What does chilli crab have to do with this medical device?

PHOTO: What does chilli crab have to do with this medical device?

FROM its humble beginnings at hawker centres to being listed in CNN's 50 most delicious foods list, the chilli crab's journey has been an interesting one. It has now inspired a team of researchers in Singapore to create a miniature robot with pincers and hooks that can remove early-stage stomach cancers without leaving a scar. And three Indian patients became the first to be treated using the robot at a hospital in Hyderabad in July last year.

The researchers claim that the procedure takes less than 20 minutes and allows patients to go home the same day, thereby reducing costs substantially.

Developed by associate professor Louis Phee of Nanyang Technological University (NTU) and Professor Lawrence Ho of National University Hospital (NUH) after six years of research, the robot will be commercially available only in three years. However, its trials and tests are underway.

Dr Ho and Prof Phee were inspired by Hong Kong surgeon Sydney Chung to develop the robot after a chilli crab dinner in Singapore in 2004.

In the device, the pincer and the hook are attached to an endoscope which enters the stomach through the mouth. With the help of a tiny camera on the endoscope, a surgeon can see inside the stomach.

The robotic arms, which are 6mm in diameter, are controlled using a video game-like joystick. The pincer is then used to hold up the cancerous tissue while the hook slices it off.

The arms have the capability to feel the softness of the delicate stomach tissues and intestines, so doctors at the console can vary the pressure accordingly.

Last July, three Indian middle-aged men were treated with the help of this crab-like robot, called MASTER (Master And Slave Transluminal Endoscopic Robot). The operations, which were broadcast live, were performed by Dr Duvvuru Nageshwar Reddy and his team at the Asian Institute of Gastroenterology (AIG) in Hyderabad. All three procedures were successful and two of the patients left the hospital the same day while one was kept on observation overnight as he experienced slight bleeding.

Prof Phee, who is the chairman of IEEE Robotics and Automation Chapter, Singapore, told tabla! that AIG, which is one of Asia's largest outpatient centres doing therapeutic endoscopy, was chosen for the surgery as it was the first to get required approval for human trials and also because the patients were readily available.

"Dr Reddy is one of the best gastroenterologists in the world. So, having him test the robot and getting his approval was important," Prof Phee said. "We were glad to see the huge media interest, because we truly believe this is revolutionary. On the day of the surgery, we felt like Bollywood stars, surrounded by a crowd of photographers and journalists," said Prof Phee on the media's reaction in Hyderabad that day.

Claiming that flexibility was one of key aspects he kept in mind while developing the robot, he said: "Most surgeons will say 'I just want to get my hands inside'. For the hands are flexible and dexterous. But where small movements are concerned, hands aren't so steady. That's where a robot is superior."

He stated that the idea for developing a machine like this was to use natural holes, rather than making new ones. He sees this as the way forward for surgical science. "It might sound like science fiction at the moment, but who knows in 20 years' time, a heart bypass surgery could be performed through the mouth," Prof Phee added.

Dr Ho, who is the head of the gastroenterology and hepatology department at NUH, said the six-year research cost about $100,000 and was funded by NTU, National Medical Research Council and supported by Singapore Gastric Cancer Consortium.

Pointing out that the current model of the robot is a prototype which will undergo many tests, modifications and improvements before it can be made commercially available, Dr Ho said: "What's exciting about this machine is that it is likely to cut down the cost for patients quite substantially. Since it is like an endoscopy, the patient is awake throughout. He doesn't even need to stay in the hospital following the surgery, which reduces the cost a lot.

"There's no need for a large team of doctors and nurses. And no scar. Logically, this really is the way forward."

In Singapore, the machine is available only at NUH and it will be used for the first time next month. It had been scheduled for use in October last year but the rarity of patients with early gastric cancer in the country led to the delay.

Dr Ho and Prof Phee have set up a company to make the robotic device commercially available by 2015.