A number of highly innovative projects in the North of Germany aim at taking robot-assisted surgery to the next level – based on artificial intelligence (AI). In Lübeck and Kiel, researchers, engineers, and clinicians develop and shape the operating theatre of the future.
How is the Da Vinci operating system becoming more and more advanced?
Robotic surgery is already with us. Instruments such as the industry-leading Da Vinci system by US tech giant Intuitive Surgical, allow surgeons to take control of multiple arms through a hand-operated console, and give them greater dexterity and vision when operating in hard-to-reach areas. But the field of robot-assisted surgical technology is in motion: Since the expiry of Intuitive’s patents, new systems from a growing number of manufacturers are now increasingly entering the market.
This both enables broader access to this technology and increases the pressure on manufacturers to innovate. Academic researchers, medical technologists and clinicians in Schleswig-Holstein have stepped in this dynamic field. Supported by the state government and EU funding, they want to significantly improve established robot-assisted surgical technology, developing a new generation of medical robots in an era of digitalization and artificial intelligence.
VR simulation is becoming increasingly modern with the Fraunhofer IMTE and LIROS projects
A visit to the Lübeck-based Fraunhofer Research Institution for Individualized and Cell-Based Medical Engineering IMTE: What currently only exists as a VR simulation will soon be reality: a fully functional operating theatre for robotic surgery. Georg Männel, group leader Training and Automation at IMTE, has brought virtual reality goggles and lets the visitor walk through an impressive simulation of the operating room and the neighboring workshop. In a matter of weeks, the real robots and all the interior equipment will move in here.
The operating room is the centerpiece of LIROS, the Lübeck Innovation Hub Robotic Surgery. The project, that Männel coordinates together with
- engineer Svenja Ipsen, group leader Robotic intervention at IMTE,
- and Tobias Keck, Director of the Surgical Department at the Lübeck Campus of the University Hospital Schleswig-Holstein (UKSH)
was supported with 3.5 million euros by the State government of Schleswig-Holstein through REACT-EU funding.
“We plan to install a two-arm and a four-arm robotic system in our realistic operating theater to simulate a broad spectrum of robotic surgical procedures,” says Männel. LIROS will at first be a unique research and development platform. It also serves as a medtech test laboratory for the industry.
How should the technology transfer take place?
“Our goal is to facilitate technology transfer and offer students and surgeons hands-on training opportunities,” says Männel. That’s why the Fraunhofer researchers are closely collaborating with the team headed by Tobias Keck, and the Surgical Department at the UKSH. Keck is a strong advocate of robot-assisted surgery and has different systems in use in clinical practice. He is also committed to generating a training curriculum for robotic surgery. Since more robotic devices from different manufacturers are entering the market and smaller scale robotic systems affordable for smaller hospitals are on the rise, training will become even more important.
“But LIROS is not just about robotics in surgery, it’s the whole surgery process that we are trying to address. Here, we integrate many of the things we’re doing at Fraunhofer IMTE and this is based on the interconnection between AI and robotics,” says Philipp Rostalski, Director of Fraunhofer IMTE.
The future of surgical robots requires a lot of training and optimisation
Rostalski points out that process optimization and automated training evaluation will play an important role here. For example, a motion capturing system for the entire operating theatre will be used to analyze how the surgical team and the robots move and perform – and these data can be used for process and training innovation. The networking of medical technology devices and the investigation of usability aspects to increase user-friendliness and safety in the operation theatre are also in focus.
Within LIROS, the Fraunhofer IMTE researchers are closely interlinked with research partners on campus especially the UKSH, Lübeck University, Technische Hochschule Lübeck, Fraunhofer Institute for Digital Medicine MEVIS and the DFKI Branch Office Lübeck. But what will the patients treated by the surgical robots look like? “Our ‘patients’ will be individual anatomical models and phantoms made by 3D printing at the Fraunhofer IMTE,” Rostalski says. They will be prepared in a room right next to the operating room. “We will really have a high-tech operating tract here at our institute, matched by a similar setup in the UKSH. This ensures a smooth transition between research and clinical practice.”
Virtual support from the UKSH at the Kiel campus
Printed or virtual models in 3D also play an important role in a robot-assisted surgery developed at the Kiel Campus of the UKSH. The project entiteled “Operation room of the Future” is like the LIROS project financed by the state government via the REACT-EU funding scheme (budget: 3.4 million euros). In Kiel the surgical disciplines are closely networked in minimally invasive and robot-assisted procedures under the umbrella of the Kurt Semm Center, which is coordinating the project. Kiel University and the companies Vater Solution and MiE Medical Imaging Electronics are also involved.
The OR of the future focuses on two subprojects that are expected to improve surgery in the foreseeable future:
Improved information flow through AI-based augmented reality
one is a so-called AI-based augmented reality solution for even more targeted and gentle tumor surgery. The developed software will help to visualize the conspicuous areas from PET-CT imaging directly in the live surgical image or provide the surgeon with a navigation aid.
Augmenting the image information from computed tomography will not only provide surgeons with enhanced information about the surgical area, but also provide 3D navigation support. This procedure is expected to help identify tumor-positive lymph nodes and other tumor structures more easily during surgery. “The high-precision registration and visual overlay of 3D tumor positions from the CT into the live image supports surgeons during the operation and allows them to identify and remove tumor tissue as quickly and safely as possible. This reduces the duration of the operation and the stress on patients,” explains Reinhard Koch, who is responsible for the first subproject at the Faculty of Engineering of Kiel University.
More precise work processes thanks to robot assistance systems
The second subproject coordinated by robotics specialist Thomas Meurer deals with the development of an AI-based robotic assistance system to optimize workflows and infection control in the OR. Until now, current surgical robots consist only of a system that is remotely controlled by the surgeon via a console. Operating room assistants support the surgeons, but work directly on the patients by hand with the necessary instruments. The technology currently being developed will enable a two-arm assistant robot.
For the patients, this should make the operation more precise, infection-proof, faster and gentler. This may shorten the healing time compared to conventional open surgery procedures. Sensors and AI ensure that the two robotic arms do not interfere with each other in the process. At the same time, the surgeons’ instruments, such as clamps, must remain in position during all assistance work.
The goal: making surgical robots available to everyone
Both research consortia in Lübeck and Kiel have decided to cooperate closely and help to make Schleswig-Holstein a key site for research and development in robotic surgery. This is exemplified by the use of an upcoming robot platform based on a novel surgical robot called Dexter, which has been developed and commercialized by Swiss company Distalmotion. The system has open interfaces and offers the experts an optimal platform for the development and testing of innovations. “We want to democratize surgical robotics and make them affordable for smaller hospitals,” says Klaus Feldmann, Sales Director Germany. The connection to hospitals in North Germany is so promising that Distalmotion has opened its German office in Hamburg.
Philipp Rostalski, who is also a member of the board of Life Science Nord e.V. says: “I’m convinced that the Kiel-Lübeck-Hamburg axis has enormous potential in the field of surgical robotics. There is potential for an ecosystem, which I will also try to strengthen and establish as a focus forresearch and development in the Life Science Nord cluster.”
Text: Philipp Graf
Featured image: © Model Eric Aderhold
