Giving the World the First Surgical Robot

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Sjaak Deckers
Sjaak Deckers, CEO

“MUSA provides superhuman precision for microsurgeons, allowing new interventions that are currently impossible to perform by hand.”

Plastic surgeons at Maastricht University Medical Center have used a robotic device to treat lymphedema in a patient surgically. This is the world’s first super-microsurgical interference with ‘robot hands.’ The surgeons applied the robotic device to suture vessels of 0.3 to 0.8 millimeters in the patient’s arm. The robotic device, created by Eindhoven company Microsure, improves the surgeon’s precision, making this procedure easier to perform. The patient is doing well, and the surgeons are enthusiastic. This extraordinary operation has been announced at the 26th World Congress of Lymphology in Barcelona.

Surgeons in Maastricht found the solution in Eindhoven. The surgical robot of Microsure, a spin-off of Eindhoven University of Technology and Maastricht University Medical Center, is controlled by a surgeon whose hand movements are converted into smaller, more precise movements, which then are performed on the patient by a set of ‘robot hands.’ The device also stabilizes any tremor in the surgeon’s movements, making the procedure more controlled and thus easier to perform. The Microsure robot is expected to enhance many microsurgical procedures and enable new interventions that are currently impossible to perform by hand. This will lead to enhanced patient outcomes and lower healthcare costs due to reduced complications and less post-operative treatment.

Shan Shan Qiu Shao, plastic surgeon at Maastricht University Medical Center: “Microsure enables us to be very precise in our movements during procedures that need a surgical microscope. Their robot allows us to operate on minuscule lymph vessels and blood vessels with more ease, while getting better results for these complex and fatiguing interventions. Besides it is very convenient that, within microsurgery, we can operate on vessels of every size with this robot. Most importantly, of course, this is good news for the patients concerned.”

Microsure is a medical device company situated in Eindhoven (Netherlands), founded by Eindhoven University of Technology and Maastricht University Medical Center in 2016. Their focus is to enhance patient’s lives through developing robot systems for microsurgery. Their current product is MUSA, the world’s first surgical robot for open microsurgery. MUSA is created in close cooperation with microsurgeons and engineers, especially for microsurgical applications. MUSA provides superhuman precision for microsurgeons, allowing new interventions that are currently impossible to perform by hand.

MUSA

The development of microsurgery is here. MUSA is the world’s first clinically available CE-certified surgical robot for microsurgery. It is produced by a team of engineers and surgeons, creating a compatible solution with current operating techniques, instruments, and other OR equipment. Running with MUSA feels almost identical to conventional microsurgery but has many extra benefits:

MUSA transmits a small footprint in the OR as the flow and infrastructure remain constant during use. MUSA’s set-up allows for a hybrid microsurgical procedure as one is seated directly next to the patient, and this also true for their assistant and staff. MUSA scales down motion seamlessly and filters out tremors to keep a steady hand at any time throughout every microsurgical procedure. MUSA needs to be controlled via joysticks while working in an ergonomically comfortable position, allowing for a better posture and solving pain and fatigue issues. MUSA aims for constant high-quality surgical performance reducing inter-operator variability and enabling safer operations and improved treatment outcomes for your patients.

The company has an excellent business team with a proven track record in the commercial, clinical and technical domain. Besides, they have strategic collaborations with clinical key opinion conductors, industrial partnerships, and quality and regulatory experts. Microsure is satisfied to create on a network of clinical and technical advisors, including top surgeons from university medical centers worldwide, with the Maastricht University Medical Center+ as a leading clinical partner.

Performing Microsurgeries

In a world-first, clinicians at Maastricht University have used a robot to perform “supermicrosurgeries,” which included operating on vessels as small as 0.3 mm in diameter. The procedures were administered on women with lymphedema, a condition that emerged from breast cancer, whose lymphatic vessels were attached to veins to provide a drain for lymphatic fluids that built up.

This is normally very difficult, as operating on such tiny vessels requires extremely stable hands. To overcome this, the researchers employed the MUSA robot from Microsure, a Dutch firm that was recently cleared in the EU. The device miniaturizes hand movements and decreases any shaking so that surgeons can work on impressively minute anatomy. It works with existing surgical tools and microscopes, and Microsure requires that introducing it into an existing operating room shouldn’t change the facility’s workflow or foundation.

The super microsurgical lymphatic-venous anastomosis (LVA) procedures were performed on twenty women who operated on using a robot or through manual surgery. The researchers showed that it takes about half as long to perform an anastomosis using a robot and that after three months post-surgery, the women treated using the robot had improved outcomes.

MUSA is the world’s first surgical robot for open microsurgery. This robotic helper is clinically and commercially available after the medical device CE-mark was assigned by notified body DEKRA recently. Microsure’s MUSA is produced by a team of microsurgeons and engineers, creating a high-precision robotic assistant cooperative with current operating techniques, workflow, devices, and other OR equipment. It enhances surgical production by stabilizing and scaling down the surgeon’s movements during complex microsurgical procedures on the sub-millimeter scale.

Microsure’s MUSA, e.g., facilitates lymphatic surgery on lymph vessels smaller than 0.3 mm in diameter. Plastic surgeons at Maastricht University Medical Center+ were the first to practice MUSA to treat lymphedema in a patient surgically. This world’s premier super-microsurgical intervention with ‘robot hands’ took place in 2017. Maastricht University Medical Center+ is now managing several follow-up clinical research projects with MUSA in different microsurgery fields. Other European hospitals are expected to start clinical studies this year.

The Procedure

A robotic system particularly designed for reconstructive microsurgery has not been ready now. The MUSA is designed to help in stabilizing the microsurgeon’s movements by filtering tremors and scaling down motions. The robot is easily maneuverable, furnished with arms holding genuine (super)microsurgical instruments that are quickly placed into the holders, and are compatible with conventional surgical microscopes. Preclinical tests of the MUSA have approved this robot’s safety and feasibility in performing microsurgical anastomosis.

In general, the system is comprised of the following: (1) master manipulators that are forceps-like joysticks positioned to the operating table. The operating surgeon controls these master manipulators. (2) A suspension ring is connected to the operating table. The ring is placed between the operating field and the surgical microscope. (3) Slave manipulators are robotic arms, which are fastened to the suspension ring. The robotic arms can be equipped with reliable (super)microsurgical instruments. (4) Foot pedals that activate the system. A digital interface converts the movements of the master manipulators onto movements of the robotic arms. Motion scaling and tremor filtration can be adjusted by the software and controlled by foot pedals.

The MUSA in a clinical setting has a microsurgeon on the left controls the MUSA via two master manipulators, which are mounted to the operating table. Two slave manipulators mounted to the suspension ring between the operating field and the surgical microscope, then mimic the surgeon’s hand movement. In this case, the microsurgeon on the right provides manual assistance during the procedure in an identical way as would be in conventional microsurgery cases with two surgeons.

Owing to advances in early diagnosis and more effective treatments, breast cancer has become a chronic condition rather than a life-threatening illness. Therefore, special attention is paid to long-term sequelae of this condition, such as breast cancer-related lymphedema (BCRL), affecting 29.4% of breast cancer survivors within two years after surgery. Treatment includes decongestive therapy consisting of compressive garments and manual lymph drainage and surgical interventions such as lymphatico-venous anastomosis (LVA). During the LVA procedure, where high precision and manual dexterity are essential for the outcome of the surgery, a super microsurgical anastomosis between lymphatic collecting vessels and the subcutaneous venous system is performed. It effectively reduces lymphedema severity in early-stage BCRL, thereby improving the quality of life (QoL) of the patient.

“We report on the first-in-human use of the MUSA for robot-assisted LVA in patients suffering from BCRL. A randomized pilot study investigates patient outcome, duration of surgery, and quality of anastomosis in robot-assisted or manually treated female patients,” according to the study conducted by Tom J. M. van Mulken, Rutger M. Schols, Andrea M. J. Scharmga, Bjorn Winkens, Raimondo Cau, Ferry B. F. Schoenmakers, Shan S. Qiu, René R. W. J. van der Hulst & MicroSurgical Robot Research Group—First-in-human robotic supermicrosurgery using a dedicated microsurgical robot for treating breast cancer-related lymphedema: a randomized pilot trial.