A robotic surgeon at Duke University has successfully found and guided a needle to a sliver of steel shrapnel, completely without human help. The technology could reduce the cost and time necessary to complete a biopsy and other surgical operations.
"Eventually you could have a ten-dollar biopsy done inside in a supermarket," said Steve Smith, a doctor at Duke University and co-author of a paper describing the work in the journal IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.
"Today that same biopsy would cost about $1,000," said Smith.
Locating a piece of shrapnel is only the latest demonstration of the autonomous robotic surgeon. Over the last two years, the team at Duke, including recent graduate A.J. Rogers, successfully performed two other tasks.
The first was locating a needle with 3-D ultrasound, and then touching that needle with another needle.
The second successful task for the robot surgeon was to locate, and then biopsy, a tumor inside a turkey breast.
About six months ago, the scientists upgraded their robot. The new robot, with six articulating joints and about the size of a suitcase, was tasked with finding a piece of steel shrapnel two millimeters by less than one millimeter submerged inside a water bath.
The new robot made it easier to find the shrapnel. The size of the shrapnel made it more difficult than the first two tasks; it was so small that it didn't appear on the ultrasound. To make it larger, the Duke scientists used a high-powered magnetic field to vibrate the sliver. All that was left was for the needle to reach out and touch the tiny metal piece.
"We keep giving the robot more and more complex tasks," said Smith. "So far the robot has been able to accomplish these tasks automatically."
Each task took an average of three minutes for the ultrasound to image, the computer to map and the needle to touch the object. Using a modern ultrasound machine (the Duke researchers use one more than ten years old) and a more powerful laptop would speed the process up to about a minute. That's roughly the same amount of time that it would take a human surgeon to complete the same procedure.
Where the time and money savings would come is taking out the human middle man. For example, human operators would have to perform a mammogram and send the results to a radiologist, who reads the image. The patient would then have a biopsy. The entire process can take a week or more. Optimized, robotic biopsies could cut that time down to hours.
Independent robot surgeons could be used for other medical procedures as well, said Smith. Using the needle, the robot could apply local anesthetics. The needle could also be replaced with a number of different tools developed for minimally invasive surgery, clearing the way for a variety of medical procedures.
"There is no limit to the way this technology could be used as long as the artificial intelligence progresses to the point where it would avoid blood vessels or nerves," said Smith. "But right now this is an early stage feasibility study."
Other doctors concur. "The robotics are certainly getting more reliable," said Paul Carson, a professor of radiology at the University of Michigan. "And when you combine that with detailed imaging of the needle and its path, this is an eminently approachable technique."
Both Carson and Smith agree that it will take about ten years for fully automated robotic surgery to become a reality. Like most medical technology, it will likely be more expensive than using a human surgeon, but eventually the cost-saving -- and life-saving -- technology will become widely available.