By Kathy Williams. Photography by Shawn Poynter.
Each year, many patients undergo colectomies to remove cancer. While lifesaving, this invasive surgical procedure removes all or part of the colon, which can be dangerous and put the patient at a high risk for infection, revision surgery, and other complications. Such invasive colectomies could be rendered unnecessary for more than 70,000 patients each year in the US if surgeons had the capability to remove cancer more easily from the inside using a colonoscope.
Patients often end up having invasive colectomies due to the difficulty of maneuvering colonoscopic instruments to dissect larger cancerous lesions with complex shapes. MABE Associate Professor Caleb Rucker is working to reduce these invasive procedures by developing a robotic surgical system that provides a safer, less invasive endoscopic approach. His efforts are being backed with a $2.3 million grant from the National Institutes of Health.
Rucker, who is leading the five-year grant titled “Saving Patients from Invasive Colectomies via Trans-Endoscopic Steerable Instrument Sheaths,” is working with UT PhD students Khoa Dang and Joshua Gaston, and teams led by co-PIs Robert Webster at Vanderbilt University and Ron Alterovitz at the University of North Carolina at Chapel Hill to build the new surgical system. Andrew Russ, a colorectal surgeon at the University of Tennessee Medical Center, is a clinical investigator on the project, along with Keith Obstein at Vanderbilt University Medical Center and Ian Grimm at UNC School of Medicine.
“My students and I have spent the last five years laying the groundwork for this project,” said Rucker. “It started with an idea I had when I was first hired at UT and was further developed in the MS and PhD theses of Ryan Ponten, Kaitlin Oliver-Butler, Jake Childs, and Patrick Anderson. We are absolutely thrilled to now have the funding to continue the research and really create this next-generation surgical robotic platform that could help save the lives of many patients with early-stage colon cancer. We are also really excited to collaborate with great teams at Vanderbilt and UNC.”
The funding will support four PhD students and provide critical resources to enhance the team’s ability to build and test the surgical robotic system in the future.
“Our system is based on a steerable tubular sheath mechanism we initially developed at UT several years ago that allows us to build very small tentacle-like robotic arms that can be deployed through a colonoscope and remotely controlled by a surgeon.” said Rucker. “This new steerable sheath concept is made possible by intelligently micromachining metal tubes with a laser to customize their material properties and enable them to be articulated merely by pushing, pulling, and rotating them at the back end. These sheaths then carry standard endoscopic tools inside their large hollow bore, providing the ability to move the tools independently of the endoscope and reducing the difficulty of removing challenging lesions endoscopically.”
The steerable sheaths, which are about the size of a needle and can bend and extend like tiny octopus tentacles, will be low-cost articulatable devices that will fit through standard endoscopes. They will allow surgeons to perform more precise surgical procedures and remove tumors as soon as they are found without making any incisions. The device should dramatically reduce the difficulty of endoscopic removal of colon polyps and local-stage tumors and prevent thousands of patients from undergoing more invasive surgeries.
“Our hope is that many of the patients who undergo invasive colectomies every year can benefit greatly by having the procedures done with our new device instead,” said Rucker. “On the personal side, my family has a history of colon cancer, so it is an honor to be able to conduct this work in the memory of loved ones and to help heal current and future generations.”
There is potential for the new surgical system to be used in a broad range of other procedures such as esophagus and stomach surgeries, intraventricular procedures in the brain, and endoscopic kidney stone removal.
Joshua Gafford, CTO of Rucker’s Nashville-based medical device startup company, Endotheia Inc., is leading the effort to commercialize the underlying steerable tube technology for other applications in urology and upper gastroenterology. Earlier this year, the company received a Breakthrough Device designation from the US Food and Drug Administration and now has priority status. If all goes as planned, Rucker’s NIH research at UT will lead to broad future applications of the new robotic system.