Akoestische energie‑emitters kunnen binnenkort de noodzaak van incisies tijdens operaties elimineren

Operatie zonder snijden

Surgery is a medical field that has made tremendous progress in the past. First with general anesthesia, then increasingly advanced procedures and precise tools, and more recently robots, as we discussed in “Top 5 Robotische Chirurgiestocks” and “Sony toont chirurgische precisie met robotica in recente microschirurgie‑demo”.

Deze vooruitgang heeft ervoor gezorgd dat operaties steeds minder invasief zijn geworden. Tegenwoordig is een zeer klein toegangspunt meestal voldoende, waardoor nauwelijks een litteken achterblijft, het bloeden wordt verminderd en de hersteltijd wordt verkort.

Robotica zou operaties in de nabije toekomst nog beter kunnen maken, dankzij onderzoekers die een manier testen om operaties uit te voeren zonder überhaupt een incisie op het lichaam te openen. En ze hebben dit bereikt door alleen geluidsgolven te gebruiken.

This project was conducted by researchers at the Virginia Polytechnic Institute and State University, University of North Carolina, and Michigan State University.

Geluidgebaseerde chirurgie

In their publication titled “Robot-assisted chirality-tunable acoustic vortex tweezers for contactless, multifunctional, 4-DOF object manipulation”, the researchers focused on places in the body that surgery robots are struggling to reach—for example, regions shielded by tissue and bone barriers.

To improve access, they used “chirality‑tuneerbare akoestische vortex‑tweezers“, essentially an ultrasound wave emitter designed to move an object at a distance.

Because sound waves travel throughout the body, they can move on-demand particles or  micro- to millimeter-sized objects inside the body without direct contact. This control included “controlling object rotation, and translating objects along arbitrary-shaped paths.”

The acoustic vortex beam can be moved at the micrometer scale. Accordingly, the particle trapping area can be precisely set in a 3D space, and moving a particle after its capture can be engineered. When moving a tiny object along the winding path of a blood vessel, this can be a critical feature.

Zhenhua Tian, Assistant Professor At Virginia Tech.

Hoe werkt het?

Acoustic tweezers are acoustic vortex fields that cross over one another to form tiny ring-shaped acoustic traps.

Bron: Science Advances

Niet alleen kan dit door botten of weefsel werken, maar het kan ook cellen, geneesmiddelen of chirurgische instrumenten binnen aders verplaatsen. En het kan dit nauwkeurig op micrometer‑schaal doen.

Door het snel verbetende concept van een akoestische tweezer te combineren met een robot (vergelijkbaar met die al in de chirurgie worden gebruikt), hebben de onderzoekers voor het eerst contactloze manipulatie met vier vrijheidsgraden (4‑DOF) bereikt. Dit betekent beweging in alle drie de ruimtelijke dimensies evenals rotatie.

De prestaties waren ook indrukwekkend dankzij het vermogen om objecten te manipuleren variërend van micrometers tot millimeters, en tevens manipulatie mogelijk te maken in een grote 3D‑ruimte van 10 cm bij 10 cm bij 10 cm.

Bron: Science Advances

Een laatste vooruitgang was het oplossen van een veelvoorkomende beperking van akoestische tweezers. De meeste vereisen transparante materialen om de beweging te geleiden. Wat uiteraard zelfvernietigend zou zijn voor chirurgie achter botten en biologisch weefsel.

Dus combineerden ze de akoestische tweezer met een echografie‑sonde. Ze ontwikkelden ook speciale software om de sonde te laten werken ondanks het “geluid” van de akoestische tweezer.

Our imaging algorithm minimizes the required pulse-echo cycles for collecting ultrasound signals and implements a frequency-domain filtering step to remove acoustic tweezer–induced signal noise.

Bron: Science Advances

Toepassingen buiten chirurgie

Acoustic tweezers are already been used for a wide range of biological applications:

• Cellen (micrometers) en volledige vislarven verplaatsen.
• Extracellulaire vesikels isoleren voor ziekte‑diagnose, of tumorcellen isoleren.
• Cellen rangschikken voor bioprinten.
• Biomarkers concentreren voor signaalversterking.
• Microrobots sturen.

The technology could also be used beyond biology. For example to manipulate safely hazardous droplets, or to control the self-assembly of colloidal materials and the arranging of nanomaterials for composite fabrication.

So overall, this discovery is likely to be first applied to the field of surgery, but could later have further applications in targeted drug delivery, 3D bioprinting, and progress in material science, including nanomaterials.

Robotische chirurgiebedrijf

While one of the most advanced robotic surgery systems is sold by Intuitive Surgical (ISRG ) (ISRG), the company has less expertise in ultrasound or endoscopy than some of its competitors.

So, it is likely that the first real-life medical application of sonic tweezers might come from medical device companies already adept at integrating together many medical device systems like robots or surgery tools.

1. Medtronic plc

Medtronic is a medical device leader, especially in surgery and intensive care. While the other segments could also be considered as afferent to it, the medical surgical segment of Medtronic represents $2.1B of revenues, out of a total of $7.7B.

Bron: Medtronic

The company has been growing through organic growth, thanks to a large percentage of the R&D budget ($2.7B in 2022) and acquisitions (9 in 2022 and $3.3 worth of further acquisitions considered for 2023).

Medtronic sees a massive opportunity for simpler, low-cost robotic surgery:

“only 2% of surgeries around the world are held with the assistance of robots. There’s 98% out there that needs to be done via robotically-assisted surgery but not today because of the cost and utilization burdens”

It is with that strategy in mind that Medtronic has developed the Hugo system.

Bron: Medtronic

It also sells the Mazor X Stealth spinal robot-assisted surgery device, thanks to its $1.7 billion acquisition of Mazor Robotics in december 2018.

Overall, the sterling reputation of Medtronics and its presence in virtually every hospital for at least some equipment gives it a good entry point to capture a solid part of the nascent robotic surgery market, either through internal development or acquisitions.

It also already sells endoscopic ultrasound systems, and its presence in cardiology could help apply the sonic tweezer technology to cardiovascular therapies and surgeries.

2. Stryker Corporation

Stryker is another leader in medical devices present in virtually every well-equipped hospital or clinic, treating up to 130 million patients annually. The largest segments are traumatology, endoscopy, and instruments.

Bron: Stryker

The company invests heavily in innovation, with $1.45B in R&D in 2022. It is also a serial acquirer, with 3 acquisitions in 2021. Most of its sales have been to the US (74%), with plans to keep growing in foreign markets.

The company has been growing in the surgery segment, notably through its 2019 acquisition of OrthoSpace for orthopedic surgeries.

It also has the Mako, for a robotic-arm-assisted surgery dedicated to orthopedic surgery.

With a strong presence in trauma, neurology, spine, endoscopy, and other internal surgery, Stryker could be among the companies to benefit the most from incision-less surgery with acoustic tweezers.

Bron: Stryker

With its strong focus on endoscopy and orthopedic surgery, Stryker is likely to become the robotic surgery leader in this segment, which is also growing due to an aging population.