Molecularly aware robotics for surgery (MARS)

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SummaryThe proposed project is aimed at the development of a semi-autonomous surgical robotics platform for the removal of tumours with unprecedented accuracy. Currently, when surgeons remove tumours, they use information collected before the surgery (ultrasound, X-ray) to locate the tumour and assess its actual extension based on what they see or feel with their fingertips. Unfortunately, it is almost impossible to tell healthy tissue from cancer-infiltrated tissue by its look, which results in lengthy operations including the careful examination of removed tissues under microscope to avoid cancer cells left behind causing local regrowth of the tumour. Since the surgical team can only examine cells which are already removed, even this approach cannot fully guarantee the complete removal of cancerous tissue. The proposed technology offers an alternative, where the surgical tool - in the current case a superfine surgical laser - is combined with a powerful microscope and a molecular analysis device. These two devices together can unambiguously identify cancerous cells and they can subsequently be evaporated using the surgical laser. While the cell-by-cell removal of a tumour may sound attractive, especially in the aspect of sparing all non-cancerous cells, at the practical level human beings cannot perform such operations as even if we assume that a surgeon can identify and remove a cell in a second, the complete elimination of small tumour would still take weeks of continuous work. However, if both the identification and the firing of the laser is performed by an artificial intelligence, this time can be reduced to tens of minutes - a commonly accepted timeframe for minor surgeries. The proposed surgical robot will look like a little tent set up over the tumour. The enclosure will house a fibre-like probe, which contains the laser, the microscope and the molecular analysis tools. The computer will be able to direct the probe at any point of the tumour with cellular precision or scan tens of mm2 area in a second. When the device is set up, it localises the tumour at first using the microscopic device, then evaporates the bulk, continuous tumour tissue, while continuously looking for signs of healthy cells with the molecular sensing tool. At the edge of the tumour it will use the microscope to find potentially cancerous cells and will properly identify them using the molecular information before removing them. The surgeon oversees the process and gives directions to the computer regarding the areas to find tumour cells and other surgical steps e.g. coagulation of minor bleeds on the surgical area. The technology will significantly increase the accuracy of cancer surgery, will make currently inoperable cases operable, decrease reoperation rate by eliminating local regrowth and minimise the complications of cancer surgery. In addition, it will give an opportunity for the healthcare providers to turn most cancer surgeries into outpatient interventions performed at outpatient clinics or even at GP surgeries. As the device will give diagnostic information itself, the detection-diagnostics-removal journey for e.g. a skin cancer will take half an hour at the GP in contrast to the current several weeks involving multiple hospital visits.