For transorbital neuroendoscopic surgery or TONES to address pathologies deeper in the brain, endoscopic technologies must evolve.
“Our ability to reach deep areas of the orbit and brain exceeds our ability to operate endoscopically in these regions,” says Kris S. Moe, M.D. ’89, Res. ’91, ’94, UW associate professor in the Department of Otolaryngology-Head and Neck Surgery and chief of the Division of Facial Plastic and Reconstructive Surgery.
To overcome this hurdle, Moe and an interdisciplinary team of researchers are working to develop a new surgical system for TONES: robotic, flexible endoscopes capable of seeing around corners and operating on targets deep within the brain, where today’s angled, rigid endoscopes cannot go.
In addition to Moe, the research group includes two neurosurgeons, Laligam N. Sekhar, M.D., FACS, and Louis J. Kim, M.D., and a pediatric urologist, Thomas S. Lendvay, M.D., from UW Medicine, and two robotics engineers, Blake Hannaford, Ph.D., at the University of Washington, and Jacob Rosen, Ph.D., at the University of California at Santa Cruz. Professors Hannaford and Rosen designed the RAVEN robot, the major surgical robotic research platform at a number of leading universities in the U.S.
With funding from the U.S. Department of Defense, the team has developed a prototype flexible endoscopic surgery system and is completing the final prototype of a robotic console. The process will include image-guided surgical planning, in which the computer offers several different options to the surgeon, and computer-assisted navigation of the endoscope into the surgical field.
“[The system] will allow us to perform surgery on areas that were previously difficult or impossible to reach,” Moe explains. It also will minimize what Moe calls pathway trauma (collateral damage) from surgery. “We have the potential to take the pathway trauma to near zero by using very fine, flexible endoscopes. Then the way to further minimize trauma is to use robotic surgery,” he says.