Autonomous, self-navigating robot repairs heart valve in groundbreaking experiment.

Scientists have successfully trained a tiny robotic catheter to navigate to a leaky heart valve using artificial intelligence and an on-board camera.

Longevity.Technology: We are excited by this world-first; autonomous robots that are minimally invasive, share knowledge, continuously improve and perform complicated microsurgery procedures to extend life.

The TRL score for this Longevity.Technology domain is currently set at: ‘Technology has completed initial trials and demonstrates preliminary safety data.‘

The TRL score for the technology addressed in this article is: ‘Late proof of concept demonstrated in real-life conditions.’

The team of bioengineers from Boston Children’s Hospital in the US likened the robot to a self-driving car, navigating its way to its chosen destination [1]. In the experiment on a pig’s heart, the researchers used scans of the heart and a cardiac map to inform the robot’s AI and then a specially-designed optical sensor used the algorithm to find its way to the desired spot by hugging the walls of the heart. The robot periodically sampled its environment [2] and used the tip-mounted camera to determine from the sensor whether it was touching the heart wall, blood or the valve itself. The bot also used the sensor to ensure it didn’t press too hard and damage the heart [3].

Pierre Dupont, Head of Pediatric Cardiac Bioengineering at Boston Children’s Hospital, said: “The algorithms help the catheter figure out what type of tissue it’s touching, where it is in the heart, and how it should choose its next motion to get where we want it to go [4].”

The robotic catheter autonomously navigated from the base of the heart took a route along the left ventricle wall to the leaking valve and then moved around the valve to the leak itself. Once it had arrived at its destination, the surgeons took over, performing a paravalvular aortic leak closure [5], which is essentially plugging the leak.

Dupont said that the robot could remove the need for fluoroscopic imaging in these sorts of valve repairs, which would prevent exposing patients to damaging ionising radiation [6]. As well as being a step towards minimally invasive techniques, the device will also be of assistance in unusual or tricky procedures and help in surgical training. Additional benefits could see the robot used in routine organ-mapping as well as providing guidance in operations in areas that lack experienced clinicians.

Although the robot took slightly longer to reach its target than the surgeon in the trial, Dupont said this was because it was tracking along the heart wall. He added: “The navigation time was statistically equivalent for all, which we think is pretty impressive given that you’re inside the blood-filled beating heart and trying to reach a millimetre-scale target on a specific valve [7].”

Over the course of 83 trials, the robot catheter reached its destination in 95% of attempts and the research team were unable to detect any signs of abrasions, bruising, or any other tissue damage [8].

The Boston team is positive about the experiment outcome, feeling that deploying autonomous robots in surgery will mitigate surgeon fatigue and allow them to focus on the trickiest part of the operation. Dupont explained: “The right way to think about this is through the analogy of a fighter pilot and a fighter plane; the fighter plane takes on the routine tasks like flying the plane, so the pilot can focus on the higher-level tasks of the mission [9].”

As the US’s Food and Drug Administration begins putting together its regulatory framework for AI-enabled devices [10], Dupont and the Boston team foresee a point where autonomous surgical robots are able to continuously pool their data, wherever they are in the world, leading to global improved performance. “This would not only level the playing field, it would raise it,” said Dupont. “Every clinician in the world would be operating at a level of skill and experience equivalent to the best in their field. This has always been the promise of medical robots. Autonomy may be what gets us there [11].”

[1] https://www.sciencedaily.com/releases/2019/04/190424153600.htm
[2] https://hms.harvard.edu/news/first-medical-robotics
[3] https://vector.childrenshospital.org/2019/04/autonomous-medical-robot/
[4] https://futurism.com/the-byte/doctors-autonomous-surgery-robot-heart
[5] https://bit.ly/2z84gFz
[6] https://www.theengineer.co.uk/autonomous-medical-robot-boston/
[7] https://bit.ly/2KFPD2R
[8] https://bit.ly/2Mn1dSJ
[9] https://bit.ly/309nXZD
[10] https://www.fda.gov/media/122535/download
[11] https://www.eurekalert.org/pub_releases/2019-04/bch-afi042219.php
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