Co-founder of TU/e spin-off Microsure, microsurgeon Tom van Mulken, defended his PhD thesis at Maastricht University on October 18th. He studied the safety and capabilities of a surgical support robot for microsurgical procedures.

Thanks to a newly developed surgical robot, reconstructive surgery can be performed more safely and accurately in the future. This is also expected to lead to fewer complications and faster patient recovery.

Precision robot transforms reconstructive microsurgery

Medical technology has been a fascination of mine ever since I was introduced to engineering. I’ve been around medical equipment since I was three years old due to a heart condition, and I used to go into those huge MRI machines not knowing anything about what this technology did. Turns out that it’s a pretty important tool that doctors use to get images inside the body. Not even ten years after the first MRI was taken, the first robotic system was used for a biopsy, thus beginning the history of robotic technology used in medical applications.<h2 dir="ltr">Robotics&nbsp;</h2>The use of surgical robotics wasn’t approved in the US until 1997, when the Food and Drug Administration (FDA) allowed use of the technology for visualization and extraction purposes—only a fraction of its capabilities. Today, robotics help doctors perform minimally invasive surgeries, which allow patients to recover more quickly with less scarring and reduced risk of infection.<img src="https://s3-us-west-1.amazonaws.com/wevolver-project-images/froala%2F1706616150236-51973348978_5ea53c8bec_k.jpg" style="width: 766px;" class="fr-fic fr-dib">Nicolas DUPREY/ CD 78 on FlickrThe goal of using robots in surgical applications is complete autonomy. However, this quickly shifted to robotic systems that are controlled by the surgeon. The da Vinci system was the first FDA-approved controllable system used for medical robotics in North America. This system set the surgical robot standard and continues to grow to more than 6,000 units and 8.5 million operations worldwide1. For minimally invasive surgeries, the da Vinci system allows the surgeon to make precise incisions efficiently, effectively, and with fewer risks of error. The da Vinci system also eliminated the need for an assistant in the operating room, as engineers added a third arm equipped with the tools necessary to complete the procedure.Besides surgical robots, healthcare facilities have also implemented robotic systems such as exoskeletons and delivery robots to help both patients and doctors in their respective activities. Exoskeletons help rehabilitate patients with mobility issues primarily below the waist. Exoskeletons utilize sensors to detect small electrical signals and respond with movement2. At this time, mobile delivery robots have limited uses but currently assist in transporting medication to patients, reminding the patient to take their medicine, and delivering samples to and from the lab.<h2 dir="ltr">Nano-robots</h2>Nanorobotics is the next step in creating life-changing technology for the medical industry. These microscopic robots will be able to travel and think autonomously to find and fix health issues in the body. These tiny bots can be the size of a human hair and will be able to connect and form any shape necessary for treatment. In terms of the sensors used in these nanorobots, you might say that teamwork makes the dream work, as researchers continue to use biological reactions to target and determine what job needs to be accomplished.<img src="https://images.wevolver.com/eyJidWNrZXQiOiJ3ZXZvbHZlci1wcm9qZWN0LWltYWdlcyIsImtleSI6ImZyb2FsYS8xNzA2NjE1OTQ0NDQ3LWxvdWlzLXJlZWQtcHdjS0Y3TDQtbm8tdW5zcGxhc2guanBnIiwiZWRpdHMiOnsicmVzaXplIjp7IndpZHRoIjo5NTAsImZpdCI6ImNvdmVyIn19fQ==" style="width: 768px;" class="fr-fic fr-dib">Photo by Louis Reed on UnsplashWe aren’t quite at the level of Tony Stark’s nanotechnology, but we are closer than ever. Though the nanorobots won’t be able to generate a full body exoskeleton in seconds, nanorobots will have the ability to find and treat damaged cells anywhere in the body. Ideally, this technology will be used for cancer treatment, as there are very few treatment options currently available. However, these microscopic bots will have many more use cases than just medicine. They could be used as research vessels, allowing engineers and scientists to build or discover microscopic properties that were previously unknown to us. Hopefully, this leads us to a real-life nanotech Ironman suit. That would be awesome.We're not quite there yet, but the following product could be an essential step forward. This week’s New Tech Tuesday features the CUI Devices AMT13A Modular Incremental Encoder Kits.The AMT13A series is an industrial-grade encoder with endless industrial use-cases including robotics. Encoders are used to sense motion and determine the position of a shaft using an LED and recording the interruption of light while in use. Having accurate positioning of motors and avoiding unwanted movement of the robot itself is vital to the success of a robot, especially those used for surgical applications. Featuring a rugged design and compact package, the AMT13A series encoder offers high accuracy at 4096 pulses per revolution (PPR) and a low current draw. The modular incremental encoder kit contains various sizes of shaft adapters and a pre-installed alignment tool to get any project fitted with an encoder.<h2 dir="ltr">Conclusion</h2>Medtech is an important and developing industry and robots are increasingly playing a key role in lifesaving procedures. Robotics used in medical applications have been around for over 20 years and the benefits have been nothing short of amazing. Engineers are pioneering the new wave of medicine with the use of robotics in a way we have only seen in movies. Today’s surgical robots provide extreme accuracy and efficiency that has transformed the patient’s experience with smaller incisions, less recovery time, and lower risk of infection. Artificial nanorobots are the next step in the evolution of medical robotics. With the implementation of nanorobots, several medical treatments will become minimally invasive and hopefully be able to cure previously untreatable diseases.

Photo by National Cancer Institute on Unsplash

Nanorobotics is the next step in creating life-changing technology for the medical industry. These microscopic robots will be able to travel and think autonomously to find and fix health issues in the body.

From the da Vinci System to Nanorobots

Understanding the biology behind an embryo&rsquo;s development is crucial not only from a basic science perspective, but also from a medical one. However, we are in dire need for tools that can help us systematically and explore embryonic development.&ldquo;The original experimental approach in embryology is microsurgery,&rdquo; says Andy Oates at EPFL&rsquo;s School of Life Sciences. &ldquo;But it used to be done with a very simple microscope and very simple tools like cactus spines or sharpened pieces of wire. Another problem is that we naturally have a tremor in our hands, which makes microsurgery difficult for some people. It takes years of training, and only some people can do it, so the throughput is very low.&rdquo;<h2>Combining robotics and biology</h2>In an effort to address the current limitations of microsurgery techniques, Oates joined forces with Professor Selman Sakar at the School of Engineering, an expert in microtechnology and small-scale robotics. &ldquo;<a href="https://www.epfl.ch/labs/microbs/" target="_blank">In my laboratory</a>, we have been building robotic tools for tissue micro-manipulation,&rdquo; says Sakar. &ldquo;Together with Andy [Oates], we asked whether we could use some of these tools to facilitate research in embryology in general, to make it more reliable and give it a higher throughput, and in this case to specifically understand the biomechanics of how tissue morphogenesis [the shaping and structuring of a developing tissue] in zebrafish works.&rdquo;The two professors received funding for&nbsp;<a href="https://www.epfl.ch/schools/sv/iphd-program/" target="_blank">an iPhD</a>, a specialized doctoral fellowship at EPFL that combines life science research with another discipline. The iPhD candidate, Ece &Ouml;zel&ccedil;i, trained on both robotics and developmental biology.&ldquo;I think it&#39;s a great program, because, honestly, I would otherwise never have done such interdisciplinary research,&rdquo; she says. &ldquo;It was quite intense; it&#39;s not like you only focus on a single discipline. I learned quite a lot from both fields, and I think it&#39;s a really great opportunity if you want to acquire a unique skill set.&rdquo;<blockquote>...our research enables us to reverse engineer the developmental programs for tissue engineering<footer>Selman Sakar</footer></blockquote><h2>A new robot-assisted platform</h2>Publishing in&nbsp;Nature Communications, the researchers describe the new platform&rsquo;s role as &ldquo;robot-assisted tissue micromanipulation&rdquo;. It is compact (200 x 100 x 70 mm3), high-resolution (4 nm position and 25 &mu;&deg; rotation), and dexterous, with several degrees of freedom. The tool can position itself automatically without any manual intervention and do so with high, reproducible stability.The researchers drew inspiration from related microsurgery systems from ophthalmology and neurology, which are also quite compact and precise, and also rely on microscopes, even though their target objects are often larger than an embryo.The scientists tested the platform&rsquo;s capabilities by using it to study body axis elongation of the zebrafish embryo. &ldquo;<a href="https://www.epfl.ch/labs/oateslab/" target="_blank">Our lab</a> focuses on how the backbone forms, and part of that is how the body elongates, grows out, and segments itself,&rdquo; says Oates. &ldquo;We use the zebrafish embryo as a model, and the idea is to look at the contribution of different parts of the embryo to the process of development. In this case, we look at how embryos elongate themselves and how they segment themselves, and how those two processes interact. Our approach is to physically separate elongation and segmentation by microsurgery, and see how each operates when the other process isn&rsquo;t there.&rdquo;<iframe width="640" height="360" src="https://www.youtube.com/embed/tfQT2B6iJ58?&wmode=opaque&rel=0&enablejsapi=1&origin=https://www.wevolver.com" frameborder="0" allowfullscreen="" class="fr-draggable" data-lf-form-tracking-inspected-kn9eq4roawkarlvp="true" data-lf-yt-playback-inspected-kn9eq4roawkarlvp="true" data-lf-vimeo-playback-inspected-kn9eq4roawkarlvp="true"></iframe>Using the platform, &Ouml;zel&ccedil;i and her colleagues were able to target precise regions of the zebrafish embryo. The robot-assisted microsurgery allowed them to remove the embryo&rsquo;s elongating tail and grow it separately &ndash; a process called explanting, which is often used in embryological research.<blockquote>Our approach is to physically separate elongation and segmentation by microsurgery, and see how each operates when the other process isn&rsquo;t there.<footer>Andy Oates</footer></blockquote>The study revealed a surprising behavior of the embryo&rsquo;s notochord, which acts as an early &ldquo;backbone&rdquo; for the larva when it begins to swim. &ldquo;The notochord pushes so hard inside the tail that it can buckle itself,&rdquo; says Oates. &ldquo;Normally the embryo would elongate uniaxially, but once we physically stopped the process, the notochord kept elongating, generating compressive stresses that led to buckling.&rdquo;<h2>Biology for advancing engineering &ndash; and vice-versa</h2>&ldquo;In addition to embryology, our research enables us to reverse engineer the developmental programs for tissue engineering,&rdquo; says Sakar. &ldquo;If we understand how forces lead to tissue morphogenesis, we could replicate these conditions with engineered tissues&nbsp;in vitro. Like biochemical factors, providing the right mechanical environment and signals is critical for the tissues to develop and function properly.&ldquo;We are also motivated to create biological machines that are designed to perform specific engineering tasks. For example, we would like to engineer mini-hearts that serve as organic pumps with much simpler architecture compared to the real heart. To this end, robot-assisted microsurgery provides not only the construction principles, but also provides the means to manufacture machines from the living matter through&nbsp;<a href="https://actu.epfl.ch/news/tissue-engineering-using-mechanobiology-and-roboti/" target="_blank">mechanically-guided self-assembly</a>.&rdquo;But will such platforms gain broader use? &ldquo;I envision that such robotic micromanipulation tools will become instrumental in every life science laboratory,&rdquo; says Sakar. &ldquo;Regardless of the chosen biological model system, ranging from single cells to organisms, robotics and automation can empower the scientists.&rdquo;&ldquo;Medical robots are quite advanced,&rdquo; he adds. &ldquo;It is time to bring the unique capabilities of surgical robotics to the biomedical research community. Handling biological samples in an automated fashion will increase the throughput, precision, and repeatability of data acquisition while democratizing procedures that require fine skills and years of experience. Combined with intelligent imaging and microscopy, the possibilities are endless.&rdquo;<hr>ReferencesEce &Ouml;zel&ccedil;i, Erik Mailand, Matthias Rüegg, Andrew C. Oates, Mahmut Selman Sakar. Deconstructing body axis morphogenesis in zebrafish embryos using robot-assisted tissue micromanipulation. Nature Communications 24 December 2022. DOI:&nbsp;<a href="https://www.nature.com/articles/s41467-022-35632-4" rel="noopener" target="_blank">10.1038/s41467-022-35632-4</a>

Combining biology and robotics, scientists at EPFL have built a robotic microsurgery platform that can perform high-precision, micrometer-resolution dissections to advance our understanding of how the vertebrate body forms during embryonic development.

A robotic microsurgeon reveals how embryos grow

Image credit: Wyss Institute at Harvard University

Article #8 of Improving Lives with Digital Healthcare Series: Advancements in electronics have transformed the healthcare sector. The focus is on improving the experiences of users by utilizing cutting-edge technologies like advanced drug delivery systems, wearables, surgical robots, and more.

The Next-Generation of Medical Technologies: Digitized, Miniaturized, and Connected

This is the third article in an&nbsp;<a href="https://www.wevolver.com/article/biomedical-instruments-and-the-future-of-digital-healthcare/draft" rel="noopener noreferrer" target="_blank">8-part series</a>&nbsp;featuring articles on Improving Lives with Digital Healthcare. The series focuses on electronic systems that enable innovation in the healthcare industry. This series is sponsored by Mouser Electronics. Through the sponsorship, Mouser Electronics shares its passion for technologies that enable smarter and connected applications.Cardiovascular diseases are among the leading causes of premature deaths globally, accounting for 17.9 million deaths in the year 2019.[1] Advancements in biomedical instrumentation and engineering have made it possible for doctors and surgeons to treat patients and save them from some of the most complicated conditions considered incurable in the past.This article presents an overview of how new sensing, communication, and energy systems, engineered for the healthcare sector can be used to transform cardiovascular disease treatment procedures.<h2 dir="ltr">Precise, Accurate, and Real-Time Sensing for Cardiovascular Procedures</h2>To diagnose and deliver the best therapy and monitor patients after treatment, engineers working on the latest generation of cardiovascular devices are taking full advantage of microelectronics. Improvements in these electronic systems allow designers to integrate multiple modalities within the same instrument.&nbsp;An example of such a sophisticated biomedical instrument is a cardiovascular catheter. It is a commonly used tool that includes a flexible tube directed through a blood vessel to the heart to diagnose or treat certain cardiac diseases such as clogged arteries or irregular heartbeats.[2]&nbsp; The device provides treatment, diagnosis, and monitoring capabilities. Combining different functions into a single cardiovascular catheter enhances the possibilities of minimally-invasive surgery. The integration of multiple modalities in devices like cardiac catheters brings with it considerable complexities.&nbsp;Sensors are vital in understanding the patient&rsquo;s anatomy, with some devices incorporating more than 300 electrodes. Each of these electrodes needs to be connected via a cable to the 3D mapping system. A large number of wires and cables required means the connectors need to feature high contact densities while also delivering superior performance. The voltages detected by these electrodes can be very faint, so contacts with high reliability and low contact resistance are essential to prevent the signal from being lost.These new medical devices must be flexible and adaptable. Every person is different, and their anatomy is unique. Physicians must be able to capture a complete understanding of individual differences with the latest sensors that collect accurate information and generate a high-resolution mapping of the patient&rsquo;s physiology. This advancement in visualization enables faster diagnosis.&nbsp;<iframe id="63c824610d03bb0008bb8ede" width="250" class="specs-iframe" height="400" src="https://wevolver.com/iframe/specs/sensirion-ld20-0600l-liquid-flow-sensor-evaluation-kit?iframe=true" frameborder="0" scrolling="true" data-lf-form-tracking-inspected-kn9eq4roawkarlvp="true" data-lf-yt-playback-inspected-kn9eq4roawkarlvp="true" data-lf-vimeo-playback-inspected-kn9eq4roawkarlvp="true"></iframe>By reviewing the impact of the procedure even while it is still underway, surgeons can be provided with instantaneous feedback on the treatment results. This feedback allows the therapy to be delivered more effectively, reducing the need for post-operative care and the chance that the procedure might have to be repeated.<h2 dir="ltr">New Energy Sources Facilitate Minimally Invasive Cardiovascular Surgeries</h2>Modern sensors enable physicians to deliver treatments with a high degree of accuracy and take advantage of new energy sources for ablation. Doctors are turning to innovative energy sources and advanced sensing technologies to guide diagnosis, treatment, and post-treatment monitoring. Microwaves, cryoenergy, and even lasers allow physicians to treat patients using minimally invasive techniques that deliver great clinical outcomes.Once the physicians are armed with the complete picture of their patient&rsquo;s needs, they provide therapy that will selectively destroy cells within the heart that create abnormal electrical signals. It is imperative that the treatment precisely targets the damaged cells while preserving healthy tissue, and this is among the reasons why new energy sources are so important. The latest instruments can deliver the energy with pinpoint accuracy while monitoring the effects in real-time.&nbsp;The latest technologies allow doctors to operate without the risk of complications with open-heart surgery. Traditional risks to the patient that are reduced with the new procedures include the possibility of strokes, post-operative infections, and long recovery times. Minimally invasive operating technologies improve the patient&rsquo;s experience by reducing the need for extensive post-operative care, lengthy hospital stays, and consequently, their expenses too.<h2 dir="ltr">Hybrid Connectors for Reliable Data Exchange in Biomedical Electronics</h2>Along with low-voltage signal contacts, connectors must deliver the energy needed for the latest technologies. Radio Frequency (RF) energy sources and imaging catheters utilizing transducers need dedicated coaxial contacts. The potential use of lasers means that fiber optic contacts offer the ideal method to deliver therapy, bringing with them yet another form of contact. Optical fibers can also provide illumination and collect high-resolution imagery, providing physicians with the real-time feedback critical to their chances of success.&nbsp;Therefore, the ideal connector solutions for cardiovascular medical devices are typically hybrid, designed to accommodate different contact types. Hybrid connectors can employ a mix of high-density signals, high-power signals, RF, and optical fiber contacts, all within a single assembly that combines compact design and ease of use.<h2 dir="ltr">Molex Connectivity Solutions Power Next-Gen Healthcare Technologies</h2>Molex offers a range of connectors that have been designed specifically for use in the medical industry. Configurable connectors and cable assemblies provide the ability to create customized solutions for the latest generation of cardiovascular surgical equipment.<img src="https://images.wevolver.com/eyJidWNrZXQiOiJ3ZXZvbHZlci1wcm9qZWN0LWltYWdlcyIsImtleSI6ImZyb2FsYS8xNjU5NTk1NjA5Nzk3LTE2NTk1OTU2MDk3OTcucG5nIiwiZWRpdHMiOnsicmVzaXplIjp7IndpZHRoIjo5NTAsImZpdCI6ImNvdmVyIn19fQ==" class="fr-fic fr-dii" alt="Molex MediSpec MPC Interconnect System">Fig. 1: Molex MediSpec MPC Interconnect System<a href="https://www.mouser.com/new/molex/molex-medispec-mpc/" target="_blank">Molex MediSpec Medical Plastic Circular (MPC) Interconnect System</a> combines premium performance and ease of use to meet the stringent standards of medical devices. MediSpec MPC connectors utilize a Molex contact system to ensure a reliable electrical interface and 10,000 mating cycles. MediSpec connectors offer push-pull engagement with a unique locking sleeve.&nbsp;<h2 dir="ltr">Conclusion</h2>Doctors armed with the latest biomedical instruments can now diagnose and treat cardiovascular diseases more precisely. This minimizes the time taken for the patient to recuperate and reduces the strain on overburdened hospitals. The potential for tailored medical care is limitless as sensors grow more accurate and connectivity systems get better. &nbsp;This article was initially published by Mouser and Molex in an <a href="https://www.mouser.com/news/molex-improving-lives-with-digital-healthcare/molex-improving-lives-with-digital-healthcare.html" target="_blank">e-magazine</a>. It has been substantially edited by the Wevolver team and Electrical Engineer <a href="https://www.wevolver.com/profile/ravi.rao" target="_blank">Ravi Y Rao</a>. It&#39;s the third article from the Improving Lives with Digital Healthcare Series. Future articles will introduce readers to some more interesting applications of electronics in healthcare.<hr>Introductory article covered the f<a href="https://www.wevolver.com/article/biomedical-instruments-and-the-future-of-digital-healthcare/draft" rel="noopener noreferrer" target="_blank">undamentals of biomedical instruments and the ways in which digitizing them is transforming healthcare.&nbsp;</a>Article 1 explored the&nbsp;<a href="https://www.wevolver.com/article/design-challenges-in-consumer-and-medical-wearables" rel="noopener noreferrer" target="_blank">design challenges in Consumer and Medical wearables.</a>&nbsp;It showcased how technologies once limited to hospitals are now made available to everyone for monitoring personal health.Article 2&nbsp;was focused on the present state of robotic surgery. <a href="https://www.wevolver.com/article/connectivity-solutions-for-the-next-generation-of-surgical-robots" rel="noopener noreferrer" target="_blank">It explained how advancements in robotics and communication, combined with the expertise of surgeons, enable customized treatments for patients.&nbsp;</a>Article 3 presents an&nbsp;<a href="https://www.wevolver.com/article/sensing-and-energy-systems-for-minimally-invasive-cardiovascular-surgeries" rel="noopener noreferrer" target="_blank">overview of how new sensing, communication, and energy systems, engineered for the healthcare sector can be used to transform cardiovascular disease treatment procedures.</a>Article 4 examined&nbsp;<a href="https://www.wevolver.com/article/next-generation-medical-devices-for-brain-computer-interfaces" rel="noopener noreferrer" target="_blank">Brain-Computer Interfaces and how they help in enhancing human vision, motor recovery for disabled limbs, and more.</a>Article 5 featured an <a href="https://www.wevolver.com/article/designing-medical-devices-for-real-life-an-interview-with-molex-printed-circuit-solutions" rel="noopener noreferrer" target="_blank">informative webchat between Mike Depp, and Glen Capek from Molex, as they discussed trends in flexible electronics driving new solutions for medical wearables applications.&nbsp;</a>Article 6 discussed&nbsp;<a href="https://www.wevolver.com/article/immersive-technologies-in-medical-education" rel="noopener noreferrer" target="_blank">how immersive digital technologies like Augmented Reality (AR) and Virtual Reality (VR) make medical learning more engaging through lifelike experiences.</a>Article 7 <a href="https://www.wevolver.com/article/enabling-early-diagnosis-and-better-postoperative-care-with-remote-health-monitoring-devices" rel="noopener noreferrer" target="_blank">explained the role of wearable devices and their enabling technologies in revolutionizing continuous health monitoring.&nbsp;</a>Final article was&nbsp;<a href="https://www.wevolver.com/article/the-next-generation-of-medical-technologies-digitized-miniaturized-and-connected" rel="noopener noreferrer" target="_blank">a roundup of the entire series that tried to give readers a snapshot of the potential of medical technologies in the present times.</a><hr><h2 dir="ltr">About the sponsor: Mouser Electronics</h2>Mouser Electronics is a worldwide leading authorized distributor of semiconductors and electronic components for over 1,100 manufacturer brands. They specialize in the rapid introduction of new products and technologies for design engineers and buyers. Their extensive product offering includes semiconductors, interconnects, passives, and electromechanical components.<img src="https://images.wevolver.com/eyJidWNrZXQiOiJ3ZXZvbHZlci1wcm9qZWN0LWltYWdlcyIsImtleSI6ImZyb2FsYS8xNjU4NDAwODAzNTQ3LTE2NTg0MDA4MDM1NDcucG5nIiwiZWRpdHMiOnsicmVzaXplIjp7IndpZHRoIjo5NTAsImZpdCI6ImNvdmVyIn19fQ==" class="fr-fic fr-dii"><h2 dir="ltr">References</h2>[1] Cardiovascular diseases (CVDs), 11 June 2021, World Health Organization [Online], Available from: <a href="https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)" target="_blank">https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)</a>[2] Cardiac Catheterization, WebMD, [Online], Available from: <a href="https://www.webmd.com/heart-disease/cardiac-catheterization1" target="_blank">https://www.webmd.com/heart-disease/cardiac-catheterization1</a>

Article #3 of Improving Lives with Digital Healthcare Series: Using real-time sensing, new energy sources, and multifunctional connectors, it's possible to carry out cardiovascular operations with reduced risks and faster recovery time.

Sensing and Energy Systems for Minimally Invasive Cardiovascular Surgeries

This is the second article in an&nbsp;<a href="https://www.wevolver.com/article/biomedical-instruments-and-the-future-of-digital-healthcare/draft" rel="noopener noreferrer" target="_blank">8-part series</a>&nbsp;featuring articles on Improving Lives with Digital Healthcare. The series focuses on electronic systems that enable innovation in the healthcare industry. This series is sponsored by Mouser Electronics. Through the sponsorship, Mouser Electronics shares its passion for technologies that enable smarter and connected applications.Development in robotics has completely transformed the landscape of manufacturing. The speed and precision that make robots valuable for industrial applications also make them attractive in the medical field.&nbsp;In this article, we look at the present state of robotic surgery. We explain how advancements in robotics and communication, combined with the expertise of surgeons, enable customized treatments for patients.&nbsp;<h2 dir="ltr">Advancements in Robotics for Improved Healthcare</h2>Healthcare professionals are constantly developing new techniques to provide the greatest possible care for patients&mdash;treatments that include improved clinical outcomes and reduced hospitalizations. The first robots in the medical world were introduced in the late1980s and were designed to facilitate surgeries with robotic arms and optical instruments.[1]One of the most significant advantages of using robots for surgery is facilitating keyhole surgery or surgery through small ports. Unlike traditional open surgery, a small incision is made in the patient through which a robotic arm is inserted. This arm can &ldquo;extend the surgeon&rsquo;s hands&rdquo; into the precise location of the anatomy where the surgeon will perform the required procedure. The port&rsquo;s small size means that damage to healthy tissue is kept to a minimum, reducing both patient discomfort and the time needed for recovery.Surgeons using surgical robots can perform operations with previously unachievable precision.&nbsp;By making the robot an extension of the surgeon&rsquo;s mind and skills, suturing, dissecting, and retracting tissue can be more precise, guided by 3D cameras that can simultaneously improve visualization and record or stream the procedure.<h2 dir="ltr">Medical Treatments Tailored to the Patient</h2>Because every patient is different and has a unique anatomy, each will uniquely present symptoms. Robotic tools are designed to augment the surgeon&rsquo;s skills in understanding the subtleties involved in treating patients, including how to take patients&rsquo; unique anatomies and disease manifestations into account, with the precision that robotic systems can deliver.Robots in medical procedures allow the surgeon to reach places that would have previously required invasive techniques and their associated hazards. The challenge of providing visualization, precision movement, and tactile feedback to facilitate the surgical procedure, all within minimally invasive instruments and tools, means electronic systems are under increasing pressure to provide more sophistication in smaller packages. Medical robots need to perform all these tasks, and to do so, they must possess communication systems with low latency and high reliability.<h2 dir="ltr">Applying Fiber Optics for Data and Energy Transfer</h2>One of the most exciting aspects of this latest generation of robots is the use of optical technology. Fiber has long been used in the telecommunications industry due to its ability to carry large amounts of data over long distances. In the medical environment too, fiber is being used in different ways.&nbsp;Its small diameter is ideal for employment in minimally-invasive surgery, and its unique properties allow it to be used to provide surgeons with high-resolution, real-time visualization. In addition, new sources of energy are being used to deliver treatment to highly localized areas without damaging the surrounding tissue. One of these techniques is laser therapy, which can be applied with remarkable precision using optical fiber.Elsewhere in the robot, large numbers of sensors are collecting data about everything from the positioning of the device to the resistance being encountered. Data collection is incredibly vital, as surgeons depend on the information provided by the sensors to give the &ldquo;feel&rdquo; or &ldquo;touch&rdquo; of the instrument. The use of haptic controls provides the surgeons with the feedback they need while conducting delicate operations.&nbsp;Therefore, the modern surgical robot is a complex, autonomous device that can serve as an extension of the surgeon&rsquo;s own hands. Far from replacing these professionals with decades of experience, these highly sophisticated machines enable the best surgeons to deliver minimally-invasive care and facilitate faster recovery for patients.<h2 dir="ltr">Integrating Complex Subsystems with Multifuncional Connectors</h2>This sophistication comes at a cost, however. Combining complex functionality into a single machine&mdash;with optimal levels of visualization, precision movement, and tactile feedback&mdash;requires complex electronics systems, and systems engineers are under pressure to deliver the best possible performance in the smallest possible package. This complexity of connections becomes even more significant when the time comes to connect the robot to the outside world.The growing complexity of surgical robots, coupled with the broad range of tasks they need to perform, is creating challenges for interconnect designers. The extensive use of microelectronics and multiple operating modes bring with them the need for higher connector densities and mixed contact types. With the need to incorporate power, signal, high voltage, and even optical fiber, engineers require connector solutions that are adaptable and reliable.<h2 dir="ltr">Molex High-Performance Interconnects for Advanced Medical Applications</h2>Molex has a comprehensive range of connectors that have been designed specifically for use in the medical industry. Its dedicated family of configurable connectors and cable assemblies are instrumental in providing the hybrid connectivity demanded by medical robots.&nbsp;<img src="https://images.wevolver.com/eyJidWNrZXQiOiJ3ZXZvbHZlci1wcm9qZWN0LWltYWdlcyIsImtleSI6ImZyb2FsYS8xNjU4Mzk5NDE1NjUzLTE2NTgzOTk0MTU2NTMucG5nIiwiZWRpdHMiOnsicmVzaXplIjp7IndpZHRoIjo5NTAsImZpdCI6ImNvdmVyIn19fQ==" class="fr-fic fr-dii">Fig. 1:&nbsp;<a href="https://www.mouser.com/new/molex/molex-medispec-mpc/" rel="noopener noreferrer" target="_blank">Molex MediSpec MPC Interconnect System</a><a href="https://www.mouser.com/new/molex/molex-medispec-mpc/" rel="noopener noreferrer" target="_blank">Molex MediSpec Medical Plastic Circular (MPC) Interconnect System</a> combines premium performance and ease of use to meet the stringent standards of medical devices. MediSpec MPC connectors utilize a Molex contact system to ensure a reliable electrical interface and 10,000 mating cycles. MediSpec connectors offer push-pull engagement with a unique locking sleeve.&nbsp;Lightweight medical-grade plastic housings withstand medical industry sterilization processes, including autoclave, ethylene oxide (EtO), gamma, and chemical. An IP64 rating option is available, protecting against dust ingress and splashing water. In addition to various medical applications, these Molex connectors are also ideal for instrumentation, test and measurement, avionics, data acquisition, and entertainment equipment.&nbsp;<h2 dir="ltr">Conclusion</h2>Robots used by doctors performing critical surgeries are expected to handle a large amount of data from various sensors and 3D cameras. At the same time, these robots may also have to deliver optical energy at precise locations if required during the surgical procedure. It is essential to make sure the connectivity infrastructure used in the medical robots performs actions and collects feedback reliably, in real-time.&nbsp;This can be achieved by making use of medical applications-centric connectivity systems. With the right tools in hand, product engineers can be assured their devices for the end-users comply with the highest standards of reliability.This article was initially published by Mouser and Molex in an <a href="https://www.mouser.com/news/molex-improving-lives-with-digital-healthcare/molex-improving-lives-with-digital-healthcare.html" target="_blank">e-magazine</a>. It has been substantially edited by the Wevolver team and Electrical Engineer <a href="https://www.wevolver.com/profile/ravi.rao" target="_blank">Ravi Y Rao</a>. It&#39;s the first article from the Improving Lives with Digital Healthcare Series. Future articles will introduce readers to some more interesting applications of electronics in healthcare.<hr>Introductory article covered the f<a href="https://www.wevolver.com/article/biomedical-instruments-and-the-future-of-digital-healthcare/draft" rel="noopener noreferrer" target="_blank">undamentals of biomedical instruments and the ways in which digitizing them is transforming healthcare.&nbsp;</a>Article 1 explored the&nbsp;<a href="https://www.wevolver.com/article/design-challenges-in-consumer-and-medical-wearables" rel="noopener noreferrer" target="_blank">design challenges in Consumer and Medical wearables.</a>&nbsp;It showcased how technologies once limited to hospitals are now made available to everyone for monitoring personal health.Article 2&nbsp;was focused on the present state of robotic surgery. <a href="https://www.wevolver.com/article/connectivity-solutions-for-the-next-generation-of-surgical-robots" rel="noopener noreferrer" target="_blank">It explained how advancements in robotics and communication, combined with the expertise of surgeons, enable customized treatments for patients.&nbsp;</a>Article 3 presents an&nbsp;<a href="https://www.wevolver.com/article/sensing-and-energy-systems-for-minimally-invasive-cardiovascular-surgeries" rel="noopener noreferrer" target="_blank">overview of how new sensing, communication, and energy systems, engineered for the healthcare sector can be used to transform cardiovascular disease treatment procedures.</a>Article 4 examined&nbsp;<a href="https://www.wevolver.com/article/next-generation-medical-devices-for-brain-computer-interfaces" rel="noopener noreferrer" target="_blank">Brain-Computer Interfaces and how they help in enhancing human vision, motor recovery for disabled limbs, and more.</a>Article 5 featured an <a href="https://www.wevolver.com/article/designing-medical-devices-for-real-life-an-interview-with-molex-printed-circuit-solutions" rel="noopener noreferrer" target="_blank">informative webchat between Mike Depp, and Glen Capek from Molex, as they discussed trends in flexible electronics driving new solutions for medical wearables applications.&nbsp;</a>Article 6 discussed&nbsp;<a href="https://www.wevolver.com/article/immersive-technologies-in-medical-education" rel="noopener noreferrer" target="_blank">how immersive digital technologies like Augmented Reality (AR) and Virtual Reality (VR) make medical learning more engaging through lifelike experiences.</a>Article 7 <a href="https://www.wevolver.com/article/enabling-early-diagnosis-and-better-postoperative-care-with-remote-health-monitoring-devices" rel="noopener noreferrer" target="_blank">explained the role of wearable devices and their enabling technologies in revolutionizing continuous health monitoring.&nbsp;</a>Final article was&nbsp;<a href="https://www.wevolver.com/article/the-next-generation-of-medical-technologies-digitized-miniaturized-and-connected" rel="noopener noreferrer" target="_blank">a roundup of the entire series that tried to give readers a snapshot of the potential of medical technologies in the present times.</a><hr><h2 dir="ltr">About the sponsor: Mouser Electronics</h2>Mouser Electronics is a worldwide leading authorized distributor of semiconductors and electronic components for over 1,100 manufacturer brands. They specialize in the rapid introduction of new products and technologies for design engineers and buyers. Their extensive product offering includes semiconductors, interconnects, passives, and electromechanical components.<img src="https://images.wevolver.com/eyJidWNrZXQiOiJ3ZXZvbHZlci1wcm9qZWN0LWltYWdlcyIsImtleSI6ImZyb2FsYS8xNjU4Mzk5NDE1Mzk0LTE2NTgzOTk0MTUzOTQucG5nIiwiZWRpdHMiOnsicmVzaXplIjp7IndpZHRoIjo5NTAsImZpdCI6ImNvdmVyIn19fQ==" width="720" height="91" class="fr-fic fr-dii"><h2 dir="ltr">References</h2>[1] Moore, Eric J.. &quot;robotic surgery&quot;. Encyclopedia Britannica, 23 Nov. 2018, [Online], Available from: <a href="https://www.britannica.com/science/robotic-surgery" target="_blank">https://www.britannica.com/science/robotic-surgery</a>.

Article #2 of Improving Lives with Digital Healthcare Series: Improved healthcare robots facilitate minimally invasive surgical procedures with features like visualization, precision movement, and tactile feedback. Having a good connectivity infrastructure supporting the devices ensures reliability

Connectivity Solutions for the Next-Generation of Surgical Robots

In this episode, we talk about how a group at MIT has developed an easy-to-use handheld device to treat internal bleeding and a joint effort between MIT and Imperial College London which resulted in a marine mammal call sensor that can leverage machine learning models locally using power generated from the mammal calls. As always, you can find these and other interesting &amp; impactful engineering articles on Wevolver.com.&nbsp;<iframe height="200px" width="100%" frameborder="no" scrolling="no" seamless="" src="https://player.simplecast.com/85e3afbd-7cfe-4610-9f0b-a640df7c26c2?dark=false" class="fr-draggable" data-lf-yt-playback-inspected-kn9eq4roawkarlvp="true"></iframe><hr>This podcast is sponsored by <a href="https://www2.mouser.com/" id="isPasted" rel="nofollow" target="_blank">Mouser Electronics</a>. &nbsp;&nbsp;<img src="https://s3-us-west-1.amazonaws.com/wevolver-project-images/froala%2F1647956698241-Mouser-sponsor-1-a.jpg" style="width: 766px;" class="fr-fic fr-dib"><hr><h3 id="isPasted">EPISODE NOTES</h3>(3:38) -&nbsp;<a href="https://www.wevolver.com/article/handheld-surgical-robot-can-help-stem-fatal-blood-loss/" target="_blank">Handheld Surgical Robot</a>(16:13) -&nbsp;<a href="https://www.wevolver.com/article/ultra-efficient-machine-learning-offers-on-device-inference-powered-solely-by-sound-under-the-sea/" target="_blank">Sound Powered Marine Call Identifier</a>Episode 62 was brought to you by Mouser Electronics, Farbod &amp; Daniel’s favorite electronics distributor. Click <a href="https://eu.mouser.com/empowering-innovation/artificial-intelligence/ai-saves-lives#talksaving" target="_blank">here&nbsp;</a>to read the article discussing the utilization of AI to save lives in rural regions of Africa.<hr>About the podcast:Every day, some of the most innovative universities, companies, and individual technology developers share their knowledge on Wevolver. To ensure we can also provide this knowledge for the growing group of podcast listeners, we started a collaboration with two young engineers, Daniel Scott Mitchell &amp; Farbod Moghaddam who discuss the most interesting content in this podcast series.&nbsp;To learn more about this show, please visit the <a href="https://www.wevolver.com/profile/the.next.byte" target="_blank">shows page</a>. By following the page, you will get automatic updates by email when a new show is published.Be sure to give us a follow and review on <a href="https://podcasts.apple.com/nl/podcast/the-next-byte/id1548255861?l=en" rel="nofollow" target="_blank">Apple</a> podcasts, <a href="https://open.spotify.com/show/6lPPsRtegnivsRUEsQ09R7?si=IPMiah7xT_apJtPjqvXMlA" rel="nofollow" target="_blank">Spotify</a>, and most of your favorite podcast platforms!

Matt Johnson (right) and Laura Brattain test a new medical device on an artificial model of human tissue and blood vessels. The device helps users to insert a needle and guidewire quickly and accurately into a vessel, a crucial first step to halting rapid blood loss. Photo: Nicole Fandel

In this episode, we talk about how a group at MIT has developed an easy-to-use handheld device to treat internal bleeding and a joint effort between MIT and Imperial College London which resulted in a marine mammal call sensor that can leverage machine learning models locally

Podcast: AI Powered Devices For Saving Lives & Studying Oceans

In the last decade, robots started to use artificial intelligence and deep neural networks to analyze and process data to recognize and predict patterns– later becoming a vital part of the healthcare system. Starting with early detection of diseases, assisting people with disabilities, provision of telemedicine services to performance of surgery, robot-assisted surgery is an invasive technique that assists surgeons to perform complicated surgical procedures. However, it is very important to know patients’ perception of having surgical procedures performed on them by robots and what are the reasons for people to trust the robots being used in surgical intervention. In the paper, “Do People Trust in Robot-Assisted Surgery? Evidence from Europe” the team reports that “as the experience of using robots increases, the predictive coefficients related to information, attitude, and perception of robots become more negative” [1].Autonomous anastomosis has been one of the challenging soft tissue surgeries as they require intricate imaging, tissue tracking and surgical planning techniques along with precise execution in unstructured environments. While in a laparoscopic setting, these surgeries introduce more challenges as they require high maneuverability and repeatability under limited access and visibility of the target tissue. To solve these challenges faced by surgeons, robot-assisted surgeries play a vital role in reducing complexity and improving efficiency. A team of researchers affiliated with the University of North Carolina, John Hopkins University in Baltimore and Children’s National Hospital in Washington proposed an enhanced autonomous strategy for laparoscopic soft tissue surgery and demonstrated robotic laparoscopic small bowel anastomosis in phantom and in vivo intestinal tissues.<h2 dir="ltr">Autonomous Robotic Laparoscopic Surgery</h2>In the paper, “Autonomous robotic laparoscopic surgery for intestinal anastomosis” the researchers developed a smart tissue autonomous robot (STAR) with several autonomous features including a tissue-tracking system, detecting the breathing motion of tissues, detecting robot tool failure, controlling camera motion and many more [2]. All of these autonomous features make the system highly autonomous in deformable environments unlike the existing works of low autonomy in complex tasks or high autonomy in simpler tasks. The main objective was to increase overall accuracy while reducing operator workload and maintaining safety for patients to trust robot-assisted surgeries.&nbsp;Another contribution made by the researchers is a machine learning technique to track tissue movement in response to patient breathing. This will help the robot to operate under motion constraints which lacked in the previous work for open surgical intestinal anastomosis [3]. “We demonstrate implementation of such soft tissue robotic surgeries in a series of in vivo survival studies via porcine models for laparoscopic bowel anastomosis,” the team notes in the research article.<h2 dir="ltr">Smart Tissue Autonomous Robot</h2><img src="https://s3-us-west-1.amazonaws.com/wevolver-project-images/froala%2F1646772675282-Smart+Tissue+Autonmous+Robot+Surgery.png" style="width: 800px;" class="fr-fic fr-dib" alt="Smart Tissue Autonomous Robot Surgery">Smart Tissue Autonomous Robot Surgery System [Image Source: Research Paper]<div style='pointer-events: none; overflow: hidden; padding-bottom: 2px; z-index: auto; position: absolute; left: 0px; top: 495.925px; height: 39px; width: 766px; font-style: normal; font-variant: normal; font-weight: 400; font-stretch: 100%; font-size: 14px; font-family: "PT Serif", serif; text-align: center; text-transform: none; letter-spacing: normal; word-spacing: 0px; tab-size: 8;'> </div>The STAR architecture consists of a KUKA LBR Med robot with integrated motorized Endo 360 suturing tool for robotic suturing and a KUKA LBR Med robot that carries an endoscopic dual-camera system consisting of a NIR camera and a 3D mono-color endoscope. The onboard camera system is incorporated for autonomous tracking of biocompatible NIR markers on the target tissue and constructing a 3D surface of the tissue, which is used for suture planning. The STAR system also allows tracking of the breathing motion of a patient&nbsp;“The 2D view of the camera was also used as visual feedback for the operator when supervising the autonomous control (Fig. A). The view is provided from the 3D mono-color endoscope when it is not running in the point cloud collection mode, which can be confusing to the operator.”The general workflow of the enhanced autonomous STAR system starts with initiating a planning sequence using the GUI (Fig. B) that uses a tissue-tracking algorithm to generate two suture plans (for stationary tissue), which are then filtered for noise and STAR predicted tool-tissue collision. Once the plan is approved, the suture placement routine takes place by moving the tool to the location of the first planned suture. As precision is very important for such complex surgeries, the STAR system detects if the change in tissue position is greater than 3mm compared with the current surgical plan, it notifies the operator and goes back to step 1 of initiating a new suture planning.&nbsp;“In the instances when a planned stitch was not placed correctly or if the suture did not extend across two tissue layers, the operator repeated the last stitch with a slight position adjustment via the GUI before the STAR continued to execute the suture plan. It is worth noting that although direct intervention from the operator was used to correct missed stitches, most of the workflow was completed in an autonomous manner,” the team argues. "This strategy can be expanded in future works whereby the STAR system autonomously detects, adjusts, and repeats a missed stitch to result in a completely autonomous anastomosis procedure."More details on the performance of the STAR system can be found in the research work available in the ScienceRobotics journal under <a href="https://www.science.org/doi/10.1126/scirobotics.abj2908" target="_blank">closed-access terms</a>.&nbsp;<h2 dir="ltr">References</h2>[1] Torrent-Sellens J, Jiménez-Zarco AI, Saigí-Rubió F. Do People Trust in Robot-Assisted Surgery? Evidence from Europe. Int J Environ Res Public Health. 2021 Nov 28;18(23):12519. DOI: 10.3390/ijerph182312519. PMID: 34886244; PMCID: PMC8657248.[2] H. Saeidi, J. D. Opfermann, M. Kam, S. Wei, S. Leonard, M. H. Hsieh, J. U. Kang, and A. Krieger, “Autonomous robotic laparoscopic surgery for intestinal anastomosis,” Science Robotics, vol. 7, no. 62, 2022.&nbsp;[3] A. Shademan, R. S. Decker, J. D. Opfermann, S. Leonard, A. Krieger, P. C. W. Kim, Supervised autonomous robotic soft tissue surgery. Sci. Transl. Med. 8, 337ra64 (2016).

Smart Tissue Autonomous Robot for Autonomous Laparoscopic Soft Tissue Anastomosis [Image Source: Research Paper]

An enhanced autonomous strategy for laparoscopic soft tissue surgery and demonstrated robotic laparoscopic small bowel anastomosis in phantom and in vivo intestinal tissues.

Can robot-assisted laparoscopic surgery exhibit high levels of autonomy?

Russell H. Taylor has over 40 years of professional experience in the fields of computer science, robotics, and computer-integrated interventional medicine. &nbsp;He received a Bachelor of Engineering Science degree from Johns Hopkins University in 1970 and a Ph.D. in Computer Science from Stanford University in 1976.&nbsp;He joined IBM Research in 1976, where he developed the AML robot language and managed the Automation Technology Department and (later) the <a href="http://cs.jhu.edu/~rht/RHT%20Medical%20Robotics%20Research%20at%20IBM.html" target="_blank">Computer-Assisted Surgery Group</a> before moving in 1995 to Johns Hopkins, where he is the John C. Malone Professor of Computer Science with joint appointments in Mechanical Engineering, Radiology, and Surgery. &nbsp;He is also the Director of the <a href="https://lcsr.jhu.edu/" target="_blank">Laboratory for Computational Sensing and Robotics (LCSR</a>) and of the (graduated) NSF Engineering Research Center for Computer-Integrated Surgical Systems and Technology (CISST ERC).Dr. Taylor’s research interests include robotics, human-machine cooperative systems, medical imaging &amp; modeling, and computer-integrated interventional systems. He is Editor-in-Chief Emeritus of The IEEE Transactions on Robotics and Automation, and has served on numerous other editorial and scientific advisory boards. &nbsp;In 1994 he was elected as a Fellow of the IEEE “for contributions in the theory and implementation of programmable sensor-based robot systems and their application to surgery and manufacturing”, and he is also a fellow of the National Academy of Inventors, of the AIMBE, of the MICCAI Society, and of the Engineering School of the University of Tokyo. In 2020, Dr. Taylor was elected to the National Academy of Engineering “for contributions to the development of medical robotics and computer-integrated systems.” &nbsp;He is also a recipient of numerous awards, including 4 IBM Outstanding Achievement Awards; 4 IBM Invention Awards; the Maurice Müller Award for Excellence in Computer-Assisted Orthopaedic Surgery; the IEEE Robotics Pioneer Award; the MICCAI Society Enduring Impact Award; the IEEE EMBS Technical Field Award; and the Honda Prize.<h1>Soft Robotics with&nbsp;Russell Taylor</h1>Marwa ElDiwiny, host of the Soft Robotics podcast, interviews Rusell about Redundancy And The Unavoidable Trade-offs At Surgical Robotics.<iframe src="https://open.spotify.com/embed/episode/6COMP0eZxbR3PPQMPe5Kjo" width="100%" height="232" frameborder="0" allowtransparency="true" class="fr-draggable"></iframe>

On Redundancy And The Unavoidable Trade-offs At Surgical Robotics

Russell Taylor "Surgical Robotics"

Flexible endoscopes can snake through narrow passages to treat difficult to reach areas of the body. However, once they arrive at their target, these devices rely on rigid surgical tools to manipulate or remove tissue. These tools offer surgeons reduced dexterity and sensing, limiting the current therapeutic capabilities of the endoscope.Now, researchers from the&nbsp;<a href="http://seas.harvard.edu/" target="_blank">Harvard John A. Paulson School of Engineering and Applied Sciences</a> and&nbsp;<a href="http://wyss.harvard.edu/" target="_blank">the Wyss Institute for Biologically Inspired Engineering</a> at Harvard University have developed a hybrid rigid-soft robotic arm for endoscopes with integrated sensing, flexibility, and multiple degrees of freedom. This arm &mdash; built using a manufacturing paradigm based on pop-up fabrication and soft lithography &mdash; lies flat on an endoscope until it arrives at the desired spot, then pops up to assist in surgical proceduresThe research is described in <a href="http://onlinelibrary.wiley.com/doi/10.1002/admt.201700135/full" target="_blank">Advanced Materials Technologies</a>.<img src="https://s3-us-west-1.amazonaws.com/wevolver-project-images/froala%2F1569906785018-ArmwithWritingWeb.jpg" style="width: 766px;" class="fr-fic fr-dib">Multi-articulated soft pop-up robotic arm. Concept of the system (left): An endoscope navigating in the GI tract and detail of the arm mounted at the tip of the endoscope. Soft pop-up arm (right) performing tissue counter-traction during an ex-vivo test on a porcine stomach (Image courtesy of Harvard University)Soft robots are so promising for surgical applications because they can match the stiffness of the body, meaning they won&rsquo;t accidentally puncture or tear tissue. However, at small scales, soft materials cannot generate enough force to perform surgical tasks.&ldquo;At the millimeter scale, a soft device becomes so soft that it can&rsquo;t damage tissue but it also can&rsquo;t manipulate the tissue in any meaningful way,&rdquo; said Tommaso Ranzani, a postdoctoral fellow at SEAS and the Wyss Institute and coauthor of the paper. &nbsp;&ldquo;That limits the application of soft microsystems for performing therapy. The question is, how can we develop soft robots that are still able to generate the necessary forces without compromising safety.&rdquo;Inspired by biology, the team developed a hybrid model that used a rigid skeleton surrounded by soft materials. The manufacturing method drew on previous work in origami-inspired, pop-up fabrication, developed by Robert Wood, the Charles River Professor of Engineering and Applied Sciences.Wood coauthored the paper and is a Core Faculty Member of the Wyss Institute. &nbsp;Previous pop-up manufacturing techniques &mdash; such as those used with the&nbsp;<a href="http://micro.seas.harvard.edu/research.html#flapping" target="_blank">Robobees</a> &mdash; rely on actuation methods that require high voltages or temperatures to operate, something that wouldn&rsquo;t be safe in a surgical tool directly manipulating biological tissues and organs.So, the team integrated soft actuators into the pop-up system.&nbsp;&ldquo;We found that by integrating soft fluidic microactuators into the rigid pop-up structures, we could create soft pop-up mechanisms that increased the performance of the actuators in terms of the force output and the predictability and controllability of the motion,&rdquo; said Sheila Russo, postdoctoral fellow at SEAS and Wyss and lead author of the paper. &ldquo;The idea behind this technology is basically to obtain the best of both worlds by combining soft robotic technologies with origami-inspired rigid structures. Using this fabrication method, we were able to design a device that can lie flat when the endoscope is navigating to the surgical area, and when the surgeon reaches the area they want to operate on, they can deploy a soft system that can safely and effectively interact with tissue.&rdquo;The soft actuators are powered by water. They are connected to the rigid components with an irreversible chemical bond, without the need of any adhesive. The team demonstrated the integration of simple capacitive sensing that can be used to measure forces applied to the tissue and to give the surgeon a sense of where the arm is and how it&rsquo;s moving. The fabrication method allows for bulk manufacturing, which is important for medical devices, and allows for increased levels of complexity for more sensing or actuation. Furthermore, all materials used are biocompatible. &nbsp;The arm is also equipped with a suction cup &mdash; inspired by octopus tentacles &mdash; to safely interact with tissue. The team tested the device ex vivo, simulating a complicated endoscopic procedure on pig tissue. The arm successfully manipulated the tissue safely.<img src="https://s3-us-west-1.amazonaws.com/wevolver-project-images/froala%2F1569906823020-ArmPigWeb.jpg" style="width: 688px;" class="fr-fic fr-dib"><div class="inline-image">Soft pop-up arm performing tissue counter-traction during an ex-vivo test on a porcine stomach (Image courtesy of Harvard University)</div>&ldquo;The ability to seamlessly integrate gentle yet effective actuation into millimeter-scale deployable mechanisms fits naturally with a host of surgical procedures,&rdquo; said Wood. &ldquo;We are focused on some of the more challenging endoscopic techniques where tool dexterity and sensor feedback are at a premium and can potentially make the difference between success and failure.&rdquo;The researchers demonstrated that the device could be scaled down to 1 millimeter, which would allow it to be used in even tighter endoscopic procedures, such as in lungs or the brain.Next, the researchers hope to test the device&nbsp;in vivo.&ldquo;Our technology paves the way to design and develop smaller, smarter, softer robots for biomedical applications,&rdquo; said Russo.

SEM images of the hybrid soft pop-up actuators. The image has been colored in post processing to differentiate between the soft (in yellow) and the rigid structure (in blue) (Image courtesy of the Wyss Institute at Harvard University)

Bioinspired approach combines pop-up fabrication with soft robotics

Smaller, smarter, softer robotic arm for endoscopic surgery

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surgical robots

surgical robots

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