The robot, known as Axsis, is one of the world's smallest known robots designed for surgical use and could offer a glimpse into the future of surgical robotic technologies.

Kristopher Sturgis

Engineers from Cambridge Consultants, a product design and development firm out of the UK, announced this week the arrival of Axsis -- a new miniature robotic tool designed to provide increased precision, access, and navigation for a variety of different clinical procedures that current surgical robots cannot perform.

The technology was designed to be the size of a soda can, using flexible instruments that provide the robot with more freedom and mobility to perform precise actions inside the body. Chris Wagner, head of advanced surgical systems at Cambridge Consultants, says that this new robotic technology addresses one of the major challenges to robotic surgery: size. 

"One of the main challenges of surgical robotics is how to incorporate the system into the operating room, and the workflow of current procedures," he says. "Current surgical robots are amazing devices, but they are large pieces of equipment that limit their adoption. We've taken a different approach -- using a flexible instrument to articulate inside the body doesn't require large motions outside of the body, nor does it require significant robot forces pushing against the body wall, which allows the robot to be smaller. Thus, the entire system can be made smaller, easing the introduction with current operating rooms and workflows."

The design of the Axsis robotic tool is completely state of the art, aimed at creating space efficiency with the operating room. The size and flexibility of the technology allows for use inside and outside of the body, offering precision on a wide variety of different surgical procedures.

"This flexible approach enables a small robot on the outside of the body, as well as an instrument on the inside of the body," Wagner says. "We've designed our instruments using a stack of rolling stainless steel rings, precision micro-machined to achieve the necessary tolerance and performance. The rings are rolling to provide low friction articulation, as well as made out of metal to achieve a high articulator stiffness. The rings also contain a working channel to allow for fluid management that is normally a part of intraocular tools." 

Wagner says that one reason most current surgical robotic tools are so large stems from the use of long, straight instruments designed to pass through small holes in the body to access surgical sites. This kind of equipment requires large robotic motions outside the body, to create motions inside the body.To address this issue, the group decided to take on the challenge of designing a smaller, more robust robotic technology that could broaden the impact and use of robotic innovation.

"Building a surgical robot that can work on a size scale of less than 10 millimeters is difficult," he says. "So we took it as a technical challenge by asking ourselves, is there anything stopping us from building a robot on this size scale? What we've found so far, is that the answer is no. We've been able to construct articulating end effectors with a 1.8-mm outer diameter that are the same size as current surgical tools, but with full articulation. I think the most exciting aspect for me has been demonstrating that robotics can be applied to a wider range of procedures than ever before, potentially increasing the quality and availability of lifesaving surgical procedures."

Robotics have already begun transforming surgical procedures, despite some questioning their future in medicine. Researchers and engineers have begun to shift to more flexible robotic adaptations--something Axsis aims to do as well. Wagner hopes the new technology could usher in a new wave of miniature robotic systems that could revolutionize some of the more delicate and minimally invasive procedures that require small, precise movements.

"I think the main impact is to demonstrate miniature robotics capabilities that can be incorporated into future products, whether they are full featured surgical robots, or more specialized surgical tools," Wagner says. "One key benefit that robotics can provide is more precise tissue manipulation through motion scaling and tremor reduction, while maintaining minimally invasive access."

When it comes to potential applications, the list could be quite expansive, covering procedures like cataract surgery, to a variety of other delicate procedures like esophageal and gastrointestinal tract procedures. The goal is for Axsis to provide surgeons with a tool that could be used to enable surgical outcomes that are not currently possible today.

"I do think that the benefits that robotics provide will continue to make it into the operating room, and the choice to use a robot for a surgery will become a no-brainer," Wagner says. "We hope that this system demonstrates what's possible in the next generation of surgical robotics, and we hope that this or similar technologies are further developed and the benefits that robotics can bring to surgery become more widespread, thus increasing patient safety and leading to better surgical outcomes. The challenge is on the makers of these tools to ensure they can be provided in a way that is compatible with the workflow and budget of tomorrow's surgeons." 

Kristopher Sturgis is a contributor to Qmed.

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[video courtesy of CAMBRIDGE CONSULTANTS]