Though the da Vinci Surgical System seems like cutting-edge technology, most surgeons are quick to admit that it a first-generation device — the model T Ford of its kind.
Strong collaborations exist between Vanderbilt University Medical Center surgeons and School of Engineering engineers, allowing development of the next generation of surgical technology.
“There are a lot of places interested in capitalizing on robotics, but there aren’t a lot of places working to make it better,” said Duke Herrell, M.D., associate professor of Urologic Surgery. “One of the things I love about Vanderbilt is that we have this great undergraduate and graduate campus next door. I can walk right over and be in their lab and talk about new innovations.”
Herrell collaborates closely with Bob Galloway, Ph.D., and Michael Miga, Ph.D., professors in the Department of Biomedical Engineering. Their current focus is image-guided surgery, the premise of which is to easily show the surgeon the tissue structure in the operating field and where instruments are in relation to it.
Current image-guidance systems use scans that were taken days or weeks before the surgery. As time elapses or the surgeon operates, those scans become more and more inaccurate. Miga develops mathematical models predicting how tissue decays and Galloway incorporates that into the image shown to the surgeon, giving him or her a highly accurate presentation of the tissue in real time.
“Imagine seeing clearly on a screen the three-dimensional kidney, all its vital structures and the tumor you want to remove. As you’re operating, you know when you are about to hit a blood vessel or critical nerve,” Herrell said.
The group’s work won Best Research Paper at the World Congress of Endourology last year, and they say that the close partnership between engineering and surgery is the key to their success.
“You have to have engineers, who are true innovators and constantly want to change things, teamed with surgeons who understand the real-world task, so that what comes out is something useful,” Galloway said.
An area with major potential for robotic innovation is Neurosurgery because the da Vinci is too large to fit in many areas around the brain.
“We have many orifices, like the nose and mouth, to access the brain, it’s just a matter of developing the next technology to get us in there safely and accurately,” said Reid Thompson, M.D., chair of the Department of Neurological Surgery.
Robert Labadie, M.D., Ph.D., associate professor of Otolaryngology and Biomedical Engineering, and Robert Webster III, Ph.D., assistant professor of Mechanical Engineering, head a team developing a truly autonomous robot and recently demonstrated the world’s first robotic mastoidectomy on a human cadaver. (Video available at www.vanderbilt.edu/caos.)
Labadie’s team has also used robotic technology to develop a minimally invasive approach for cochlear implantation that is under FDA review for clinical implementation.
“A lot of people say we don’t really need these robotic innovations. They’re expensive and we have good outcomes as it is,” Herrell said. “But I’m not happy with the status quo. I don’t think we’ve figured everything out. We can always be better.”