May 9, 2024
Making Microsurgery Accessible to All
This is a demonstration video showing the suturing of corn kernels with tiny suture needles called 12-0 using the surgical assistance robot.
Reference : Fernandes, M., Tramontin, D., Pimentel, A., Costa, L., Neto, D., Xavier, D., Bentes, L., & Santos, D. (2022). Low cost and easy acquisition: corn grain in microsurgery training. Revista do Colégio Brasileiro de Cirurgiões, 49.
Microsurgery refers to surgical procedures performed on minute human tissues using a surgical microscope and other instruments. Such operations require high levels of skill and can be conducted only by a limited number of physicians and facilities. Sony, driven by the desire to make this advanced surgery more accessible to both those performing treatment and those in need of treatment, is advancing research and development of surgical assistance robot technology.
The robot system mainly consists of a tabletop console operated by the surgeon and a robot performing procedures on the patient. The movements of the surgeon’s hands on the console are replicated at a reduced scale of about 1/2 to 1/10 at the tip of the robot arm’s surgical instrument. This motion scaling technique enables surgeons to perform precise operations beyond their physical limitations. The system is designed to be used in various facilities and surgical scenarios, with the console and robot made as compact as possible.
- Key Technical Features
- 01 Taking Advantage of the Surgeon’s Dexterous Fingers
- 02 Smooth and Intuitive Remote Operation
- 03 Unique Automatic Instrument Exchange Function
- 04 High-definition 4K Imaging
01
Taking Advantage of the Surgeon’s Dexterous Fingers
Microsurgery involves a combination of extremely tiny motions, such as inserting needles into small blood vessels, and relatively larger motions like pulling threads. There has been a concern that, while the motion scaling technique, which is an advantage of this surgical assistance robot technology, simplifies extremely tiny motions, it may reduce the efficiency of relatively larger motions.
To address this concern, Sony has developed a small and lightweight control device that can be manipulated with fingertips in a similar way to conventional surgical instruments. By making the most of the capabilities of human fingertips, ultraprecise operations can be achieved without the need to significantly increase motion scaling. These technologies aim to allow surgeons to comfortably perform various tasks in a stable posture with their hand rested on the handrest.
02
Smooth and Intuitive Remote Operation
While the intervention of robots between surgeons and patients enables finer movements, it can also lead to delayed or jerky movements of instruments, reducing the intuitiveness of robot-assisted surgery and complicating procedures.
To tackle these challenges, all joints of the robot arm, from the joints corresponding to human shoulders and elbows to the ultra-small wrist joints at the tip of the instrument, have been changed to low-friction joints, thereby achieving smooth and jerk-free movements.
Additionally, an electric control system focused on low latency and a mechanical system focused on lightness enhance the responsiveness of robot movements. These measures result in smooth and low-latency movements of the instrument tip, providing an intuitive remote operation experience that minimizes the sense of robot intervention.
03
Unique Automatic Instrument Exchange Function
Small-sized instrument with wrist joint
Surgeries involve various stages, each requiring specific instruments. For instance, tweezers are used to grasp tissues, while scissors are used to cut threads. In actual surgeries, surgeons and assistants quickly exchange these instruments many times during procedures.
Taking the smooth workflow in such medical settings as a reference, Sony has developed an automatic instrument exchange function. This technology automates the instrument exchange done by human hands in conventional surgical assistance robots, allowing for more stable and faster exchanges. Specifically, the entire instrument has been miniaturized, with a mechanism designed to store multiple instruments near the two robot arms. This enables instruments to be exchanged efficiently in small motions from either robot arm without interrupting the surgery for manual intervention. It is aimed that this function will eliminate temporary interruptions when changing robotic instruments, making robotic surgical assistance smoother.
04
High-definition 4K Imaging
4K3D stereo camera installed on robot prototype
Stereo viewer using 1.3-type 4K OLED Microdisplays
Magnified stereoscopic viewing of minute tissues is essential for microsurgery.
The prototype is equipped with 1.3-type 4K OLED Microdisplays developed by Sony Semiconductor Solutions Corporation, allowing operators to view high-definition images of the affected area and the movement of surgical instruments. Thanks to faithful reproduction of color, texture, and depth this makes possible, the prototype aims to provides visual support for microsurgical procedures.
Feedback from specialists
Mukumi Clinic, Director, Plastic surgery specialist
Dr. Makoto Mihara
JR Tokyo General Hospital, Department of Lymphatic and Reconstructive Surgery, Chief physician, Plastic surgery specialist
Dr. Hisako Hara
Proof of Concept Experiment
In February 2024, experiments using this prototype were conducted at Aichi Medical University, where physicians and medical staff not specialized in microsurgery successfully anastomosed animal’s blood vessels (approximately 0.6 mm in diameter) in the super-microsurgery*1 field. This marks the world’s first case*2 of successful blood vessel anastomosis in the field of super microsurgery using a surgical assistance robot capable of automatic instrument exchange.
Going forward, Sony plans to work with university medical departments and medical institutions to further develop and verify the effectiveness of robotic surgical assistance technology. Continuing to move forward with R&D, the company aims to help resolve issues in the medical domain and contribute to the advancement of medicine by providing robotic technologies.
*1 Surgery that deals with extremely small blood vessels and nerves with a diameter of 0.3 to 0.8 mm is called supermicrosurgery, especially.
Reference: Masia J, Olivares L, Koshima I, Teo TC, Suominen S, van Landuyt K, et al. Barcelona consensus on supermicrosurgery. J Reconstr Microsurg (2014) 30(1):53–8. 10.1055/s-0033-1354742
*2 As of May 9, 2024; according to a survey by Sony Group Corporation
Aichi Medical University, Department of Anatomy
Professor Munekazu Naito
Humans possess remarkably superior brain and hand coordination compared to other animals, allowing for precise and delicate movements. Microsurgery represents one of the cases where this capability is maximally utilized. However, it takes months to years of extensive training for even skilled physicians to master this technique. In this collaborative study, Sony’s surgical assistance robot technology was tested to assess its capacity to enhance the skills of novice microsurgeons. The results demonstrated exceptional control over the movements of inexperienced physicians, enabling them to perform intricate and delicate tasks with adeptness akin to that of seasoned experts. I hope that surgical assistance robot technology will bring about a future where the expanded capabilities of human physicians enable advanced medical practices.
Aichi Medical University, Department of Anatomy, Thoracic Surgeon
Dr. Tomohito Ohkubo
As a specialist in thoracic surgery, I have mainly performed surgeries for lung cancer. Lung cancer surgery does not generally involve anastomosis of minute blood vessels or nerves under a microscope. Therefore, I performed a microvascular anastomosis for the first time in this experiment using Sony's surgical-assistance robot. The first thing I felt when operating the robot was that I was able to anastomose minute blood vessels with the same sensation as when manually anastomosing larger blood vessels. After sharing this experience with other novice microsurgeons and allowing them to experience the operation, they were equally successful in anastomosing minute blood vessels with the assistance of the robot. Seeing all this firsthand made me convinced that such surgical assistance robot technology would contribute to the further spread of microsurgery in the future.
