News

Developing robotic tools for surgery

The Business Times by CHIN YONG CHANG

Singapore

SPUN out of research from the National University of Singapore and Nanyang Technological University, EndoMaster gives surgeons the tools to remove gastrointestinal cancer tumours without the need for surgical incisions on the body or organ.

In short, it aims to create the world's first flexible robotic system for endoluminal surgery to treat early stage gastrointestinal cancer.

Through advances in robotic technology and artificial intelligence, the company has developed robotic tools which fit on the end of a flexible endoscope.

They resemble two tiny arms, one with a cautery tool and one with a grasper, each no longer than a few centimetres.

To remove tumours located in the large intestines, the surgeon would take advantage of the body's natural orifices by inserting the flexible endoscope into the anus of the patient.

There would also be a light source and camera attached onto the endoscope to allow the surgeon to see what they are doing. No incisions or cuts are needed.

Once the flexible endoscope is deep enough for the tools to be able to reach the tumour, the surgeon would then control the tiny robotic arms and perform the surgery.

The company's chief executive officer Goh Seow Ping told The Business Times in a recent interview that the company hopes to revolutionise how surgeries for gastrointestinal cancer are done.

Current gastrointestinal cancer treatments are invasive and are often highly traumatic for the patient.

The cuts needed during open or keyhole surgery usually mean long hospital stays and higher risk of complications after the surgery.

For surgeons to get at tumours in the digestive system, they would ordinarily have to make incisions at the patient's torso. This is true for open surgeries as well as for keyhole surgeries.

Although existing surgical methods may be effective at tumour removal, Mr Goh said these methods are highly traumatic to the human body due to their invasiveness.

Open surgeries may require the patient to undergo up to two weeks of hospital stay to recover from the operation, with a 29 per cent chance of complications arising as a result of the operation.

Keyhole surgeries are better, but still require the patient to stay in the hospital for up to a week, with a 21 per cent chance of complications.

EndoMaster's endoluminal procedure, on the other hand, reduces complications rate to below 5 per cent, and lowers hospital stays to a day or less.

"In open or keyhole surgery (for gastrointestinal cancer), the surgeon would have to cut the patient open, remove a section of the large intestine before re-stitching the rest of it together. Removal of even a small section of the intestine is a complex procedure. Hence complications may happen.

"However, for the EndoMaster robotic system, no cuts are made and neither is any portion of the intestine removed. Hence there would be lesser chance of complications. All we are doing is removing the tumour from the inside, so the tumour is removed while organ preservation is achieved," said Mr Goh.

There are also benefits for the surgeons, as Mr Goh said that EndoMaster's procedure would only take three to four days to learn, as compared to the six-to-12-month-long processes that other procedures may take to learn. Chief operating officer Colin Tan likened the controller setup to an Xbox controller and said it was designed to be as easy to use as possible.

The movement of the robotic arms corresponds to how the user moved the left and right hand, making its controls highly intuitive.

The procedure is designed to be done by a single operator, though Mr Goh clarified that this does not mean that surgeries would be one-man jobs as assistants would still be needed during the surgery.

The actual procedure time would be reduced from two hours for open and keyhole surgeries to 45 minutes for EndoMaster's endoluminal one.

The focus on early stage gastrointestinal cancer in the initial stages is not in any way restrictive. The sub-market for treatments for gastrointestinal cancers alone is in excess of S$1 billion, said Mr Goh.

Furthermore, the company has plans to take this technology even further, building devices which can take advantage of the body's other natural orifices like the mouth, nose, and ears to treat other ailments.

Mr Goh said that the advanced technological breakthroughs in both the robotic and algorithmic elements mean that the procedure is sufficiently differentiated from other similar offerings on the medical technology circuit.

Furthermore, the company has many unique robotic patents as well as trade secrets in algorithms and artificial intelligence which are very high in value.

Mr Goh spoke optimistically about the future of the medical industry, believing that automation is the way forward when it comes to surgical procedures.

He said that just as driverless cars may one day become a reality, so too may doctorless surgeries as such processes are increasingly becoming automated.

The company aims to end its R&D developments by the third quarter of this year, and complete clinical trials by 2Q 2019.

It seeks to get European regulatory approval in 3Q 2019 before launching its product in hospitals and partner institutions there.

It is also seeking regulatory clearance for the Singaporean, American, and Chinese markets.

Based entirely in Singapore, the company has 25 full-time staff - of which 80 per cent are engineers - and about 20 consultants and advisers. It aims to surpass S$100 million in revenue within five years of product launch.