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The Flex® Robotic System, based on the research of CMU's Howie Choset, enables surgeons to access and visualize hard-to-reach anatomical locations through the mouth. Source: Carnegie Mellon Univ.In 2010, Prof. Howie Choset, of Carnegie Mellon Univ.’s Robotics Institute, traveled to Prague. He wasn’t there necessarily for vacation, rather it was business. From an operating room, he watched as surgeons used the snake-arm robot he conceived and developed on the first human patient.

“It was just amazing that we were able to make a robot go in a person and then help somebody,” Choset said in an interview with R&D Magazine. “It was one of the most bittersweet moments in my professional career.”

Sweet because an intangible idea he conceived was finally brought to reality, but bitter because the company Choset co-founded—Medrobotics—was running full steam ahead on a track separate from him.

In July 2015, Medrobotics received clearance from the U.S. Food and Drug Administration (FDA) to market the Flex Robotic System for transoral procedures. At the end of 2015, the Univ. of Pittsburgh Medical Center became the first hospital to use the device on a patient.

“Minimally invasive surgery is clearly a continuing trend in medicine. You want to have less pain for the patients. It’s also lower cost because you don’t have the same surgical suite requirements. People return to their lives more quickly because the recovery time goes down. And there’s actually a fourth benefit that I think gets overlooked a lot, and that is we can disseminate medical care more easily,” said Choset.

“As the procedure becomes more minimally invasive, you won’t have to be in the hospital anymore. This is one of my long-term goals as a researcher. I want to democratize surgical care.”

The journey to the Flex Robotic System began in the early 1990s, when Choset was a mechanical engineering graduate student at the California Institute of Technology. Choset’s advisor Joel Burdick was toying with the idea of a small surgical snake robot.

A robot crawling through and around a human’s body? The idea straddled far beyond the line of feasibility for Choset. Nevertheless, he delved into the snake robot field, albeit exploring different applications and industries.

After receiving his degrees, Choset joined Carnegie Mellon, where his research group primarily focused on snake robots due to the technology’s wide array of applications. “Snake robots can be used for getting into nuclear power plants… [and]… they can be used as a tool for rescue workers in a collapsed building,” he said.

About seven or eight years into his career, Choset met Alon Wolf, and the two began working on robotics in the medical field. Around that same time, Choset wandered into a lecture given by Marco Zenati, a professor of surgery at the Harvard Medical Center. The lecture inspired Choset to consider developing a snake-arm robot for the medical field. During the lecture, he emailed Zenati about collaborating. And so, the three people behind Medrobotics united.

“(Zenati) had the medical vision,” said Choset. He was able to “look at the robots my group was developing and then take it a couple of steps further.”

Still, the surgical snake-arm robot was fantasy in Choset’s mind. He figured the development process would be a long haul, with perhaps a National Institute of Health (NIH) grant somewhere down the line. But one day, the group met and decided to knock out the product’s design.

“I sat down, I thought about it, and then 20 minutes later the design for the snake robot came out,” said Choset. For a man who finds his eureka moments at inopportune times—after leaving the office, or following a night’s rest—it was a well-timed moment for innovation.

“So we got the idea very quickly, and then we got our NIH grant,” said Choset. “The three of us were able to get some initial prototypes working in animals very quickly.”

It was no easy task.

For a functional human being, exercising dominion over one’s extremities is a fairly simple and unthinking affair. Picking up a cup from the table is barely a consideration.

But let’s say that one wants their blindfolded friend to pick up the cup. That person would then have to rattle off orders to assist the friend’s maneuverability. Add obstacles and the task only grows in difficulty.

That’s why building and programming a robot is difficult, added Choset. It’s not only about figuring out the correct mechanism to carry out a task, but also figuring out how to replicate the fluidity of natural movement.

Controlled by a medical grade joystick, the surgical snake-arm robot combines the benefits of both the rigid laparoscope and the flexible endoscope, which are two popular tools used for minimally invasive surgeries. Physicians use the joystick to navigate the interior of the human body. The device’s head is outfitted with a high-definition video camera, and has ports positioned on its sides for surgical tools.

“Within a year, we got (the surgical snake-arm robot) down to about 11 mm in diameter,” said Choset.

“One of the things great about our robot and the design I conceived is that it uses conventional motors and wire,” he added. Rather than use futuristic materials not ready for prime-time, Choset successfully got four motors to marionette 102 degrees of freedom.

From there, Medrobotics gained investment from Pittsburgh Life Sciences Greenhouse. Through the firm, the company raised around $10 million in financing. Samuel Straface eventually took on the roles of Medrobotics’ president and CEO.

Since then, Choset has taken a backseat with the company. “The company made (my prototype) a medical robot,” he said. “They deserve all the credit. I just started things.”

But he’s still kept in the loop. When the company’s Flex Robotic System was used in Pittsburgh, Choset was at his son’s soccer game. After the surgery, he received a happy text message from Univ. of Pittsburgh Medical Center’s Dr. Umamaheswar Duvvuri.

It was a “unique set of circumstances that brought about the development of this mechanism, and I consider myself very fortunate to be a part of it,” said Choset.

Eventually, Choset sees surgical snake-arm robots reducing the number of “mundane” surgeries on a surgeon’s plate, allowing them to focus on more complex operations. As some Flex-probe-based procedures become routine, the tasks could be relegated to non-surgeons.

“When you have a technology that enables people with access to less resources to do the same procedure, that procedure no only goes down in price but it also occurs with a lot more higher frequency,” he said. “And that’s where I believe the future of this medical robot is going.”       

Choset hopes to focus his future research on natural orifice transluminal endoscopic surgery, a procedure where the idea is for the surgeon to access the body through an orifice, and poke a hole in a luminal tract before proceeding with surgery. According to Choset, the luminal tract can heal much more quickly than flesh, bone, and muscle. 

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