![]() ![]() ![]() At the tip of the arm is a white light source, an optical fiber laser for cauterization, a fiberscope for observation, and a tiny forceps for gripping tissue. The tiny arm can curve through 180 degrees, allowing it to point in every direction including directly back at its entry point. The machine itself is the size and shape of a large Thermos bottle but its business end is only 5.5 millimeters in diameter-about one fifth of an inch-and consists of a segmented robotic arm. The telerobotic system is designed specifically to operate in this challenging environment. “Because you are working through a long, rigid tube, this can be a difficult procedure, especially in some areas of the bladder,” says Herrell. Among the factors that contribute to this persistence is the difficulty of accurately identifying tumor margins and failure to remove all the cancerous cells. But, when the surgeon judges that the tumor is superficial-restricted to the bladder lining-then he or she attempts to remove it using the resectoscope.īladder cancer is so expensive to treat in part because the tumors in the bladder lining are exceptionally persistent and so require continuing surveillance and repeated surgeries. If the surgeon, using endoscopic observation or biopsy, determines that a tumor is invasive and has penetrated the muscle layer, then he later performs a cystectomy that removes the entire bladder through an incision in the abdomen.įrequently this is done using a normal surgical robot. These contortions are also necessary when removing tumors in less accessible areas. The medical team must press and twist the scope or push on the patient’s body to bring other areas into view. In some operations, surgeons replace the cauterizing tool with an optical-fiber laser to destroy tumor cells.Īlthough the endoscope can give a good view of the bladder lining directly across from the opening of the urethra, inspecting the other areas is more difficult. ![]() The instrument contains several channels that allow the circulation of fluid, provide access for an endoscope for observation, and interchangeable cauterizing tools used to obtain biopsy tissue for evaluating the malignancy of the tumor and to resect small tumors. ![]() The traditional method, which Simaan observed, involves inserting a rigid tube called a resectoscope through the urethra and into the bladder. Duke Herrell, an associate professor of urologic surgery and biomedical engineering, who specializes in minimally invasive oncology at Vanderbilt University Medical Center. The specialized telerobotic system “doesn’t take the judgment out of surgeons’ hands, it enhances their capabilities and hopefully gives them surgical superpowers,” comments collaborator S. Its features and capabilities are described in an article published in the April issue of the journal IEEE Transactions on Biomedical Engineering. That experience inspired Simaan to develop a system that uses micro-robotics to perform this difficult type of surgery. “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,” says team leader Nabil Simaan, associate professor of mechanical engineering at Vanderbilt University. It is also designed to make it easier to remove tumors from the lining of the bladder regardless of their location-an operation called transurethral recession. The working end of the bladder cancer telerobot is only 5.5 millimeters in diameter and is shown in a glass flask about the size of a human bladder. ![]()
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