Implantable biorobotic organs.
Implantable biorobotic organs.
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DOI：
10.1063/5.0032508
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发表时间：
2020-11
影响因子：
6
通讯作者：
A. Menciassi;V. Iacovacci
中科院分区：
文献类型：
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作者：
A. Menciassi;V. Iacovacci
几年前，IEEE Spectrum 的一篇社论确定了 8 项“机器人”技术，为现代医学走向仿生铺平了道路。这些范围从众所周知的用于刺激神经系统的植入电子设备到用于恢复感觉、输送药物或替换整个器官的植入系统。长期以来，仿生器官的概念一直与科幻小说和人体增强联系在一起。目前，供电、传感和驱动技术、微加工技术和通信协议方面的显着进步使得这一概念从科幻小说到临床上可行的完全植入式设备的转化成为可能。我们在此定义了这种新型机器可植入生物机器人器官（IBRO）。根据定义，IBRO应该赋予意识、行动和认知能力，通过感知体内信号并采取相应行动，有利于与人体的正确整合，从而像自然器官一样以闭环方式调节生物和代谢过程[图1]。 1(a)]。虽然起搏器和神经刺激器等传统可编程设备由于无法根据身体需求调节其操作而不属于 IBRO 定义，但最新技术中已经报道了一些有趣的 IBRO 示例。这些植入设备的运作远远超出了简单的电或机械刺激器的范围，旨在恢复失去的器官功能，例如抽血、排尿、激素输送和组织再生。一个典型的例子是设计用于机械辅助衰竭心脏的软机器人套筒。该套筒采用仿生设计，包括多个单独收缩的软致动器，以分层螺旋和圆周方式排列，从而模仿哺乳动物心肌纤维的方向。该装置植入心脏周围，并主动压缩和扭转，充当心室辅助装置（VAD）。根据心率、肺动脉、升主动脉压力和流速或自然心室压力等患者表现参数，对软执行器进行精细控制，使其与跳动的心脏同步收缩和放松[图1]。 1(b)]。软机器人套管可以根据患者的具体需求进行定制，并有可能成为心力衰竭患者移植的桥梁。由于 IBRO 能够替代器官功能和生物/代谢过程，并且可以完全植入，因此可以作为移植和组织工程方法的有效替代方案，从而克服供体短缺问题并追求高通量的器官功能替代。尽管组织工程和再生医学前景广阔，特别是在与宿主的整合方面，但由于细胞活力、扩散和运输机制控制以及大规模机械或分泌作用性能的困难，组织工程和再生医学尚未成熟以实现完全器官替代。另一方面，尽管 IBRO 是完全人造的，但它可以依靠综合机电一体化和材料技术，同时有可能使我们能够安全地与宿主整合并取代器官功能，而无需再次进行药物治疗或生命辅助机器。从工程角度来看，开发这种新型完全植入式机器人对可穿戴和半植入式系统（例如假体或大多数耳植入物）以及传统机器人提出了新的挑战。
A few years ago, an IEEE Spectrum editorial identified 8 “cyborg” technologies paving the way for modern medicine to go bionic. These range from well-known implanted electrical devices for stimulating the nervous system to implanted systems to restore senses, deliver drugs, or replace entire organs. The concept of bionic organs has been linked to science fiction and to human augmentation since a long time. At present, remarkable advancements in powering, sensing and actuation technologies, microfabrication techniques, and communication protocols make credible the translation of this concept from science fiction to clinically viable fully implantable devices. We herein define this new class of machines implantable biorobotic organs (IBROs). By definition, an IBRO should endow awareness, action, and cognition capabilities to favor proper integration with the human body by sensing in-body signals and acting accordingly, thus regulating biological and metabolic processes, in a closed loop fashion as natural organs do [Fig. 1(a)]. While traditional programmable devices such as pacemakers and neurostimulators do not fall into the IBRO definition due to the inability to modulate their operation according to body needs, some interesting examples of IBRO have been reported in the state-of-the-art. These implanted devices operate well beyond simple electric or mechanical stimulators and are devised to restore lost organ functions such as blood pumping, micturition, hormone delivery, and tissue regeneration. A paradigmatic example is represented by a soft robotic sleeve devised to mechanically assist the failing heart. The sleeve presents a bioinspired design and includes multiple individually contracting soft actuators arranged in a layered helical and circumferential fashion, thus mimicking the orientation of mammalian heart muscle fibers. The device is implanted around the heart and actively compresses and twists to act as a cardiac ventricular assist device (VAD). The soft actuators are finely controlled to contract and relax in synchrony with the beating heart by relying on patient performance parameters such as the heart rate, pulmonary artery and ascending aortic pressure and flow rate, or native ventricular pressure [Fig. 1(b)]. The soft robotic sleeve can be customized to patient-specific needs and may have the potential to act as a bridge to transplantation for patients with heart failure. Thanks to their ability to replace organ functions and biological/ metabolic processes and to be fully implantable, IBRO can act as valid alternatives to transplantation and tissue engineering approaches, thus overcoming donor shortage issues and pursuing high throughput organ function replacement. Despite being promising, especially in terms of integration with the host, tissue engineering and regenerative medicine are not mature yet to target full organ replacement due to cell viability, diffusion and transport mechanism control, and difficulties in large-scale mechanical or secretory action performances. On the other hand, despite being fully artificial, IBRO can rely on consolidated mechatronics and material technologies, potentially enabling us, at the same time, to safely integrate with the host and to replace organ functions without recurring to pharmacological therapy or lifeassistive machines. From an engineering viewpoint, developing this new class of fully implantable robots poses new challenges with respect to both wearable and semi-implantable systems, such as prosthesis or most of the ear implants, and traditional robots.