Tiny snake-like robot could transform sinus surgery

When developing a miniature robot for sinus surgery, a team of Hamilton doctors and innovators looked to nature for inspiration. The result is a micro-sized, snake-like robot they’re developing that’s remotely maneuvered up a patient’s nose and through intricate pathways to reach the sinuses, much like a snake weaves through underground tunnels.

Team member Dr. Sarah Khalife – a Hamilton Health Sciences (HHS) otolaryngologist — received an HHS DRIVE SPARK grant to support the development of the SMART-ENT surgical robot, aimed at making sinus surgery less invasive and more precise.

Otolaryngologists treat problems involving the ears, nose, throat, head and neck. Khalife subspecializes in rhinology and skull base surgery, focused on surgery treating conditions of the nose, sinuses and skull base using cameras through the nose.

HHS DRIVE SPARK awards celebrate early-stage, high-potential ideas that are igniting change across the hospital system with grants up to $50,000 to support bringing promising innovations to life.

A nose for innovation

The SMART-ENT prototype device is just three millimetres in diameter, about the same thickness as a cell phone charging cord. Khalife is developing this innovation in partnership with Dr. Onaizah Onaizah, a mechanical engineer who leads a McMaster University lab specializing in making tiny, millimetre-scale robotic tools for health care; Dr. Benjamin van der Woerd, an otolaryngologist subspecializing in laryngology at St. Joseph’s Healthcare Hamilton; and Dr. Crystal Fong, a neuroradiologist at HHS’ Hamilton General Hospital specializing in using medical imaging like MRI and CT scans to find and diagnose problems affecting the head, neck and spine. Fong is also an associate professor at McMaster University, and Khalife, Onaizah and van der Woerd are assistant professors. Another key team member at the forefront of research and development is Griffin Smith, a biomedical engineering master’s graduate.

“McMaster is our academic partner, and this innovation is a great example of what’s possible when our researchers and innovators collaborate on projects,” says Dr. Marc Jeschke, HHS’ vice president of research and innovation, and chief scientific officer. “By combining our expertise, we’re turning great ideas into innovations that have the potential to make a real difference in health care.”

A maze of narrow passages

The sinuses are a network of air-filled bony spaces tucked inside the skull, connected to the nasal cavity by narrow, intricate passageways. These small openings allow mucus to drain and air to circulate. People have eight sinuses, four on each side of the face, and each is unique in size and shape.

For endoscopic sinus surgeries, doctors use a high-definition monitor and sinus CT scan for a precise map to guide them, as they clear out blocked pathways so sinuses can drain and the patient can breathe normally again.

This is done using a tiny camera and specialized instruments that are long and thin with different angles, so they can access the sinus area through the nose. But these tools are also straight and rigid, with several used at once to perform procedures.

“While considered minimally invasive, it can be challenging to navigate the different angles and narrow network of passageways to reach hard-to-access areas with these tools,” says Khalife, adding these instruments are standard in Canada and worldwide.

“Our surgical robot will be much smaller, less invasive and easier to maneuver.”

Inspired by nature

When imagining a better way, the team turned to nature, drawing on how snakes slither through underground tunnel systems, elephants deftly move their trunks and octopus tentacles bend, twist and reach into tight spaces.

“Nature has spent millions of years finding ingenious ways to navigate challenging environments and reach places that seem almost impossible to get to,” says Onaizah. “We wanted to learn from those remarkable designs and bring that ingenuity into the operating room.”

A better way

The SMART-ENT surgical robot features a single, thin piece of flexible tubing that houses multiple built-in channels so several tasks can be performed at the same time. The tube can accommodate specialized ports for suctioning fluids, delivering medication and cleaning the area. It also includes an LED light and a tiny camera, about the size of a grain of table salt, at the very tip to help the doctor see clearly, alongside a treatment laser to precisely target tissue.

“Our goal is to automate the tool by using a patient’s CT scan as a digital map to guide it safely through the nose and sinus area remotely,” says Khalife.

By applying a controlled magnetic field, a computer can precisely steer the tiny tube around tight corners and into hard-to-reach locations automatically.

“This tool also has the potential to be used in other types of surgeries, where doctors are operating on small, intricate, hard-to-reach areas,” adds Khalife.

Investing in HHS innovators

DRIVE SPARK funding will be used to help further develop this tool, with the goal of getting all the approvals in place for a clinical trial to test it in surgeries, down the road.

“This funding allows us to take an idea from the clinical setting and develop it into something that could have a meaningful impact,” says Khalife.

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