Medical Device Daily

While not quite “Sixty Thousand Leagues Under the Sea“ – just 62 feet, to be exact – the NASA Extreme Environment Mission Operations (NEEMO) project is an undersea odyssey for the companies and institutions who are testing their medical devices at depth in Key Largo, Florida.

Getting a large benefit is SRI International (Menlo Park, California) which demonstrated the ability to do a surgical procedure in the extreme environment of an underwater lab, robotically and telemedically.

The work done: suturing a vein, a complex operation controlled by a surgeon while seated in Canada.

A non-profit research organization, SRI International was just one of several collaborating in the NEEMO 9 mission. Among the other key collaborators: NASA (Houston), the U.S. Army Medical Research and Materiel Command's Telemedicine and Advanced Technology Research Center , and the Canadian Center for Minimal Access Surgery (CMAS; Hamilton, Ontario).

In this particular scientific test aboard the underwater enclosed lab, the Aquarius Underwater Laboratory, for the first time in history, an entire robotic surgical system was transported to an extreme environment and manipulated successfully from afar, according to SRI, which supplied the robotic system. The18-day mission began April 3 and ended last Thursday.

“It was obviously a challenge pushing back some new frontiers,“ Thomas Low, SRI director, Medical Systems Program for SRI, told Medical Device Daily. “It's not something that we thought was not going to go as well as it did. We had every expectation that it would be a successful experiment.“

SRI was founded as Stanford Research Institute in 1946. And it was from SRI that Intuitive Surgical (Sunnyvale, California), maker of the well-known da Vinci robotic-assisted surgery system for minimally invasive surgery, was spun off in 1995

To prepare for the test of the robotic system, with the mission mapped out by Mehran Anvari, a surgeon and professor in the CMAS and McMaster University (also Hamilton), SRI conducted exercises between Toronto and Menlo Park using the public Internet, Low said.

Anvari was in Canada while the surgical robot was on board the Aquarius laboratory, about 1,500 miles away in Florida. While in Canada, from a control console, Anvari performed the vascular suturing procedure.

And, in completing the surgery with robotic assistance, Anvari was able to do it with a 2-second time delay between the movement that his hands and wrists made at the console, and the resulting motion at the surgical site underwater.

“Previous research has shown that surgeons can adapt to latencies of 200 to 500 milliseconds,“ said Mark Reagan, Neemo 9 mission director, NASA. “However, common knowledge dictates that time delays greater than 500 ms (half a second) would make such a task impossible. This mission successfully demonstrated a 2-second time delay – equivalent to the time it would take for the signal to travel to the moon.“

By completing planning in advance, Low said, “[We] were able to experience most of what we discovered during the mission itself, with the exception of the extreme environment.“

John Bashkin, director of business development for SRI, a non-profit, told MDD, “That was sort of the 'dry run' for us to flush the system out – shake it out a little bit.“

SRI also redesigned the system specifically so it could be “deployed in that environment,“ Low said.

That required a design allowing the system to be packaged into components small enough so that they could easily be transported to the underwater laboratory for assembly from separate items.

Since the environment is hyperbaric – meaning that it has two atmospheres of pressure – that was a major factor in considering “how the equipment would operate,“ he said.

Meanwhile, SRI had five people in either Canada or Florida to ensure the platform worked properly.

“What we were able to do on Neemo was up to about a 2-second delay, sort of like from here to the moon, but if you're going to Mars, well, it's a lot further than that,“ he said, in explaining the fact that development will need to continue on the SRI system.

“So, how do you deal with these very long time lags between the surgeon and the surgical site and still maintain control – and how do you solve the issues of robotics that that brings up.“

The system that SRI used is generations beyond the da Vinci system, and it is designed to be used for “open“ surgeries – meaning those similar to more conventional surgical procedures with long incisions – vs. minimally invasive surgeries, Bashkin said.

He said they are using the experiment to develop “new procedures and new tools, which may be useful for laparascopic surgery, as well as open surgery.“

SRI is also looking to add greater manual dexterity to the system, or endovectors that have a small size, as compared, for example, to those on the da Vinci, so that surgery can be performed using the system on neonates, infants or adolescents.

Scaling down in size “means you have to look at entirely new ways of doing surgery,“ Bashkin said.

“We are using our robotic platform as a research platform looking at some of those issues,“ Bashkin told MDD.