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25 September 2013

Broken bones could be mended with robot-assisted surgery

A robotic system that could help surgeons put joint fractures back together using a minimally invasive approach, will be the first robot-assisted system designed to deal with this problem. 

The system is being developed at Bristol Robotics Laboratory (BRL) in collaboration with a leading orthopaedic surgeon, a company specialising in orthopaedic devices and University Hospitals Bristol NHS Foundation Trusts. Bristol Robotics Laboratory is a collaboration between UWE Bristol (the University of the West of England) and the University of Bristol. 

The project, led by Dr Sanja Dogramadzi (Reader in Robotics at BRL), has just received £642k research funding from the National Institute for Health Research (NIHR) Invention for Innovation (i4i) Programme to develop this ground breaking device.  Dr Dogramadzi is working with Professor Roger Atkins (Orthopaedic Surgeon at UH Bristol) and MatOrtho®,a UK leading medical device company. 

Broken bones that involve joints cause considerable disability and substantial NHS costs.  To work properly and avoid painful arthritis, the pieces of the joint must be put back together perfectly. Surgeons do this by making a large incision to open up the area around the joint and see the broken bits.  These wounds cause pain, scarring and infection risk and long hospital stays. To avoid these problems, minimally invasive surgery (MIS) is sometimes used, where joint pieces are manipulated indirectly through tiny wounds. Unfortunately the bone fragments cannot be reliably put back together so although the immediate recovery is quicker and infection and scarring are avoided, there is a risk of a prolonged radiation exposure during surgery and postoperatively long-term arthritis and disability. 

This new project will create a robotic system which will be used by the surgeon to put the pieces of broken bones back together without requiring a major incision combining the advantages of open surgery and MIS. 

Speaking about the project Dr Sanja Dogramadzi says, "Through our previous research, funded by the EPSRC, we developed a prototype of this system, but we are now moving to the next stage where we aim to develop a robust system and undertake preclinical testing. 

"We will design and refine our prototype devices that can access fragments using MIS and move each fragment into a perfect position. We will develop computer software which tells the robots how to move the fragments using CT scans. This will be tested in the laboratory and in cadavers. The developed robot-assisted surgical system will allow earlier surgery; reliable, perfect fragment re-alignment; less onerous surgery; improved patient outcomes; faster rehabilitation; reduced hospital stays; earlier return to work; arthritis avoidance; and significantly reduced NHS costs. 

"This collaboration is all about taking the latest advances in technology and using them in a real application which will have direct benefits to patients.  By working closely with surgeons we are able to design a workable system which will function within the constraints of medicine and meet the needs of patients.  The robots we develop will enhance the work of surgeons, by carrying out complex tasks suited to robots, while the surgeon is always in control and makes the decisions essential to the patient's wellbeing." 

Speaking about the collaboration Professor Roger Atkins says, "Surgeons have highly specialised skills and expertise, but robotic technology can enhance those skills for the benefit of patients.  Complex joint fractures frequently require a deep incision and this has consequences for the patient - a system that allows fracture reduction, (fixing the pieces of broken bone back together), without the need for open surgery, would have huge benefits for patients and potential economic benefits.  

"As part of the research we have been talking to patients on how they view the use of robots as part of surgery, and in the vast majority of cases, patients expressed positive views on this, if it will mean better treatment and faster healing.  As a surgeon, I am always looking for ways to improve or develop, particularly in areas where we can reduce complications and difficulties for the patients." 

The research will last for 3 years starting in September 2013. 

To view a video of Dr Sanja Dogramadzi and Professor Roger Atkins talking about the project, click here.