Robotic Assisted Intracorporeal 3-D Tissue Engineering – The Evolutionary Next Step

Desmond M D’Souza, MD, FACS¹, Andre Simeunovic², Ali A Adib², Peter Kneuertz, MD¹, David Hoelzle, PhD². ¹The Ohio State University Wexner Medical Center, ²The Ohio State University

Objective:

1. Develop tissue engineered materials that are friendly to the intracorporeal environment

2. Develop new additive manufacturing-based (also termed 3-D printing) robotic surgery instruments to deliver such material.

Description of technology / Method of application: Tissue Engineering (TE) is a field at the intersection of engineering and biology to build functional substitutes for damaged tissue [1], [2];  Intracorporeal TE is the fabrication of TE constructs inside the body; Endoscopic Additive Manufacturing (AM) is a tool to perform Intracorporeal TE through a ‘keyhole’ surgical site.

Preliminary Results:

1. We have been able to mimic of the interface for interchangeable instruments of the Intuitive Surgical da Vinci Xi.Three transmission elements drive the three revolute joints at the Endoscopic AM nozzle. The fourth transmission element drives a syringe pump for biomaterial delivery.

2. Nine degree-of-freedom (DOF) robot for driving the Endoscopic AM instrument.

3. Five DOF static positioning system to manually control the position and orientation of the base frame for the nine DOF robot.

4. Portable base such that the tool can be moved from the engineering lab to the da Vinci Simulation lab trainer at The Ohio State University Wexner Medical Center.

Conclusions / Future directions: Our long-term application is intracorporeal 3-D TE construct fabrication (Figure 1).   3-D TE is currently an open problem and thus will require significant advances in materials, stem cell engineering, and scaffold design and fabrication.  However, the current trajectory of using AM for 3-D TE is directly applicable to our vision of Intracorporeal TE.  If successful, TE may obviate the need for donor tissue for some classes of tissues, and the challenges of donor availability and rejection/ infection risk that accompanies tissue donation.  Currently there are over 70,000 U.S. patients on the active waiting list and 22 people die each day waiting for an organ donation, based on U.S. HHS Organ Procurement and Transplantation Network data as of January 15, 2019.  The potential impact of TE on human health cannot be overstated. 

Broader Impacts of Intracorporeal TE  is the ability to delivery TE solutions to tissues deep within body cavities in a minimally invasive manner.  Intracorporeal TE is a modern approach to the TE delivery problem, leveraging modern surgical robotics and TE fabrication technologies to provide the benefits of TE to the patient without the morbidity associated with invasive surgeries.

References:

1. R. Langer and J. Vacanti, “Tissue engineering,” Science, vol. 260, no. 5110, pp. 920–926, May 1993.

2. P. Bajaj, R. M. Schweller, A. Khademhosseini, J. L. West, and R. Bashir, “3D Biofabrication Strategies for Tissue Engineering and Regenerative Medicine,” Annul. Rev. Biomed. Eng., vol. 16, no. 1, pp. 247–276, Jul. 2014.

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Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 98911

Program Number: ETP723

Presentation Session: Emerging Technology Poster Session (Non CME)

Presentation Type: Poster

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