In the operating room of the future, robots will be an integral part of the surgical team, working alongside human surgeons to make surgeries safer, faster and more precise. Engineers in Michael Yip’s lab at UC San Diego are developing advanced robotic systems to help make that vision a reality.

From intelligent algorithms that can enable robots to lend a helping hand during surgery, to ‘smart’ endoscopes that can autonomously maneuver through sensitive nooks and crannies inside the body, the robotics technologies in Yip’s lab are all inspired by a common goal: to augment the capabilities of surgeons.

The goal is not to replace human surgeons, but to better assist and enable them to do much more, said Yip, a professor of electrical engineering. Human surgeons, he explained, are still needed to make decisions that can’t be left to a robot, such as what treatment is best for the patient, or how a surgical procedure should be performed.

Meanwhile, robots will be used to perform tasks that humans cannot. For example, flexible and dexterous robots armed with high-power computing and sub-millimeter precision will be able to perform minimally invasive surgery, control complex instruments and navigate through spaces in the body that a human surgeon can’t access. These robots could perform other advanced tasks, such as creating real-time 3D maps inside the body as they self-navigate, relying on a patient’s medical data and imaging information.

This vision illustrates the idea of ‘Shared Autonomy,’ the theme of the most recent UC San Diego Contextual Robotics Institute Forum held on campus during October. In an age of increasing automation, researchers in the institute, such as Yip, are focused on developing robotic systems that can interact well in a human world and benefit society.

The da Vinci Surgical System is a robotic surgical system designed to perform minimally invasive surgery. The system, developed by the company Intuitive Surgical, is remotely controlled by a surgeon from a console. The system is equipped with four robotic arms, but a surgeon is able to control only two of them at a time. Yip’s ARCLab currently has a full da Vinci Surgical System dedicated for research in shared autonomy.

Yip’s team aims to put the other two arms to work. To do this, they are creating software and hardware that will enable these arms to function autonomously. A goal is to have these robotic arms assist the primary surgeon with routine surgical tasks (suction, irrigation or pulling tissue back) that are tedious and are currently performed by additional human surgeons.

‘This would reduce the number of surgeons in the operating room, which would reduce the overall cost of the surgery,’ said Nikhil Das, an electrical engineering Ph.D. student in Yip’s lab. It would also free up surgeons who normally do these tasks to see other patients, he added.

Das develops motion planning algorithms that will enable the auxiliary arms to move without hitting obstacles, such as the surgeon-controlled manipulator arms. He is working on this project with undergraduate student Naman Gupta, who is visiting from Birla Institute of Technology and Science in Pilani, India. Gupta implements these algorithms in a simulated da Vinci system’s robotic arm and is in the process of validating his approach before moving it onto the ARCLab’s da Vinci system.

Other students in the ARCLab are incorporating haptics into the system so that surgeons operating the robotic arms can recover the textures and sensations of feeling the tissues, a critical sensation missing in current systems.

‘We’re trying to close the gap between the surgeon and the robot,’ Das said.

To reach truly small scales, the ARCLab is developing its own robotic catheters. These catheters are meter-long, millimeter-diameter flexible robots that can access the deepest parts of the body from atraumatic locations such as the leg. With 8 wires that are individually controlled by 8 different motors, Yip’s lab can shape and steer the robot catheters in more complex configurations and navigate far more effectively than surgeons could do manually.

One goal is to automate the catheter and incorporate haptic controls so that the operator can receive feedback from the motors. ‘That’s what makes our catheter different from the steerable catheters in industry,’ said Aaron Gunn, a mechanical engineering undergraduate working on this project.

University of California San Diego ucsdnews.ucsd.edu/feature/engineers_developing_advanced_robotic_systems_that_will_become_surgeons

Researchers from UT Southwestern’s Peter O’Donnell Jr. Brain Institute and Harold C. Simmons Comprehensive Cancer Center collaborated with investigators in the Advanced Imaging Research Center to identify 2HG (2-hydroxyglutarate), a metabolite that is produced in gliomas that carry IDH (isocitrate dehydrogenase) gene mutations.

Using MR spectroscopy, the team announced in 2012 that they could detect 2HG in the tumour with high sensitivity and specificity. This next-step study showed that 2HG can be useful in tracking the disease, researchers said.

‘This is the first non-invasive biomarker for brain cancer and represents a major advance for the field. Our current imaging is not nearly as precise and takes a longer time to see results,’ said senior author Dr. Maher, who holds the Theodore H. Strauss Professorship in Neuro-Oncology. ‘Within a week of starting treatment, we know whether we hit the target’. This new method will be a much more rapid way of assessing the therapy – allowing the physician to know to stop treatments that aren’t working or continue treatments that are.’

Most biomarkers are in the blood, so identifying biomarkers that can be tracked without drawing blood or obtaining a tissue biopsy is particularly valuable, said Dr. A. Dean Sherry, Director of the Advanced Imaging Research Center and Professor of Radiology at UT Southwestern, and Professor of Chemistry at UT Dallas, where he holds the Cecil H. and Ida Green Distinguished Chair in Systems Biology.

The technique also may serve as a model to develop other imaging biomarkers for the brain, and already is being used to learn more about the biology of glioma, the most common type of brain cancer.

‘In terms of research, the biomarker is a window’ into IDH-mutant glioma biology and we are using it to learn more about how the tumour grows, responds to therapy, and ultimately becomes resistant to treatment,’ said lead author Dr. Changho Choi, Professor of Radiology and with the Advanced Imaging Research Center, where the study was performed using a dedicated research MR scanner.

2HG tracking also could prove useful in diagnosing some brain tumours in which typical surgical procedures to obtain tissue samples can’t be done. That may be because the tumour isn’t accessible, such as near the brainstem, or when trying to get a sample could cause neurological damage. These patients are excluded from clinical trials because of the lack of available tumour tissue for diagnostic analyses.

‘We established in this study that 2HG levels in these tumours can be used to make a presumptive’ molecular diagnosis of an IDH mutation, based solely on imaging,’ said Dr. Choi.

UT Southwestern Medical Center www.utsouthwestern.edu/newsroom/news-releases/year-2016/oct/biomarker-tracks-tumour.html

New blood-testing technology is being developed by Lancaster academics.
The new small-scale technology, called EBio-LacSens’, would rapidly measure blood characteristics to monitor for sepsis or toxins. It would be a good indicator of the success of treatments following operations and it could ensure the early detection of sepsis in chemotherapy patients. In addition it could help evaluate the status of fetuses.
The device does this by taking pinprick samples of blood and providing rapid chemical analysis – in less than a minute. This quick processing of samples, when compared to the traditional process where samples that have to be sent for analysis at hospital laboratories (a process that can take hours), enables medical staff to quickly adjust treatments in response to the improved data.
Michael Mumford, from eBiogen, said: ‘This project passed its feasibility stage and it is now progressing well in its prototype stage with encouraging results. We are starting the human blood testing soon before proceeding to market. Lancaster University has enabled us to develop a rich and supportive expert network.’
By bringing blood diagnostics closer to the patient there are additional benefits of reduced risk of contamination and cost savings.
Dr Mukesh Kumar, the project Research Fellow, said, ‘Although the existing point-of-care testing kits have resolved a few conventional problems, they have not had a great impact in most clinical testing. The new technology would circumvent many current problems through miniaturization, enabling an economical, portable analyser to be used by the bedside’. The prospect of being able to significantly reduce the time between taking a sample and the delivery of the analysis is exciting and rewarding.’

Lancaster University http://tinyurl.com/zblchvt

Sooner is always better when it comes to diagnosing an illness and this is especially true when it comes to lung disease in premature infants, since it can have an impact on a child’s health in the long-term. Researchers at Baylor College of Medicine who focus on bronchopulmonary dysplasia and pulmonary hypertension, a common lung disease in premature infants, have shown that echocardiography can be used to detect the pulmonary hypertension in neonatal mice at an earlier time point than previously thought.
Bronchopulmonary dysplasia is caused by many factors, including inflammation, infection and oxidative stress. Dr. Binoy Shivanna, assistant professor of pediatrics – neonatology at Baylor and Texas Children’s Hospital, and colleagues focus on the oxidative stress and inflammation aspects of the disease, which can damage various parts of the cell and interrupt the development of the lungs. This can lead to problems such as pulmonary hypertension which increases the mortality and long-term problems in infants.
Progress developing improved treatments for the disease has been limited in part by the lack of advanced imaging techniques to detect pulmonary hypertension and lung damage at earlier time points in animal models, which is important to test these potential new treatments. This model could also help researchers better understand how pulmonary hypertension develops, which is an important aspect of Shivanna’s research. So the team set out to develop a mouse model of the disease that replicates many of the features observed in infants with the condition.
To induce oxidative stress and inflammation – two contributing factors of the development of the disease – the researchers exposed a group of newborn mice to 70 percent of oxygen or hyperoxia for 14 days, while a control group received 21 percent oxygen or regular air.
The mice exposed to hyperoxia developed lung oxidative stress, inflammation and lungs that resembled those typical of bronchopulmonary dysplasia and pulmonary hypertension in infants. Furthermore, echocardiography tests performed in the young mice showed that the animals had also developed pulmonary hypertension.
‘It’s important to understand not only the pathology, but also the functional aspect of pulmonary hypertension,’ said Shivanna. ‘This is where the echocardiography test, a non-invasive test that uses high frequency sound waves to take pictures of the heart, comes in.’
Currently, echocardiography tests have been performed in mice at four weeks of age, which might be too late to intervene. Using the latest advances in research technology, Shivanna and colleagues were able to demonstrate that it is possible to functionally detect pulmonary hypertension at an earlier time point, meaning that interventions could potentially take place sooner.
This mouse model can help researchers develop early interventions to prevent or decrease the severity of some of the later onset diseases, such as chronic obstructive pulmonary disease.

Baylor College of Medicine http://tinyurl.com/h3su3ph

Watching millions of neurons in the brain interacting with each other is the ultimate dream of neuroscientists! A new imaging method now makes it possible to observe the activation of large neural circuits, currently up to the size of a small-animal brain, in real time and three dimensions. Researchers at the Helmholtz Zentrum Munchen and the Technical University of Munich have recently reported on their new findings.
Nowadays it is well recognized that most brain functions may not be comprehended through inspection of single neurons. To advance meaningfully, neuroscientists need the ability to monitor the activity of millions of neurons, both individually and collectively. However, such observations were so far not possible due to the limited penetration depth of optical microscopy techniques into a living brain.
A team headed by Prof. Dr. Daniel Razansky, a group leader at the Institute of Biological and Molecular Imaging (IBMI), Helmholtz Zentrum Munchen, and Professor of Molecular Imaging Engineering at the Technical University of Munich, has now found a way to address this challenge. The new method is based on the so-called optoacoustics, which allows non-invasive interrogation of living tissues at centimetre scale depths.
‘We discovered that optoacoustics can be made sensitive to the differences in calcium ion concentrations resulting from neural activity and devised a rapid functional optoacoustic neuro-tomography (FONT) system that can simultaneously record signals from a very large number of neurons’, said Dr. Xose Luis Dean-Ben, first author of the study. Experiments performed by the scientists in brains of adult zebrafish (Danio rerio) expressing genetically encoded calcium indicator GCaMP5G demonstrated, for the first time, the fundamental ability to directly track neural dynamics using optoacoustics while overcoming the longstanding penetration barrier of optical imaging in opaque brains. The technique was also able to trace neural activity during unrestrained motion of the animals.
‘So far we demonstrated real-time analysis on whole brains of adult animals with roughly 2x3x4 millimetre dimensions (approximately 24 mm3),’ says the study’s leader Razansky. State-of-the-art optical microscopy methods are currently limited to volumes well below a cubic millimetre when it comes to imaging of fast neural activity, according to the researchers. In addition, their FONT method is already capable of visualizing volumes of more than 1000 cubic millimetres with temporal resolution of 10 milliseconds.
Large-scale observation of neural activity is the key to understanding how the brain works, both under normal and diseased conditions. ‘Thanks to our method, one can now capture fast activity of millions of neurons simultaneously. Parallel neural networks with the social media: in the past, we were able to read along when someone (in this case, a nerve cell) placed a message with a neighbour. Now we can also see how this message spreads like wildfire,’ explains Razansky. ‘This new imaging tool is expected not only to significantly promote our knowledge on brain function and its pathophysiology but also accelerate development of novel therapies targeting neurological and neuropsychiatric disorders,’ he concludes.

Technical University of Munich http://tinyurl.com/goxtrm5