wireless strategies to control them or enable independent decision making (autonomous actuation). We summarize early results obtained in this area and discuss possible solutions with a focus on the challenges that can be addressed by innovations in materials science and engineering.

Medical procedures have evolved from open surgeries to minimally invasive surgeries (MIS) that are routinely carried out by inserting a tethered tool into the surgical site of interest. This site is accessed through an already existing orifice or through incisions made by the surgeon, with dimensions ranging from a few millimeters to centimeters. MIS tools typically contain light sources, miniaturized cameras, cutting, grasping and suturing devices.  The surgeon operates the tools from outside the body, which enables the surgery to be performed in a minimally invasive manner. These procedures have dramatically reduced the risk of infection, decreased the duration of the surgery as well as recovery time, and minimized scarring, trauma and blood loss. However, devices used in MIS still require a tether that provides electromagnetic or pneumatic control over the surgical devices and facilitates their entry into and retrieval from the body. Robotic surgical systems like the da Vinci® and Zeus® (Intuitive Surgical) allow a doctor to conduct the surgery with greater degrees of freedom and enhanced precision, in a reproducible manner. It is important to note that there is a considerable learning curve associated with the implementation of both manual and robotic MIS procedures, which may ultimately limit their widespread utilization.

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This article is featured in:
Biomaterials  •  Nanotechnology