Minimally invasive robots implant a new flexible, maneuverable device in a living brain

Early studies tested the delivery and safety of the new implantable catheter design in two sheep to determine its potential
in diagnosing and treating brain disorders.

If the platform proves effective and safe for human use, it could simplify and reduce the risks
associated with diagnosing and treating diseases deep in the brain, fragile deep in the brain.

It could help surgeons look deeper into the brain to diagnose disease, more precisely administer treatments such as drugs and laser ablation to tumors, and better deploy electrodes for deep brain stimulation
in diseases such as Parkinson's and epilepsy.

Professor Ferdinando Rodríguez Baena, senior author of the Department of Mechanical Engineering at Imperial College London, who led the European study, said: "The brain is a fragile and complex network where nerve cells are closely connected and each cell has its own role
.
" When disease arises, we want to be able to navigate this delicate environment, targeting these areas
precisely without harming healthy cells.

"Our new precise, minimally invasive platform improves on existing technology and, if proven to be safe and effective, could improve our ability to
safely and effectively diagnose and treat human diseases.
"

As part of the 2020 Neurosurgical Enhanced Transport Ecosystem (EDEN2020) project, the findings were published in
PLoS Synthesis.

Invisible surgery

The platform improves on existing minimally invasive or "keyhole" surgeries, in which the surgeon places tiny cameras and catheters
through small incisions in the body.

It includes a soft, flexible catheter to avoid damaging brain tissue while performing treatment, and an artificial intelligence (AI)-powered robotic arm to help surgeons navigate the catheter
in brain tissue.

Inspired by the organs that parasitic wasps secretly lay eggs on tree bark, this catheter consists of four interconnected parts that slide against each other for flexible navigation
.

It connects to a robotic platform that combines human input and machine learning to carefully guide the catheter to the site
of disease.
The surgeon then delivers the fiber through the catheter so they can see and manipulate the tip to move
along the brain tissue through joystick control.

The AI platform learns from the surgeon's input and contact forces within the brain tissue to guide the catheter
precisely.

Compared to traditional "open" surgical techniques, this new approach may ultimately help reduce tissue damage during surgery and improve the length
of recovery time for patients and postoperative hospital stays.

In minimally invasive surgery on the brain, surgeons use deep penetrating catheters to diagnose and treat disease
.
However, the catheters currently in use are rigid and difficult to place
precisely without the help of robotic navigation tools.
The inflexibility of the catheter, combined with the complex, delicate structure of the brain, means that the catheter is difficult to place precisely, which poses a risk
to this type of surgery.

To test their platform, the researchers placed catheters in the brains
of two live sheep at the University of Milan's Veterinary School.
Before euthanasia, the sheep were given pain relief and monitored for pain or signs of distress 24 hours a day for a week so that researchers could examine the structural effects
of the catheters on brain tissue.

They found no signs of
pain, tissue damage or infection after the catheter was implanted.

Lead author Dr Riccardo Secoli, also from Imperial's Department of Mechanical Engineering, said: "Our analysis shows that we safely implanted these new catheters without injury, infection or pain
.
If we achieve equally promising results in humans, we hope to see this platform
in the clinic within four years.
"

"Our findings could have a significant impact
on minimally invasive, robotically delivered brain surgery.
" We hope it will help improve the safety and effectiveness of current neurosurgical procedures, where precise deployment of therapeutic and diagnostic systems is required, such as in the case of
local gene therapy.
" ”

Professor Lorenzo Bello, co-author of the study from the University of Milan, said: "A key limitation of MIS at the moment is that if you want to get through a drilled hole in the skull to a deeper part, you are confined to a
straight trajectory.
The limitation of a rigid catheter is its accuracy in moving tissues in the brain, and the tissue deformation
it can cause.
We have now found that our catheters can overcome these limitations
.
”

This study was funded
by the EU Horizon 2020 project.