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Miniature robot hand set to revolutionise surgical treatment of babies in the womb: An automated pincer will provide 3D images of foetuses and tackle damaging conditions such as spina bifida

June 1, 2014

Robin McKie Science Editor



Scientists have launched a pounds 10m project to create a tiny surgical robot hand that could transform the treatment of children with spina bifida and other congenital conditions.

The aim of the research, which is being carried out by engineers at University College London (UCL) and KU Leuven in Belgium, is to create a minuscule device that would provide 3D images of a foetus while it is still in the womb which will also act as an automated robot hand. This could carry out delicate surgery or deliver stem cells to an unborn child's damaged organs.

"The aim is to create less invasive surgical technologies to treat a wide range of diseases in the womb, with considerably less risk to both mother and baby," said the project leader, Professor Sebastien Ourselin, from the UCL centre for medical image computing.

A prime priority for the project, which is being funded by the Wellcome Trust and the Engineering and Physical Science Research Council, is to revolutionise the treatment of children with spina bifida. About one in 1,000 babies are born with myelomeningocele spina bifida, the most serious form of the condition. This is caused when the spine of an unborn baby does not form properly and amniotic fluid leaks into it. Germs in the fluid can then spread up the spinal column until it reaches the brain and inhibits its development. As a result, babies born with spina bifida often suffer severe neurological complications. The answer, doctors have concluded, is to try to patch the gap once it has appeared in the baby's spine.

Such surgery involves opening the mother's abdomen and uterus and incurs a significant risk of triggering premature birth, however. As a result, operations like these are rarely carried out. "They are very dangerous," said project manager Jenny Nery. "There is a very severe risk to the mother's health."

In addition, surgery on the unborn can only be carried out when the foetus is at least 26 weeks old. By that time, considerable damage may already have been done to the child's growing brain. "We need to find a way to block up the gap in the baby's spine at a much earlier stage in the foetus's development," added Ourselin. "Ideally, it should be done around 16 weeks. The earlier the treatment, the more effective it will be."

At present, such operations are impossible. The objective of the Wellcome-funded project is to develop instruments - based on the latest developments in optics and robotics - that will make them possible.

The engineers and doctors involved in the project envisage developing a very thin, highly flexible probe that would be inserted into the womb of a woman carrying a child with spina bifida. The head of the probe would have one strand fitted with a tiny camera that would use laser pulses and ultrasound detection - a combination known as photo-acoustic imaging - to generate a 3D photograph inside the womb. These images would then be used by the surgeons to guide the probe to its target: the gap in the foetus's spine.

The probe's other arms would also be fitted with tiny instruments which would carry a piece of gel or patch that would then be inserted over the gap in the baby's spine. "It will be like a plaster," added Ourselin. "If we can do that, there will massive gain for the foetus while there will be little risk to the mother."

At present, most designs for the robot foetal surgeon envisage a three-pronged device that has one arm fitted with a camera and two that are fitted with pincers or other instruments.

"We are still in the design stage, so we could end up with a device with four or five arms in the end," added Ourselin. "Nor would it be used merely to put in patches. It could carry out delicate surgery or deliver stem cells to damaged organs."

In addition to the spina bifida cases, the device could also help in the treatment of many other foetal conditions, such as twin-to-twin-transfusion-syndrome (TTTS) in which there is an unequal, life-threatening supply of blood twins inside the womb.

"Operating on babies in the womb should not be undertaken lightly," added Ourselin. "We need the very best surgical tools to do something like this, and this project will make sure we have them in the next few years."

Captions:

Robin McKie has been shortlisted for the 2014 journalism awards run by the Association of British Science Writers for his story 'Gene wars: the last-ditch battle over who owns the rights to our DNA'. Read the article at: gu.com/p/3f9pg


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Source: Observer (UK)


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