Hand in hand: medical robotics

30 March 2017

Exploring the integration of science and technology, Professor Zion Tsz Ho Tse’s (Croucher Fellowship, 2009) research on medical robotics pioneers landmark developments in cutting-edge clinical medicine.

The study of medical robotics combines elements of mechanical engineering, electrical engineering, artificial intelligence, medical imaging as well as medical physics, to effectively address everyday clinical issues involving diagnosis, surgery and rehabilitation.

Tse calls it a translational science, describing his research as “not purely theoretical, nor purely experimental”. It involves the analysis of intricate steps in medical operations, underlined with a strong engineering mind-set that dissects workflow and workload.

“We link up robotics that have been developed already and directly apply them to medicine. So, in other words, someone working in this field has to be able to learn both things [engineering and medicine]. Once the clinical problems are well-defined, we go to the robotics and look to modern technology for solutions. Our aim is to improve medical processes in the hospital sector with regards to operation time, recovery and technology”, he says.

Keyhole surgery for prostate cancer treatment

Most of the medical devices being reviewed and developed in Tse’s research lab are small in order to perform keyhole surgeries. This minimally invasive process involves a small incision being made on the patient’s body to mark the operation site. The doctor then plugs a catheter with an affixed robotic surgical device into the punctured ‘keyhole’ and uses it as the main operating tool for the surgery.

Due to the small incision, the amount of blood loss from the operation is reduced, thus minimizing the risk of infection as well as the time needed for recovery. The incorporation of a multi-functional medical tool also streamlines the entire operational arrangement as the device can be used to perform multiple surgical processes such as the cutting out of cancerous tissue or suturing.

One of Tse’s past projects focused on the treatment of prostate cancer. The conventional surgical plan involves a cut in the abdomen to facilitate the removal of the entire prostate gland. While this method effectively eliminates cancer cells, it can lead to serious repercussions including, a loss in sexual and urinary functionality.

“In America, prostate cancer affects 1 in 8 men, often over the age of 65. The prostate is a very important gland for male reproduction and its removal can lead to many [post-operative] complications. Therefore, my team and I collaborated with hospitals and attended many operation sessions to try and see why the surgery had to be performed in this way.”

Tse then worked with experienced radiation oncologists as well as optical scientists to develop a smart optical fibre small enough to enter the prostate from a keyhole incision. The fibre is equipped with a high intensity laser cutter that will cut the tumour from the prostate gland, leaving behind scar tissue that is no longer cancerous.

He says, “The ablation takes maybe a few minutes to complete and is minimally invasive. This shows how engineering robotics can be applied to medicine to make procedures faster and more effective. And the most important thing is to make sure the patient will recover much quicker.”

Technology fit for clinical application

While Tse predicts the use of technology in hospitals to increase exponentially in the coming 5 to 10 years, he emphasizes that this growth in medical robotics will serve as assisted technology to enable doctors to perform surgeries faster and more effectively – not make them redundant.

According to Tse, getting a new medical technology approved for use in hospitals could take at least a couple of years of research and development. The proposed device must first be tested on tissue samples from a piece of meat, then an animal cadaver, then a live animal. If the test findings remain positive, only then can testing be carried out on a human cadaver and then finally, live humans through a clinical study.

“It is the benchmark in this field – that your technology is good enough for a doctor to choose to adopt and apply to a human body”, he says.

Stem cell therapy and medical robotics for ALS treatment

Tse’s lab has developed several technologies that have successfully undergone this long experimentation and development process, and are now being applied in the clinical environment. One such research study addresses amyotrophic lateral sclerosis, more commonly known as ALS or Lou Gehrig’s disease. This disease involves the degeneration of motor neurons in patients, eventually leaving them incapable of walking, talking and taking care of themselves.

“We discovered a way to tackle ALS by using stem cell therapy. Stem cell therapy delivered to the ventral horn of the spinal cord was initially not suitable for a lot of patients due to the extreme invasiveness of the procedure, but that is where medical robotics can be incorporated to address this problem effectively”, he says.

With the aid of medical robotics, Tse and his team have developed a robotic system that is very small yet smart enough to navigate the anatomy of the spinal cord and directly insert the drug to the target area. The drug injection is carried out under accurate image guidance by the means of magnetic resonance imagining (MRI).

Big data and virtual reality technologies

Tse’s forward-thinking approach regarding medicine and technology constantly leads him to explore new avenues of research that broaden the scope of medical robotics and the application of engineering techniques in the medical sphere.

In a letter published in the prestigious journal, Science, he introduces the possibility of applying big data into public health practices. Tse explains that the public health sector is a big market where technology can be applied, smartphone technology in particular. He is currently studying how big data coming from smartphone usage can be used for disease surveillance and public health monitoring.

“Imagine if we have a disease outbreak in America, people will talk about it and tweet about it, and the information may go viral. This information and these signals can be picked up easily using big data and machine learning technologies, and we can try and localize where the disease is originating from and track the movement of the disease. This is all useful information for disease prevention and resource allocation.”

Another cutting-edge area of research Tse is involved in is to study the potential for virtual reality technologies to be used for biomedical training.

In order to get the necessary surgical experience, doctors in training must perform surgeries on hundreds of patients, and the costs of training and using medical resources can be very high. Tse found himself wondering whether it was possible to reduce the amount of time taken to train a young doctor, but still maintain the same level and quality of training. Turning to virtual reality technologies, he is looking into applying technology like 3D magnetic resonance imaging and high resolution, realistic stimulation to recreate the operational setting in detail to allow the doctor to rehearse the procedure in a virtual environment before carrying out the operation on a live patient.

Lifelong learning

Despite the dynamism and broadness of subject matter, Tse says that it is sometimes difficult to find good researchers willing to constantly be learning multiple scientific fields at the same time. 

“I have been in this field for more than 10 years and I am still learning something new every day. I attend meetings with doctors a couple of times per week to understand their concerns. I also visit operations to learn about surgical procedures from them step-by-step. When tackling medical conditions with robotics, no ‘one size fits all’ solution exists. We are always brainstorming new ideas and adopting slightly different approaches when addressing medical problems,” he says. 

Dr. Zion T.H. Tse is an Assistant Professor in the College of Engineering and the Director of Medical Robotics Lab at the University of Georgia, USA. Before joining UGA, he was a research scientist at Harvard Medical School and Brigham and Women’s Hospital on Croucher Fellowship. He received his Ph. D in Mechatronics in Medicine from Imperial College London. Most of his academic and professional experience has been in the areas of electronics instrumentation, medical devices and surgical robotics. Dr. Tse has been involved in designing and prototyping a broad range of novel analog-digital electronic devices, most of which have been applied in numerous clinical and industrial trials.

To view Dr Tse’s Croucher profile, please click here.