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Children's neurosurgeon Joseph Madsen, MD, was inspired to invention when he met a patient with a cyst on her brain stem that was virtually inoperable. "You couldn't get to it surgically unless you drilled through the mouth or nose and into the brain," Madsen says. "It wasn't worth the risks."
Working in small, inaccessible spaces in the brain or spinal cord is one of neurosurgery's biggest challenges. Robots are currently used by general surgeons, urologists and cardiac surgeons, but their heavy "arms" are far too large to maneuver in delicate neurosurgical fields, and would not make neurosurgery less invasive. Funded by the NIH, Madsen and Jim Goldie of Infoscitex, a Waltham-based engineering company, have designed and prototyped a flexible, minimally invasive device that could be fed through a small opening in the skull or spinal cord and steered to targets in the brain. Surgeons would be able to electronically control each segment of the earthworm-like device independently. An attached camera would provide views from more than one angle, allowing surgeons to scope out the tissue anatomy before performing any deep manipulations.
The project, still in the early stages, is awaiting a second round of NIH funding. In the meantime, however, Madsen and Goldie submitted a proposal to the U.S. Army Medical Research and Materiel Command's Telemedicine and Advanced Technologies Research Center, outlining the possible use of a similar approach to create laparoscopic surgery techniques and devices for treatment of soldiers injured on the battlefield. Although navigating around visceral organs to treat abdominal and chest wounds isn't the same as navigating narrow spaces in the brain, the Army saw the potential and awarded Children's and Infoscitex a Small Business Innovation Research contract to develop a Computer-Assisted Surgical Handheld Laparoscopic Tool.
The device will be a different size, shape and strength than the neurosurgery device Madsen envisions. But having pioneered many ideas and devices, with six issued patents, Madsen sees this as a positive. "You always have to think of what is needed at places other than Children's, and use knowledge from one area to solve a problem in another area," he says.
To explore other potential uses of the device, a broader team of Children's physicians has joined the project, representing Urology, General Surgery, Cardiac Surgery, Anesthesiology and Gastroenterology. The first animal experiments with the new prototypes are expected this year.
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