Research Projects

Prior to using the Zeus robotic surgical system in clinical practice, we demonstrated its feasibility in animals the size ofhuman newborns.

PORTOENTEROSTOMY

In this study, we resected the common bile duct in pigs weighing approximately 3 kilograms. We then reconstructed the biliary tract with a Roux-en- Y portoenterostomy. The pigs survived for 30 days to demonstrate function.

ESOPHAGOESOPHAGOSTOMY

To demonstrate the performance of complex surgical maneuvers in the small thorax of an animal the size of a human newborn, we performed esophageal resection and anastomosis in pigs weighing approximately 3 kilograms. The pigs survived for 30 days to demonstrate function.

PYELOPLASTY

Urologic minimally invasive surgery in children has been limited because of the complex maneuvers required. We believed that the enhancements that robotic surgery applies would remedy this. In this study we performed pyeloplasties in pigs weighing approximately 3 kilograms. The pigs had intravenous urograms prior to sacrifice to demonstrate function.

With this series of studies, we believe we demonstrated the feasibility of robotic surgery for perfonning complex task in animals the size of human newborns. While there are certainly more operations that could be used, we feel that these operations use the same surgical task, and that further studies of this sort are not necessary .

FETAL SURGERY

Most investigators of antenatal intervention have concluded that open fetal surgery is associated with significant morbidity and little advantage. They have turned their attention to minimally invasive approaches. We believe that the enhancements of robotic surgery can increase the range ofwhat is feasible with minimally invasive fetal surgery. We used fetal sheep and performed minimally invasive robotic surgery .We opened the abdomen and then closed it with a running suture. We then removed the instruments and allowed the ewes to continue the pregnancy for several weeks. The sheep were then delivered by cesarean section and examined. We demonstrated that it was indeed feasible to do a fetal laparotomy in a pregnant ewe, and carry the pregnancy for a significant period of time.

MICROSURGERY

We believe that the enhancements of robotic surgery, especially tremor filtration and motion scaling, would be of particular benefit to surgeons using the operating microscope at up to 30 power magnification. We have developed an open microsurgery system employing the Zeus robotic surgery system. This allows the surgeon to sit at a console and view both a 3-D image, at whatever magnification he/she chooses, and on a side screen a 2-D image of the larger field.

We have completed the first feasibility study in which one surgeon performed rat femoral artery anastomosis with open manual techniques and with the open robotic surgery system.

We are currently involved in a human factors study to try to elucidate what benefits there might be to this system.

A third microsurgery investigation involves using the technology to do brachial artery repairs in an animal model. The plan is for the animals to survive so we can determine the functional results

RAMAN SPECTROSCOPY FOR THE DETERMINATION OF MALIGNANCY

While this is not specifically a part of the Frankel C.A.R.E.S. program, it does fit within the scope of the Frankel Pediatric Advanced Technology Institute. Working in collaboration with the departments of Biomedical Engineering and Physics as well as the Center for Smart Sensors and Integrated Microsystems at Wayne State University, we have interrogated both animal and human tissue with Raman Spectroscopy. This is a non-destructive technique, which has the potential for incorporation into a probe that could be used either externally on patients or internally at operation to determine whether or not a particular tissue is malignant. We have demonstrated the ability of this technique to distinguish different tissue in the same animal as well as to determine the difference between similar tissues from different animal. We have also demonstrated specific Raman "signatures" for human hepatoblastoma and human neuroblastoma.

We are currently conducting a larger scale study in a mouse breast cancer model.