I know for you.

I wanted you to hear a story

from medical care of your

own really amazing work there and
Beatrice is one of them

very quickly.

I think you went through what
was a very small University

thank you very well and

amazing very very high quality guys and
then you're

three years by the actual vote

for the bill really cool thing about.

Thank you thank you very much for
inviting me here it is a really a pleasure

to visit George I think I'm really
amazed of the things you're doing here.

So today I'm going to speak
about the very briefly about

robotics Vanderbilt the and
then I'll move.

To my to the topic of my talk which
is basically divided in three chop.

The first one is about
the four colonoscopy.

The second one is a new approach.

For a robotic surgery and finally
out presents you a new development.

In the basically based platform
to pulp a T.V. show and

to detect the position of two more for
example soft Oregon like a lever.

OK So let me start quickly.

How about.

Engineering at Vanderbilt was so
in two thousand and

eleven the year I moved from Pisa to.

Vanderbilt started the program
an initiative are called vies.

We stands for
advise initiative inside the engineering.

This initiative.

We all know will become
eventually an institute.

Is composed by about twenty faculty.

ALF of their modern medical doctors they
have all of us engineering faculty this.

Let me just give you two quick
example of affiliated with the with

vi is inside the mechanical engineering
department which is where I belong.

And so this is Bob Webster Bob Webster

is also the person that convinced
me to move to Vanderbilt.

Because he did the period of his Ph D. and
then we get in contact all the time and

then you finally this made me
decide to commit them to this.

So what is doing is doing Candler
all boards which are precursor

of concentric circles that can rotate and
slide.

One Inside the other and
with these kind of you

kind of brought bodies
are able to access very very

small cavity see inside the human
body like for example this space and

see this space here at
the base of the skull.

Entering from the gnomes and

nodded very impressive guy in terms of
robotic surgery is an ability money that

moves research from Columbia University
to Vanderbilt in two thousand and ten.

And he's doing this is
now a crawl boards for

basically D.C. is.

Just for the.

Can enter inside their dorm and
do very complex B. manual task.

Surgical tasks.

So this probably will be the next
generation of subject of robots.

So I'm very very lucky to be in
this in this team in this group.

And what I'm doing is more
related to flexible and.

Particular target as I mean clinical need.

Targeting reducing give me
invest in a soft colonoscopy.

So that the disease.

At the base of this is color cancer so
Colorectal cancer is the second

leading cause of cancer and
you can see related that in the U.S..

But the good feeling about correlate
cancer if we can speak about a good thing

for cancer is that it can
be prevented in ninety five

percent of the cases if this disease
is diagnosed at an early stage.

So as you can see here in this picture.

This is the progression
of colorectal cancer.

So it start with small tissue grow and

then it grows grows grows in
a timeframe which is like five years.

OK and grows at the point where
they missed us the orders.

So basically this kind of cancer because

symptomatic at this stage after
like three or four years.

The passion start bleeding and

start to feel pain at their at this stage
it's too late to operate the cancer and

at this stage is just five
percent of Survivor today.

OK while here.

If the council is the tech to
this point it can be removed

in ninety five percent of the cases and
the survivability is very high.

So the point is we want to.

Call it a cancer at this stage.

However at this stage at a concert is
a symptomatic meaning that people is not

perceiving any pain any really any
need to go to see a doctor then.

For this series.

Especially in the US for

example colorectal cancer screening with
flexible and DOS copies recommended.

Every five years after the fifty.

OK.

The problem is that one in
three are those keeping this.

Screening and the reason is that
the current procedure is very painful.

OK is flexible and Moscow.

So flexible in the scope is very reliable
but it's also create a lot of barriers so

what is flexible in the hospital and
colonoscopy is basically the introduction

of a flexible endoscope which is a long
one point five metre long queue.

We're flexible enough to band.

But it's also stiff enough to
be pushed from the back here

to advance the inside the cone.

So this is the call and this is the end.

And you see the shape is very like.

You drag and
this is like flexible the shoes so

it's pretty shallow and technique.

Is very difficult to master.

So it's like ten years of training for
in DOS copies.

Let's focus on these scenes too and so
this is true when there's a comment on

the team but if there is an instrument
channel here which is just the.

That is used to pass instruments inside.

Like this instrument.

Here is a biopsy grasper that is used
to get the biopsy tissue sample of

of the tumor at the same channel it can
be used to pass a poly pack to me loops.

So this is basically a loop.

That can be energized with your frequency.

To remove and cut and Co argue late.

That issue here.

And so this is a Paul Raper So
this is what may grow and become a cancer.

OK And so the idea is to have
a colonoscopy every five years

detect these kind of grow and remove them.

If you remove at the proper
time then they won't combat.

Was the problem with colonoscopy so

the problem with colonoscopy
is that very frequently.

When the doctor pushed
the scope from the back.

There at the get stuck in the fall and
is not moving forward.

OK So what happened in that case
if the ED is not moving forward

the body of these two men kept
introduce it inside the body and

what you have is looping there so
this is called a loop

which is a stretching of
the tissue stretching with those

attachment those legal means which are
called this and this cause a lot of pain.

So this is really painful for

the body because it's interesting
that inside the color.

We don't have pain receptors
like we have in the end so

if we scratch the inside of the tissue we
don't feel and if we don't feel any pain.

If the tissue is stretch.

All very expand the and
if these messages are stretch a den.

The passion feeds a lot of pain.

So we don't want this kind of
release kind of thing so and

I stick chronology that comes and

there are introducing an invasive of all
scholars copies capsule and almost copy.

So in two thousand here two thousand
Kompany means that even image and

introduce a capsule endoscope
which is basically Air eleven

millimeter in by a meter by twenty six
millimeter the length swallow ball.

Capsule which has one or two cameras that

shot picture at two to
seven to fifteen frames.

Second off the inside of the body and

transmit those picture wirelessly to one
ten places on the belly of the patient.

So the patient can go around doing
in DOS copy basically do is normal

activities without being cause they are
two to the bed to a bed in the capital.

So this technology here.

Became the gold standard the or
small bowel inspection.

So this small bowel is the section of
the intestine between the stomach and

the call and is very in the media
alone because the intestinal tract.

So reaching that with the flexible and
the scope is a nightmare.

These cops rule is perfectly sweet
a bowl for the small intestine and

so it became the gold standard for
diagnosis in that region.

The same company tried to propose
a capsule especially developed for

colon which is called color on which we've
thirty five frames per second a very

wide angle which is one hundred seventy
two degrees from me on each side.

However.

These cuts failed to get F.D.A.

approval and is still failing
to get the F.D.A. approval.

That is why is low specific city low
specifically mean there are a number

of false negatives so i number of
people that get this capsule and

this capsule say you have nothing
you can go wrong and stay.

I mean the locks are.

But the capsule was just missing.

So this is why.

This is false negative and this is
very low so consider that flexible in

DOS could be sort of the shock or
not be here is ninety five percent.

While this is really unacceptable so
F.D.A.

didn't approve a call on for clinical use.

So the technical motivation.

For these fail you are number one
possibly So the passion of the cops or

the cops who goes down.

There's no way to stop the cops to move
it around wherever they're there want to.

There is a collapse of the tissues
collapse of around the car.

So the call on is like three times
seen by a meter the cops will.

While there's more testing as
the same diameter of the cops.

So as the cops are past the small
intestine it can seal around in the collar

and this is not going to happen because
the tissue is collapse all around the car

so I show you some movies about that you
get that that point better with movies.

Also there are not whats available so

there is no way to get the biopsy
there is no way to remove a poly.

In case a poly is seen.

So this is why we are trying to
work on a robotic capsule and

the scope I started working on this.

When I was a faculty in some
time now within the framework

of a big European project called Vector
and I keep my research in this field.

Now that I'm at Vanderbilt So
this is a nice.

Pictorially major of what we want
to we would like to get there.

It cuts through with
legs that crawl inside

the colon with surgical
instruments a camera.

And this gives an idea of what we
want to put inside the house and so

we want practical from
martial art to at us for

interacting with the shoe
to improve vision.

Maybe having out of just about for
hosts of we want medical

sensor if possible said diagnostic sensor
to understand if the capsule is working.

Of course we want a vision sensor like
a camera on top of that we need control

electronics.

To manage all these sensors and duct
Wetter's we want read your communication

to control wireless and we will.

It's this is pretty challenging.

To feed everything inside
the is more volume so we start.

Target volume that we have so

if we want to cut through all
the can be swallowed by the passion.

Then the day I meet it
is eleven millimeter and

the length is twenty six meaning that if
we want to have the retrograde access so

then we can relax the specific question
and they have like thirty millimeter in

diameter by thirty millimeter which gives
us a little more room to play with.

There are basically talk
about acting to hold motion.

This was very early work
that we did there and

it's my piece is a little slow.

Here we are so this is.

This is the elderly dead in this.

So this was two thousand and
six two thousand and nine and

let me play D.N.A. machine again.

Yes So this is a twelve legged
capsule that I developed when I was

so it's eleven million meter in their
meter thirty millimeter in length and

it has to set off six legs so

each set is activated independently
tax through the brushless motor.

These capsule was able to create space and

propel forward and backward dance
to the optimization of the game.

Speed was five centimeter per minute and

the pulling force was three point eight
Newton overall and zero point sixty six.

This was a collaboration with Bob Webster
at the time he was at the issues to

the center and
that was very nice from a scientific

perspective we published plenty
of papers on this platform but

was not really selling their
idea of having a leg crawling.

Somebody score.

So it was.

Jokes apart.

This was a very deadly Katyn
complex Robert with seventy

two parts micro fabricated parts
that needs to be assembled.

It was like precision watch like Swiss
procedural watch and so we said OK.

The other problem was that in this volume
we were not able to get the battery.

So the battery was like a tender
another capsule on the back same size.

So it was really unfeasible
then we came across this movie.

Let's see if it starts and play.

Cora the sound that is very.

That's such a blur.

So we saw this and
say why we don't use a mind to.

We decided to have a big permanent magnet
places that the end effect for the body.

And then have a permanent
magnet inside because as well.

And so we didn't need any power we
needed neither any mechanism and

nothing was protruding
outside the capsule.

And we were able to get a very nice man.

If you less sure of of the cup soon
as you can see here this is a bench

top dry while here it should
start in vivo piece of.

Yes.

So you can see looking down looking.

This is an inverted aisle we did when.

I was in piece and you can see the cops
will move their rotated inside

the call on of of a piece.

And so this was like two thousand and
nine two thousand and ten and

so we figured out that also the company

producing the endoscopic
capsule in two thousand and

eleven data died the magnetic money
if you Lashon as well and the.

Olympus sent in a joint venture
developed modified an M.R.I.

magnetic resonance imaging.

Gantry to control a car soon as well.

So what they are doing both
both those groups are basically

asking the passion to
drink one liter of water.

And develop a magnetic locomotion
of a cup so inside the stomach.

So basically the stomach is a large cavity
that can be expanded by water intake.

And these are all the image
that one can get from a camera

inside the stomach we feel with water.

We are trying to hold the color.

OK so the column as I was
saying we need to create space.

So we in the previous
movie we had to flash.

Here the colonies collapse as is usually
doing physiological conditions so

you see is not possible to see
very well it's not possible to

manipulate the cops are very well.

So what we did that to our destiny and

here what this is this is also
another demonstration of.

Are we.
Important is looming expansion to detect

polyps So you see these simulate polyps.

And you cannot see anything if
you don't inflate a little bit.

So what we did to tackle this

problem was two beds equally
give up on wide less approach.

But rather.

Introduce a chair here so
this is designed for retrograde approach.

A flexible endoscope or and
we have this software from which

we can in soufflé to call on and also we
can get the signal from the camera and

we can use the same channel to
pass our flexible instrument.

What is the advantage of the advantage of

magnetic locomotion in this case is that
we can pull the cup so from the front.

So it's like a front wheel
drive a soft color scope and

also we can orient the ared of the car

by magnetic linger and this was done in
a flexible endoscope by cable driving and

this cable driving was what was required
in the stiffness of of the scope.

So if you see our platform here.

This is the camera with the magnet and
this is the softer tester why D.C.

is a pediatric and the scope so
this is there's more or

less than those two that you can find so
you see there isn't the fair and

send as I said before pain comes
from being or from stretching.

Of the tissue that comes from
this part of the instrument.

So our eye part is that our approach
is not stretching the movement

not stretching the tissue so our part is
that our device is completely painless.

And so here you can see the platform
we have different tools.

So this is a poly pact.

And so these sorts of solve the problem
of cuts an endoscopy where there are not

available in this case turns to
the channel and we can use standard

flexible instruments like pull it back to
me loop a biopsy grasp it or in this case.

It's an evil basket and so
this empowers the endos.

To do the same kind of activities.

He's used to do in flexible endoscopes And

so we also tried this
platform in vivo on pigs.

And it performed pretty well so
you can see like

the camera view from the magnetic to
while doing biopsy while using a police.

Well this is a view of the camera
from an external and the scope and

you can see we can flip the capsule one
hundred eighty degrees while here this is

the big permanent magnet outside
the body of The Passion of the pig and

this is the light coming from the cult so
inside the body off of the air and so

we demonstrated this but
when I meant to tell the two thousand and

eleven get good feedback.

And we also tried to do comparative
studies with colonoscopies.

We compared the study with a colonoscopy

eleven experts in the last
popular eleven trainees.

So what we did most rated in this
work is that we were able to get.

The end of the call on all the time so

navigation was OK We were
able to find the polyps.

With the same acute A C.
as colonoscopy standard colonoscopy.

We'd be most today that standard
colonoscopy next ten days before.

Similarly to the robotic
capsule in trainees them.

So these such jesters that the learning
curve of a robotic platform may be faster.

Then what required for colonoscopy and
this is also the lesson that we learned

from intuitive from the surgical Robert
which is easy to use easier to use than

the problem is that robotic platform
required much more time to perform

and this was a limited current
implementation of the platform so

basically in our platform at that time.

The user was the guy.

With the joystick or
with the phantom interface.

Here he was driving the external magnet so
there was no information about

position of the intention of
the capsule inside the body.

So basically it was driving the cops
really not in a loop I would say.

And so basically there was no information
about if the cops who were stuck unity

sure if the cops who was performing
their desire to change importance.

So what we're trying to do now is to
implement real time post detection of

the capsule and see these if they expect
to pose a goody agrees with the pose

of the cop so and so if they pose agrees
with the magnetic field the projection

projected from the external monitor and
those who we would like to include

the tension because for safety reason
we want to have a want to prevent

the dead the intern magnetic
force the movement of the cone

in our case we need a real time forts and
position detection technique which

is compatible with magnetic open air
shows which is a little tricky because

there are a lot of good prose that action
system based on electromagnetic field.

But this is something that would
not work with the big man and

the magnet to control the cops.

So we develop.

Media through system based on six months
at a field sensor which are mounted

all around the paramount a magnet
which is inside the capsule and

we also have an X. a little meter that
is used as an incline on earth and so

basically the idea is that
these magnetic field sensor

measure their magnetic field generated
by the external magnet at the Council.

OK And then these field these rotate
the on the basis of the information

of the matter of the capsule and
also we have an inkling or method out.

Side so we basically do that.

And then we perform a search for this

a matching value of the magnetic field
on a pre-calculated magnetic field map.

Of the of the magnetic field
generated by the external monitor.

So this works pretty fast.

The timer.

We basically calibrate the approach and
let me skip through the movie.

So basically you can see here
the capsule which is connected with to

allow Martian while
the external permanent magnet

is moved from a robotic arm instead of the
capsule and reliable to tech easier time

position of the external magnet and
body international become so and

these words in a word space of thirty
cubic centimeter which is approximately

the appropriate word space for
a for a couple of DOS copy and

it has a lot of attention accuracy
of about the size of the capsule and

the refresh rate is five millisecond
which is pretty good for control.

So the same approach was used.

So the same ardor was used to dead detect
the Internet it for it's so in this trial.

We freak said the Council on
a log on the log said here and

turns to the magnetic field we predicted
that the intent magnetic force.

So here you can see before it says
measured by the load cell and

the faults as predicted by the measured
on measure in the magnetic field so

you see that it can detect pretty well
we do the good accuracy which is like

four point five million
units on the forests and

then allow us to get
measured in this case here.

So in this case we want to do
this is the magnet is there not.

President about the car.

I'm so here what we are doing.

Yeah we want to track.

There.

The starting Marshawn
of the capsule to us.

These are these magnet and so to Detective
real time when the cops who started his

posse in his Martian and also the tech the
force the clothes the start the motion.

Is work pretty well.

Then.

Now let me move very quickly about
what we did for acquittals for

tissue interaction in a while a set of so
as I was saying in the plot when a shot so

far we have a channel and
we can go inside the standard instruments.

We also did something in the field of
wide lists with widely sister minutes so

one activity is this one here so

basically this is a magnetic cartoon so we
have a permanent magnet as well here but

this capsule is there a ball
to deploy a surgical clip so

this is a surgical clip which
is used the to stop bleeding and

is usually deployed through
a flexible endoscope or

so we develop a capsule which can
by maybe late by a magnetic field.

To detect to stay to to basically orient
the capsule lead on top of her bleeding.

And then once we are in the proper
position we are able to fire decree.

And move out the cup
soon by a magnetic field.

So of course I mean this is just about
the wireless mechanism we didn't integrate

a wireless card with a wireless camera
on top which is also part of the deal.

So you can see here the card
solicitor leads the and

then the cops to the cities and
the capsule is moved away.

Another nice wide Lescott So

we develop is a wireless capsule for
a random biopsy in this small bowel.

So this this is very interesting for
detecting and diagnosing.

Inflammatory Bowel Disease
like Crohn's disease or.

And to do.

There is required to get them done
biopsies inside the small bowel as I said

before the small bowel is the most remote
region to be reached by the outside of

the body and so we decided to develop.

A small capsule to get multiple multiple
random sample inside the small bowel.

So since we wanted to have
a smaller bowl device so

we decided to I mean in order to mirror
two guys they did they mention we

decided not to use our two efforts
electronics and battery with

just a little either a magneto mechanical
method and his mother which we invent.

So basically the idea is to
have it come up soon with

the two symmetrical element that are now
explain one of those two elements.

So this sperm on a magnet is a cylindrical
permanent magnet which is fixit

to the frame of the Cup So these are their
permanent magnet candidate on the shaft.

And this shaft is connected to it and
OK so

that here there is a see if you like
Blade then there is an opening here.

So basically in normal
condition this rotating

magnet stays in this certain tension
because it mates with these peaks of mine.

Once I come close with an external magnet.

I basically work together with
the feats of magnet to attract

the capture two wires the loom and
the wall or.

At the same time.

This rotates to expose
the red ball to the black

blue ball of the external magnet and
so basically the mechanism open and

they specify that he should then
as I move the external magnet this

magnetic spindle it's a magnetic
being comes back into the wall and

basically claws and cut the ship.

So you can see this
concept toward the net.

The movie here.

And so you can see the capsule.

We are coming close.

With an external magnet
then moving it away.

And so magically we load
the democratic spring and

we are able with this approach
to cut a sample of the tissue.

So this is completely without
any buttery operating the device

and this kind of the so
you see here the next we will try and

here we were able to cut
the region of the fish and

get one cubic millimeter of tissue and
so this is completely without having any

you see what is being taught any kind
of electronics and this concept.

So this capsule was like nine point five
millimeter in diameter by twenty three

million inland.

And this was tempered scale even further
by just using a single couple of markets.

OK Let me move forward.

So these I mean given the time that
I have this is what I'll present.

I have presented to you
about the cups rule and

DOS copy if you want to prove
furthur we wrote a review

paper on an review of biomedical
engineering this is a thirty page long

paper detailing all the state of the art
in terms of couple cups of robots.

So if you are interested this
is a good the document to start.

And now move to the second part of
met all about abdominal surgery still

using magnetic coupling
in a different way.

So basically in size Jersey.

They have all shown as basically as I
showed before for a flexible in the US.

We want to reduce the trauma inside.

And so the evolution.

Went from open side Gerry.

With big scar it's big.

I mean.

Easy access for the sergeant to the tissue
but the downside was long recovery time.

OK and
then laparoscopic surgery was introduced

the where there are four or
three to four small incisions.

And the surgeon operates through
those limited number of parts

through long Vichy these two men so
this is kind of

putting a burden on Sergeant because it's
much more difficult but on the other end.

You can do surgery within one day and

then the passion can go back home at the
end of the day which is really something.

That reduces the cost for example of other
then of course having a great benefit for

the patient on the same line robotic
surgery was introduced to sort of body.

With an Intuitive Surgical Da Vinci
platform

is still this kind of approach
of number of minimal incision.

But in this case the robotics.

Allowed for.

I despair it is so
medically the instrument here

there's a six to seven degrees of
freedom and there is also Reese the.

Sergeant is sitting at the console
with three divisions so

there is also that itself.

So it's robotic surgery
really starting off

some of surgeon abilities during open
Sanjay like the division and the extended.

However is still requiring
a number of incision.

So surgical techniques is moving
towards one or no incision I thought.

And so one side you call technique which
is now going in becoming very very popular

is a lot on the scopic single in
seizure side singlet side side.

Basically all the instruments
pass through the same incision.

So it D.M. the repair.

Just one sky which can be
at the belly boughten And

so when the static outcome
may be pretty critical.

The Intuitive Surgical also
developed a platform for

single incision surgery which got F.D.A.
approval D C.

And so now is in use.

Also in the U.S. where basically all
the instruments and to from the same site.

This is a very hot topic for

research should there is no group
in at Vanderbilt doing his neck.

Robert for the kind of.

That kind of application.

Still on single incision side there was

a platform developed in two thousand and
seven at University of Texas.

Where several eastern rates
where we introduce from a single

part the magnetic

field across the abdominal OK
this was two thousand and seven

the down side of this approach is cross
coupling between different instruments.

And also basically there was
there was to manually operate

the external external martinet the so
here you can see a Canada development

by tax us together with at ACORN and
kind of starts.

So you see the problem here.

If I want to look down I have
really to push against that issue.

So this kind of motion is
not that they're liable and

it may become may be on for
depression as well.

So you see with us.

So we said I mean

this is another platform developed by
the University of Nebraska where there is

a single granite coupling here and then
there are the robotic arm away bone board

MOTM it's the downside of this is that if
you want to keep the incision down to.

Fifteen millimeter the kind of mortar
that you can embed inside your robot

are very I mean no power and definitely
the mechanical power is very low.

So what we are trying to
do is to deploy magnetic

robots from the single incision point and

then more you laid the magnetic field
to get precise robotic control.

So let me show you one example.

So this is a lot of scope becoming a we
develop when I was still in Italy and

saw this coming our way
through one coating module and

one module at the top or
with the coming out with vision.

And what we have here it's a martyr that
bears equally rotate separate money and

marking them.

And this is covered with
an external monitor magnet.

And what happiness rotate these
internal magnet I can get traction or

repulsion we respect to
the external permanent.

So once I am in a position
by rotating the internal

model by rotating the internal
permanent magnet.

I think at this degree of freedom
without pushing against the tissue and

they're very reliable
control on on motion.

So there's equally This is a study
we develop we perform a very.

Where we compare a man one camera.

So the one that I showed the movie before
where if you want to look down you have to

push with our camera and so
we were able to get eighty degree

of Martian in this degree of freedom
we did a solution of one degree and

without pressing against
the body of the passion.

So this was a devastating.

And so there was very traumatizing.

And so we said OK why don't we
apply the same concept of moving.

The magnets in a robotic
way I mean you control it.

Way also to develop.

And so we are now developing the concept
of magnetic spur basically this is

a huge degree of freedom and if you letter
that can be used to lift up in Oregon.

So let's say I have to
do a side Julie below

the lever I need to lift up the lever.

OK And this this tool with just two
degrees of freedom can help me there.

And so
the idea here is to have this money but

even from the outside that couples
with this magnet inside the robot.

And this coupled with these and

using those as third gear is
basically across the abdominal wall.

So we had we had some preliminary try
out some bench with a model rotating

an external monitor and

we demonstrated we are able to transfer
about five vats of mechanical power.

So what we are doing now is try
to quantify a little better.

What is the mechanical power we can we
can transmit So this is the external

mater rotating and it's there are moderate
we have an internal market here connected

to dynamometer So we are basically
now increasing the load the torque

at the load to see how much
we can turn to for this.

Mechanical power and

also if we are able to detect
the sleeper agent of the spirit here.

And try to get like a smart control

to prevent see which is an ongoing
activity last part of my thought.

This is a recent activity that we
just published on engineering.

It's like on line since last week and

this is a mix between cuts
widely of domino outside.

So the problem in both
laparoscopic surgery.

What exactly is that the surgeon
has no way to pulp a the tissue.

OK.

Interestingly the two more
is stiff than L T Sure so

if you want to remove
a lever to her like this one.

What side you would do in open surgery
would go inside with his own hand and

pulp eight and then detect the where the
two mores by detecting the stiffness OK.

And that is very relevant for

leave to more of a section
because we have just one lever.

While we have to keep the knees and so

we really need to save as much of
will to lever tissue as possible to

prevent transplantation the need for
transplantation.

And also laparoscopically where
a section is exponentially growing.

Because of the fast recovery time.

But as I said there is no way to
palpated the show in laparoscopic or

robotic surgery.

So we want a way to precisely
dainty five to more margins right.

Now this is done.

Currently this is done with
the intro parity rootless ounces so

these are two possible approach.

This is the uterus and probe modified
to be used by a da Vinci robot.

And the Basically what you see is the lies
of tissue underneath the uterus and probe.

This is another robot
which can be grasping by.

Surgical grasper and money if you lated to
push against the tissue to get as well.

A vertical slice of tissue that city so
very different slices not really

al full in detecting that you want my
Gene what would be really helpful is

a by the dimensional men in

the dimensional map with their with Guy
being in respect in the tomb and so let's.

This is a.

He had been a weird with
a stone embedded in it.

And this is a passion instrument
that Kelly measured the stiffness.

Of the tissue and for
Molly's in the small in the tension there.

We can definitely assume that
the tissue is a linear elastic and so

if we are able to measure the indentation
depth and in that there should pressure we

can build a map of the dimensional
map where Steve first map

where we can identify the exact location
of that human and use this method.

To remove the tumor and save as much
as possible of the entity should.

Many limitations of these techniques
is that we need an entry point.

And.

The hardware required for
this is pretty cumbersome.

So we said why don't we do
it widely scarps all that is

created be dimensional or two dimensional
stiffness meant to guide the sides in.

Localizing the to want to do that we
need where shown for for pulp a tinder.

We need to measure indentation depth and

proposition we want proposition
to reconstruct the mare.

We need in the pressure and
we need to stress mission there so

we address the first problem of providing
the two ashen by basically developing

a capsule that can be grasped by
standard operating scopic tool and

pushed by the sergeant data
actively against the belief

in order that he should follow
colonization we bears equally

use the same locality they're
shown that I already shown before

with a little meter and they're not
aware you of all Effect sensor.

And so those all Effect sensor
measure their magnetic field which is

created by an extent upper management.

So while before for capsule and
for capsule called ASCII.

We were using the permanent magnet
outside the body also for money.

If you let Ch'ien in this case we
just create a magnetic field for

local is national.

That so
this is the same movie should be for so

we use the same kind of the session to
eat into the position of the capsule and

also to measure the indentation that.

To detect the invitation
pressure we use it.

Tactile approach.

Where we embed inspired by the hour by
robotics lab where we embed the magic

pressure sensor inside silicone rubber
This is all open source tactile look.

And basically what we have
is a pressure sensor here.

Silicone rubber and
we are able to sense pretty precisely so

it's not that clear here but we have
we have basically the pressure sensor.

On top of the cup so we are like.

Potential five kilos and
then accuse us of thirty four.

This is like characterization of
the probe with respect to a load of.

So let me go quickly here.

Let's move to this.

Here basically what we did was
to create a tissue similarity or

with different both embedded into it and
we were able to hate this

sample of tissue and
recreate a stiffness distribution.

That once we were happy
about this technology.

Together with the University of Colorado
Boulder which is collaborating with on

some of these on this research.

We did in vivo tired so you can see here
the capsule which is being introduced

through a through surgical.

Seizure and then we use the same incision
to pass a surgical instrument so

you can see the surgeon here
basically introducing the cups and

then he placed back the port to.

Go inside with a lot of scopic
grasper to grasp the capsule.

So in this case we injected in
the lever of the animal in jail

to simulate it to want to simulate
a stiffer region inside the body of

inside the inside the organ and
the goal was to pulp eight the lever and

try to find the position
of that that general.

So you see here.

The sergeant palpated in believe
in creating the stiffness map so

while he's part patting
you can see the pressure.

And also the position of the cultural

as soon as the surgeon he said
about the number of points he got.

We can just get the bottom
clear the stiffness matter

which is this when the stiffness map
can be used for tissue reception and

so this is this then we reconstructed
with a standard the material test.

At the end of the lever trial we
expanded the lever and we compared and

the matching is pretty pretty good.

So next point.

Next what we have trying to do right
now is to provide the real time

view of capsule position with
respect to the stiffness map.

So that we can guide the chute
a section doing and in vivo side.

And kind of into a whole different.

So there's a Kelly what I have
show you is first of all magnetic.

Capsule Robert for colonoscopy and
in this case modern it is most used for

both of mine if you leisure and detection
and what we are doing now the challenge.

Where do we are facing now is
closing the loop of robotic on.

With magnetic money.

I've shown you in approach to
transport mechanical power

through magnetic coplanar in
this case we are growing.

This is like the coming out power
transfer to the Dr and his mother.

So this is something like more dead.

And then finally I have
shown you a very applied.

I mean very up sample
of using modern it is

together with wireless technology
to develop wireless device.

Our goal at Vanderbilt is to move to
clinical trials as soon as possible.

So these are quiet some redesign of all
our platform in terms of the F.D.A. home.

This is stuff required star human and so
I mean but it's the only way to go and

you months to try to make
an impact the challenge for

magnetic UK where they're shown is
interaction with metallic objects so

there is a risk for passion of open air
thoughts due to the excellent question of

metallic object with a big
permanent mark in M.R.I.

and also there is the challenge of
the decrease in acuteness of magnetic

base localization and
also there is a big challenge with special

because we are having we are pursuing
magnetic coupling across the skin.

That's Any sure for large distance.

And large the eastern side of these
passions still an open channel.

So let me acknowledge
first of all again and

again the agency saw first of all and
I said full with the C.P.S.

system good amp where I'm yeah I about
the development of cups with Robert.

Then give any machine which is these
really Kompany developing the small

capsule and then he gave us a grant to do.

To study a novel technology for
control cups Windows copy and

fire brought from there for the grant
that is starting right now to push

the magnetic colonoscopy
platform towards clinical trials.

Last but not least my
collaborators my lab the saw my

five graduate students one undergraduate
students which is a very good

collaborator with a very good be you care
about where the rockets leave their skin.

Peter with Jesse all glee collaborators
their collaborator the University

of Colorado.

Mike crane sure and his group
are especially for wireless passion.

Last but not least the components of my
four metal Arbet are all of the audio and

I'm in charge of.

That.

Thanks a lot for YOU THANK YOU THANK
YOU THANK YOU THANK YOU FOR IT.

So.

All so

basically the sure human tissue is
not in affecting at all magnetic.

That that's pretty it's pretty good.

So basically we have
plastic model simulator and

what we got there are cuter see is the
same that we got then when we do anymore

or could ever so that's a that's a pretty
reliable platform for test of bands.

As long.

I mean the many influences.

If you get subject at least two men so

they have metallic parts
they affect the feel.

Yes So that that's definitely an issue and
we characterize for example for wireless.

Paschal we have seen that we have
a degree day degree Deshawn off.

Of the session acute five percent.

But we mean the grasp or
gasp in the cops will have to

be offset or that the beginning of the
procedure so provided that the sergeant

keep the same grasp tight for
all the creation of the map then

the influence of the grasp is just that
if there's an offset and he put it out.

One of the many hours.

Only shows your potential perfect.

Yeah dead that's in the show The Good
point is that magnetic field

decay very fast with the stanza So

you really need to be close to
the platform to affect the measurements.

So they grasp in basically
grasping the cops like this.

On top of the magnetic field sensor as an
effect but if you have something outside.

I mean as long as it's
like ten centimeters away.

You have no friends.

So you mean like.

We want them out.

So that's basically something that we try

we tried to pick up soon inside
the color and then turned inside the.

They are during our cavity.

We.
The permanent mild winter.

The part I mean that would that would
definitely improve the controllability

The point is that Sargent wants.

The lowest number of
incision as possible and so

in that case you don't want really
to have additional skylights But

what what you are saying I think
is maybe correct me if I'm wrong.

We're doing something similar here.

So.

Yeah.

In this coming here.

So.

What we're doing here.

Is basically the external
magnet is fits in a position.

And what we do here is with the mater
moving the internal magnet.

And so this provide does a motion which
is a relative to the external Mark met.

But the external magnet
really doesn't move.

So it's like.

Applying the same principle of arc
where shot from the on that side.

That would improve Yeah I mean I
think this is a very nice idea.

Yeah dead that would definitely
improve I mean as close as you are to

to the magnetic field source
a strong as is the field the better.

Is your hallucinations.

We are also using all that approach to
localization which I didn't mention for

the sake of time but.

In colonoscopy we are also trying to
reconstruct the change in post with visual

visual Crucis we have fission
extraction and try to understand.

What was the change imposed by looking at
the feature did move or in between frames.

That's something that's definitely without
having need for additional hard work.

That also there is the approach with
a meal which didn't explode yet but

we would soon start window a lot
of like slam technology so

our marketing technologies can be
applied in this field there and

there is not yet a lot of this is
still like an open field release.

There.

Thank you.

So thank you.