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

Pierpaolo Petruzziello uses his thoughts to control the Life Hand prosthetic which is directly wired to his nerves.

Scientists are becoming increasingly adept at creating machines that can successfully attach to your neurons. In the realm of prosthetics, the ultimate artificial hand is one that can accept commands directly from the user’s brain and transmit sensation back. At the Universita Campus Bio Medico in Rome, surgeons connected wires from the nerves of an amputee named Pierpaolo Petruzziello to an artificial limb called Life Hand. Over a month, Petruzziello was able to move the mechanic limb in gestures more complex than any previous device has accomplished. Researchers report that the Life Hand obeyed about 95% of the commands mentally sent by Petruzziello. This remarkable success was possible even though the hand itself was never implanted onto the patient. Check out the videos from the Associated Press and Discovery News after the break.

If the specifics of Life Hand are giving you a mild sense of deja vu, you’re not alone. In late October I reported on Smart Hand, a similar device tested in Sweden on a different young man – Robin af Ekenstam. The two projects are actually related. Both were part of a larger EU task force working on artificial limbs. If the Life Hand and Smart Hand look nearly identical, that shouldn’t be surprising either, considering that both were constructed at the Scuola Superiore di Sant’Anna in Italy. The largest difference between the two devices (besides the name) is that the Smart Hand is taking steps towards implantation, while the Life Hand is focusing on the complexity of gestures and reliability of signals to/from the device.

It’s a little strange that each innovation in science and technology is presented as a completely separate achievement in the major media outlets. The work done in Sweden and Italy for these artificial limbs is related and enjoys a healthy level of collaboration. Which is good news for those interested in one day owning an artificial limb. The more that data is shared between these groups (and their competitors from around the world) the quicker we’ll see a device that can accurately replace a human hand. However, as we discussed with Deka’s Luke Arm and DARPA’s Revolutionizing Prosthetics program, such a hand may be too costly for most people to afford for years after it debuts.

Eventually though, the price of prosthetics will decline just as all other accelerating technologies tend to do. And I think the Life Hand definitely shows that prosthetics is an accelerating technology. The degree of gestures that it can perform is very promising, even if, as Petruzziello has joked, those gestures were sometimes obscene.

[video credits: Associated Press, Discovery News]

The Smart Hand allows its user to feel what it senses, allowing for precise control.

When Luke Skywalker has his hand cut off in The Empire Strikes Back, he simply has it replaced with a mechanical one that looks, moves, and feels like a real hand. Now, whether you have lost your limb to a lightsaber or a disease, there is a real world equivalent to Luke’s bionic fist: the Smart Hand. Developed by EU researchers, the Smart Hand is a complex prosthesis with four motors and forty sensors designed to provide realistic motion and sense to the user. That’s right, Smart Hand is the first device of its kind to send signals back to the wearer, allowing them to feel what they touch. The first time I saw this, it completely blew my mind. Take a look at the video from BBC News after the break.

Generally when we’ve discussed haptics (sense of touch interfaces), it has been in relation to remote access or telepresence robots. At once, the use of haptics in prostheses is both more intuitive and more intimate. The ability to create feeling extensions of one’s body has implications beyond the (not so) simple creation of life-like limbs. We could see bionic replacements that augment human physicality beyond the normal limits. These replacements, if accompanied by an advanced sense of touch, would have all the benefits of a natural part of your body and yet function better. Full body replacement, or rather body displacement, is the stuff of science fiction movies like Surrogates. Yet if we find a way to perfectly translate mechanical sensation to human sensation, there would be little technological obstruction to extending our consciousness outside our biological bodies.

Phantom limb syndrome is the sensation amputees have that their missing body part is still there. The brain has remained open to receiving input from those nerves although they were cut off long ago. Likewise, impulses from the brain to control the missing limb still travel down the neurons towards the sight of amputation. Scientists can use electronic sensors to pick up the control signals and relay them to a mechanical device. We’ve seen this technology used in the HAL exoskeleton from Cyberdyne, and in the i-Limb prostheses. Smart Hand is unique because it also takes advantage of those phantom limb pathways still being open. Doctors connect the sensors in the hand to the nerves in the stump of the arm. Now, patients can feel as well as control an artificial limb.

The Old You…Maybe Better?

The goal of the Smart Hand project is to create a replacement limb that is as near to identical to the lost one as possible. This means creating a prosthesis that functions and relays sensory input like a normal biological hand. In both objectives, the Smart Hand is far from ultimate success. Four motors, though providing an impressive range of motion, do not have the full degrees of freedom, nor the variation in applied strength that a human hand has. Likewise, it is amazing that the forty sensors can communicate with the human brain at all, but they do not provide nearly as much sensation as the millions of nerves in your biological hand. Yet, as mentioned in the video, the current Smart Hand prototype represents more than ten years of dedicated work.

I only point out the current limitations of Smart Hand to better highlight its enormous potential. Robin af Ekenstam (the patient in the video) can pick up objects, and can feel the fingertips of the prosthesis even at this stage of development. It is clear from his involvement in this project that this level of capability is well worth the time and effort involved. In other words, an imperfect Smart Hand is still a very desirable hand, and can perform remarkable tasks. What happens as Smart Hand gets even better?

The number of scientists dedicated to answering that question is rather astounding. In the Smart Hand project we see the work primarily of Lund University in Sweden and the Scuola Superiore Sant’Anna in Italy, but contributors include researchers in Denmark, Israel, Ireland, and Iceland. We’ve seen many other successful prosthetic companies including i-Limb, DEKA, and Ossur. A good number of robotic hand projects work in parallel with prostheses research, including the gentle SDM robotic hand we recently discussed. On the frontier of nerve-machine connectivity are projects like Braingate, which directly connect motor nerves to computers.

Clearly, there is an abundance of resources being directed at all angles of this research coming from many different regions and fields of expertise. When we consider these resources we can rest assured that although it has taken ten years to give us the current version of Smart Hand, it will take much less time to make large improvements upon the technology. Whether or not those improvements occur in this project, or another, it is likely that prosthetic work could see some sort of exponential growth in the upcoming years.

Which means that sooner than we may think, those suffering from missing limbs may be able to heal themselves to a degree beyond their expectation. In the next several years, perhaps decades, prostheses may come to match our natural bodies in most meaningful ways.

Beyond that, of course, sits the realm of abject speculation, but if artificial limbs will one day match the human ones, there’s no reason they couldn’t be further improved. We would then see bionic limbs, or perhaps entirely bionic bodies, which exceed human limitations. Could these mechanical bodies be accepted as authentically human? Already the Olympics have decided that some athletes with prostheses have an unfair advantage and are ineligible to compete. In the years to come we will see how society at large reacts when “good enough” becomes “good as new” and finally “better than ever”.

[photo credit: Smart Hand Project]

[video credit: BBC News]