Scottish partnership leads the way.
Robotic-assisted surgery offers many benefits to patients. Keyhole surgery using a surgical robot allows patients to recover more rapidly for example, and robotic surgical systems make it easier for surgeons to undertake complex and delicate operations. Currently however, robotic assisted surgery does not offer surgeons any sense of touch, leaving them reliant on visual information.
There is therefore a need for improved tactile feedback and a partnership between engineers from Heriot-Watt University and surgeons at NHS Lothian/University of Edinburgh promises real benefits. Together the team has developed a method of mechanically palpating human soft tissue using micro-mechanical probes to assess tissue ‘quality’, or stiffness. The engineers and surgeons focused particularly on diseases of the prostate, and have shown that mechanical palpation, or touch, can differentiate between benign and malignant prostate tissue, a valuable additional tool for robotic assisted surgery. Led by Heriot-Watt’s Professor Bob Reuben and Professor Alan McNeill from Lothian University Hospitals and the University of Edinburgh, the group has received funding from the Engineering and Physical Sciences Research Council (EPSRC), the Urology Foundation/John Black Charitable Foundation and the Medical Research Council. As well as showing that their technology can be used to diagnose whether prostate tissue is cancerous or not, the group is continuing to miniaturise it for use in robotic surgical platforms.
This presents engineering and biomedical challenges such as making stiffness measurements at ever smaller scales, down to cell-level, in the living surgical environment and interpreting these measurements in clinical terms. The potential impact of the work is huge, including the possibility of being able to detect and monitor cancer non-destructively at an early stage, which could lead to real breakthroughs in clinical practice. The group has established a start-up company, called Palpation Diagnostics Ltd, which has received Horizon 2020 Phase 1 funding to undertake a feasibility study and market research. This showed a real demand for a device to help in the diagnosis of prostate cancer and the company is looking for further funding to bring their device to market. “Robotic-assisted keyhole surgery is a tremendous tool, allowing surgeons to work with great precision. Cancer changes the texture of the prostate and so touch can be very useful in helping surgeons be even more precise. The palpation tool uses micro-mechanical technology to provide the surgeon with more information about prostate tissue during an operation than they could get even if they could actually handle it,” explains Professor Reuben.
“Our section of the team are engineers, not medics, and when we started work to develop this tool we were thinking of it as a purely diagnostic option,” he continues. “However it has paralleled developments in robotic-assisted surgical tools and now we are hopeful that we can join the two together to provide a really sensitive yet powerful device to support prostate operations.” The recent introduction of robot-assisted laparoscopic radical prostatectomy by Professor McNeill and the team at the Department of Urology at the Western General Hospital presents a further opportunity for collaborative working between health care professionals, engineers and industry. “Minimal access or keyhole surgery performed in high volume centres offers patients the best outcomes and a rapid recovery,” Professor McNeill highlights. “Robot-assisted surgical systems help provide access to these undoubted benefits but currently lack the tactile feedback normally available to surgeons. Our experience of this type of surgery and collaboration with engineering colleagues at Heriot-Watt University provides us with an excellent opportunity to provide this missing element in robotic surgical systems.”