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Rensselaer Researchers Secure $2.7 Million NIH Grant To Advance "Scarless" Surgery
New Study Uses Virtual Reality Tools To
Accelerate Development of Next-Generation Natural Orifice
Translumenal Endoscopic Surgery
Researchers at Rensselaer Polytechnic Institute have secured
a $2.7 million grant to develop the first-ever virtual reality
simulator for next-generation “scarless” endoscopic
surgery.
The four-year study, funded by the U.S. National Institutes
of Health (NIH), seeks to accelerate the development of natural
orifice translumenal endoscopic surgery, or NOTES. This
emerging surgical technique shows promise for operating in the
human abdomen with no external incisions, no external scarring,
less pain, and potentially a lower risk of post-operative
infection and immobility.
In NOTES, a flexible endoscope is inserted through a natural
orifice, such as the mouth, anus, or vagina. A small internal
incision in the stomach, vagina, bladder, or colon then allows
the endoscope access to the abdominal cavity. Potential NOTES
procedures, for example, are removal of the pancreas or
appendix through a patient’s mouth.
While “scarless” procedures are promising, the development
of tools, techniques, and platforms are currently based on
extensive animal testing. Rensselaer Professor Suvranu De, who is
leading this new study, said NOTES will benefit greatly from
computer-based modeling and simulation – which in recent
decades has redefined the way most engineering systems, from
aircrafts to microprocessors, are designed. To accomplish this,
De’s team will develop a touch-sensitive virtual reality
simulator for NOTES. The system will build from De’s NIH-funded
work on creating simulation technology for laparoscopic
surgery.
“NOTES is a revolutionary surgical paradigm that is viewed
as a natural convergence of diagnostic endoscopy and minimally
invasive surgical procedures,” said De, director of the Center
for Modeling, Simulation and Imaging in Medicine (CeMSIM) at
Rensselaer. “However, the current enthusiasm regarding NOTES
should not overtake a cautioned approach to its implementation.
Our new simulator will help evolve NOTES procedures, and will
emerge as a platform for surgeons to learn, practice, train,
and become certified in NOTES techniques before attempting them
on human patients.”
De is also a faculty member in the Department of Mechanical,
Aerospace, and Nuclear Engineering at Rensselaer, with a
joint appointment in the Department of Biomedical
Engineering. Partnering with Rensselaer on this study are
Beth Israel Deaconess Medical Center, Massachusetts General
Hospital, Cambridge Health Alliance, Children’s Hospital
Boston, and Tufts University in Boston.
Endoscopic procedures, such as a colonoscopy, involve
inserting a flexible endoscope into the body. Endoscopes are
equipped with a light, camera, and other tools that allow
surgeons and physicians to perform a large number of operations
and procedures. The progression of the endoscope through the
body is guided by the surgeon via handheld controls.
In NOTES, tiny surgical instruments advance through the
endoscope and enter the abdominal cavity by perforating the
wall of the stomach, colon, vagina, or other viscera. After
performing the surgery, the instruments are withdrawn and the
visceral wound is closed. Researchers are currently using
animal studies to advance and perfect this technique, but these
tests often result in difficulties during the procedure as well
as post-operative complications.
To move away from slow and costly animal testing, and to
help discover optimal techniques for accessing different
internal organs via NOTES, De and his interdisciplinary team
will develop a touch-sensitive NOTES virtual reality simulator.
The system will feature custom robotic interfaces and
computational technology developed at CeMSIM to provide an
environment that looks and feels identical to what a surgeon
would experience when performing the procedure on a live
patient.
The simulation’s realistic computer-generated models are
displayed on a monitor, and users interact with the simulation
both visually and using their sense of touch. The simulator’s
advanced haptic touch-feedback system feels like the real thing
– a physician cutting or manipulating tissue with the simulator
will feel with their hands the lifelike toughness, sponginess,
and resistance of virtual tissue.
De said the key challenges related to creating a NOTES
simulator include developing realistic hardware interfaces,
accurate computer models of multilayered hollow organs such as
stomach and intestines, and realistic simulations for the
interaction of flexible surgical tools with soft tissues in
real time.
“The aim of this study is to overcome these preliminary
challenges, and develop the first virtual reality NOTES
simulator that is firmly based on physical experiments and
surgical experience. The simulator must also be realistically
responsive to physiological consequences of surgical
complications,” De said. “There’s still much work to be done,
and much validation, before we can think about using NOTES or
our NOTES simulator in a clinical setting. But this study
places us on the right path to advancing this promising,
exciting new technology.”
The first simulated NOTES procedure the researchers will
tackle, De said, is an appendectomy.
For more information on De’s research at Rensselaer,
visit:
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Published
June 20,
2011 |
Contact: Michael Mullaney
Phone: (518) 276-6161
E-mail: mullam@rpi.edu |
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