System can assist doctors in procedures that need very fine control of movements. Understand.
By Guilherme Eler
12 Feb 2020, 5:33 pm
Imagine that you are a surgeon assigned to reconstruct the nerves in an injured patient's leg. It is an extremely delicate procedure, which requires super precise movements. A minimal error can cause the small veins you try to reconnect to cut. And now?
It is for these and other situations in which doctors' precision needs to be, literally, surgical that robots can be useful. Today, tools already exist that give more stability in meticulous tasks of the type. The Da Vinci robot, for example, has a set of clamps that is capable of operating with an accuracy of 1 millimeter. It smoothes the surgeon's hand movements, making the incisions much more accurate – and also eliminating any tremors.
But researchers have been developing even more sensitive equipment to be used in interventions involving veins with fractions of a millimeter. It is what is known as “super microsurgery”, detailed procedures that require a lot of dexterity and patience on the part of the surgeon. Equipment so precise that it increases control to the tenth or hundredth of a millimeter is not yet on sale. But that should change in the years to come.
This is indicated by a study by scientists from Dutch universities and published in Nature Communications magazine. They successfully completed the first test of a robotic super microsurgery in humans.
Twenty women with lymphedema, a condition associated with breast cancer that causes an obstruction of the lymphatic system, causing swelling in the limbs, participated in the experiment. Basically, what the surgeons had to do was connect intact lymphatic vessels to nearby veins, bypassing the obstructed areas, which cause the swelling. Thus the lymphocytes – cells responsible for fighting infections that run through the lymphatic vessels – could circulate around the region again, relieving symptoms. It is as if you pull an auxiliary pipe to avoid the section of a plumbing that is clogged and does not let the water through. Only everything, of course, on a millimeter scale.
Half of the women were operated in the conventional way, and the rest, by doctors assisted with the MUSA robotic system. Produced by the Dutch company Microsure, it has pedals and a kind of joystick, which control a set of calipers. The equipment reduces movements, which makes them much more precise: when the doctor moves the robotic forceps 1 cm, the scalpel moves only a tenth of a millimeter. This allows to operate veins with a diameter between 0.3 and 0.8 mm.
According to the researchers, some of the patients who were operated on with MUSA showed faster recovery. But that does not mean that the technique is the definitive answer for microsurgery. Although their time with practice has decreased, doctors using the new system have completed the procedure in 115 minutes. Doctors without robotic help, on the other hand, did so in 81 minutes. And it has the price. Hospitals are expected to pay a few million dollars if they want to have an auxiliary tool of this type.
Despite this, the study published in Nature indicates that the system is effective and safe. The idea now is to repeat the feat in other medical centers around the world to make the technology more accessible in the future.