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Ingestible Surgical Robots—Hard To Swallow Concept?

No, it’s not a LEGO space station. This is ARES, the self-assembling robot you may someday have to swallow.

Medical robots are advancing at phenomenal speed, and within years micro-sized robots could be assisting surgeons with operations from inside their patients. Scuola Superiore Sant’Anna’s CRIM Lab in Italy has developed a robot called ARES (Assembling Reconfigurable Endoluminal Surgical System) that will be assembled inside the human body. This modular design is leading the way for a new breed of device that may one day take the place of our most trusted surgeons’ hands. ARES may only be a concept at present, but the project represents amazing new possibilities in the field of robotic surgery.

Engineers behind the ARES project are thinking up ways to bypass external surgery altogether—by operating from within the patient. The ARES robot was designed to self-assemble inside the body after patients swallow up to 15 parts. Using a modular approach, each of these parts would have its own role to play—image control, communications, structural functions and diagnostics, among others—while forming whatever the structure needed to carry out a particular operation. Weighing in at 5.6g, each module is 15.4 mm in diameter and 36.5 mm in length, and each represents a single pill to be ingested by the patient. Computer simulation would be essential to determine setup for each operation; medical data including scanned images would allow doctors to test procedures before selecting the appropriate modules.

 ARES Project SSSA

ARES poking around in a human stomach.

Patients would ingest liquid prior to the operation in order to distend the stomach. Once inside, ARES would be assembled at the intervention site—magnetic assembly is currently on the drawing board—and disintegrate or be expelled naturally once the operation is over. The program is currently focusing on the digestive tract—a logical site due to its relative size to the robot. If this type of surgery is to work elsewhere in the body, modules will have to be a lot smaller.

Current robotic devices, like the Da Vinci, make surgery less invasive, but controlling robosurgeons on the outside still requires external incisions. Benefits of an ARES style system include avoiding incisions and minimizing pain, expediting patient recovery. Also, modules would be able to excise biopsy samples from the body to be examined post-op. Then there’s increased mobility. This new breed of medical robot could one day emulate biological organisms like insects and bacteria, in order to travel more freely through our bodies. And because ARES would be present in the body’s natural environment, diagnostics would be less limited than those run using traditional optical methods.

If successful, the prototype will inspire new designs, including other ingestible robots made to enter the body through natural orifices, or those injected through tiny incisions. The same scientists developing ARES in Italy have also produced the ‘spider pill’—a camera in a pill doctors can navigate using remote-controlled legs (something new for camera pills). Even if the thought of spiders crawling inside of you is a bit disturbing, this is real progress. Go to 0:17 to see a brief shot of the ARES concept in the video below:

Capsule endoscopy (the technology that uses swallowed video capsules) has been successfully used for years, but despite its progress, actually using these systems could be difficult. New robotic procedures deprive surgeons of their sense of touch, which creates a ‘blind spot’ for sensing tension and pressure. Ingestible robot surgery puts robots further out of grasp—the only connection being a screen facsimile of the patient’s interior. While haptic technology may eventually solve sensory deprivation in the operating room, no usable methods exist. Novel computer systems require professionals to adopt new approaches to familiar situations and, with the case of ingestible robots like ARES, concerns with citotoxicity and other biocompatibility issues will most-likely stall development. Also, it hasn’t been determined as to how these robots will exit the body once operations are completed. What potentially hazardous elements might these robots leave behind?

Regardless, becoming skilled in robotic surgery is the most promising way for surgeons to address their human limitations. If successful, the ARES project would greatly impact the future of surgery. There’s only two real questions: How long will this revolutionary method take to develop?  And, will the pills come in red and blue?

[image credit: ARES Project SSSA]

[source: BBC, ARES NEST, Professional Engineering Publishing]

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