Programmable Matter: Applications for Gastrointestinal Endoscopy and Surgery

Over the past few decades, robotics has become a more integral aspect to the practice of medicine. Robots have been particularly useful as diagnostic tools (eg, PillCam1Schoofs N. Deviere J. Van Gossum A. Pillcam colon capsule endoscopy compared with colonoscopy for colorectal tumor diagnosis: a prospective pilot study.Endoscopy. 2006; 38: 971-977Crossref PubMed Scopus (243) Google Scholar) and for surgery. One of the main challenges in using robotic tools is that they are usually of a fixed size and shape. Their inflexibility can make movement into and out of small, delicate openings difficult. This physical limitation also impedes their use in natural orifice transluminal endoscopic surgeries.2Zorron R. Soldan M. Filguerias M. et al.Notes transvaginal for cancer diagnostic staging: preliminary clinical application.Surg Innov. 2008; 20: 10Google Scholar One way to eliminate this obstacle is to have a robot, which could change its shape to move through and around obstructions, then form into the optimal shape to perform its task when it reaches the target of the operation. Recent research in programmable matter may fulfill these objectives. Programmable matter3Goldstein S.G. Campbell J.D. Mowry T.C. Programmable matter.IEEE Computer. 2005; 38: 99-101Crossref Scopus (241) Google Scholar is a general classification for a material that can change its physical attributes (shape, color, texture, index of refraction, etc) based on user input or by environmental stimulus, through some kind of internal information processing. The material itself analyzes its surroundings to compute which properties to take on. Claytronics is an example of programmable matter4Goldstein S.G. Mowry T.C. Campbell J.D. et al.Beyond audio and video: using claytronics to enable pario.AI Magazine. 2010; 30: 2Google Scholar, 5The Claytronics GroupThe claytronics project.www.cs.cmu.edu/∼claytronicsDate: 2009Google Scholar currently being investigated by Carnegie Mellon University and Intel Research. The goal of the Claytronics project is to create a programmable material from millions of cooperating individual sub-millimeter particles. Each particle, or catom, is essentially a very limited “robot” that can sense the environment, in particular other catoms, and perform computation to move about neighboring catoms to create new shapes under program control. Under these conditions, claytronics could become injectable medical instruments. The claytronics would be injected through a syringe, near the area of operation. Then, under remote control, it would be guided to the specific site and shaped into the desired instrument, where it is then able to perform the operation. The current state of Claytronics, and programmable matter in general, is still a long way from being able to complete such an operation. In the rest of this article, we describe a less ambitious, but still distant goal, of using programmable matter for colonoscopies. Colonoscopies seem to offer a suitable goal for introducing claytronics into medicine. Colonoscopies require increased surgeon availability, patient comfort, and decreased miss rate of polyps and adenomas. About 41.8 million average-risk people aged ≥50 have not been screened for colorectal cancer according to national guidelines, such that widespread screening with flexible sigmoidoscopy or colonoscopy may take up to 10 years, depending on the proportion of available capacity used for colorectal cancer screening.6Centers For Disease Control and Preventionwww.cdc.gov/cancer/ colorectal/index.htmDate: October 2010Google Scholar Even so, many cancerous lesions remain undetected. New colonoscopy miss rates for adenomas (>1 cm) fall between 12% and 17%.7Krier M.J. Pasricha P.J. Not your father's colonoscopy: a high-tech future for screening and surveillance of colorectal cancer.Gastrointest Endosc Clin North Am. 2008; 18: 607-617Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar The effectiveness and speed of the screening process must be improved. Claytronics will provide doctors with tools to generate a prognosis more accurately and efficiently. A programmable matter colonoscope would have the same basic functions as the current colonoscopes. We seek to enhance the operation of these functions through increased mobility, control, and imaging techniques. The advantages of this technology include the ease of use, minimal operator training, sedationless operation, and a low perforation risk.7Krier M.J. Pasricha P.J. Not your father's colonoscopy: a high-tech future for screening and surveillance of colorectal cancer.Gastrointest Endosc Clin North Am. 2008; 18: 607-617Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Mobility in traversing the colon is crucial to the effectiveness and time consumption of a colonoscopy. Wireless operation will be not only beneficial, but necessary to the mobility of the unit. The unit will be externally powered through magnetic induction, eliminating the need for a tether. Claytronic's ability to change shape and navigate folds in the colon without an additional tether will decrease the time needed in guiding a colonoscope, along with the risk of bowel perforation. It also would be able to maneuver around waste in the event of inadequate colon preparation, allowing the colonoscopy to continue as planned. By compiling the images taken from the individual cameras on the surface of each catom, we can formulate an image that will be higher in resolution and wider in angle. Most standard colonoscopes maintain a fixed angle of view of only 140°, requiring the camera to loop back, increasing the risk of perforation.7Krier M.J. Pasricha P.J. Not your father's colonoscopy: a high-tech future for screening and surveillance of colorectal cancer.Gastrointest Endosc Clin North Am. 2008; 18: 607-617Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar With the catoms moving relative to each other, an image with 360° could be potentially obtained. The claytronics would have the ability to perform a polypectomy similar to the current colonoscopes. The claytronics could encapsulate the polyp and remove it through heat ablation. There are 2 advantages to this approach. Excessive blood loss would be reduced by simultaneously cauterizing the surface while removing the polyp. To introduce claytronics as a stand-alone endoscopic device, we suggest a 3-step process. First, claytronics could be used at the tip of a standard endoscope to help guide the camera and possibly provide greater visibility to the surgeon. The claytronics can be powered and controlled by the endoscope, eliminating the immediate obstacles associated with individual cameras or an external power supply. Cameras in the catoms would be unnecessary, because they are only working as a directional supplement. The claytronics are purely there to provide additional support to the endoscope and more precise maneuverability. This will give greater access and increased visibility to intricate or delicate locations. In the second step, the claytronics would be used without an endoscope—moving on its own as a camera device into the colon, carrying along a tether. The tether would continue to power the device as it traverses the colon. This step may be difficult to implement, because the claytronics must be able to maneuver with the weight of the tether dragging behind it. However, the system would be self-mobile, with control commands being transmitted through the tether. A skilled practitioner would still be needed to guide and control the claytronics. In the final step, the claytronics would take the form of a suppository working in conjunction with a wireless power supply and control patch worn by the patient. The claytronics will at last be a completely independent device. The shape of the claytronics pill will affect the speed, movement, focus, and overall quality of the colonoscopy. By expanding into a ring, the claytronics could slow down or station itself at a point of concern. It could also narrow and lengthen to squeeze through small passageways. With advancements in power supply, the ability to move fecal matter also poses a realistic possibility. It essentially incorporates similar ideas as the PillCam,1Schoofs N. Deviere J. Van Gossum A. Pillcam colon capsule endoscopy compared with colonoscopy for colorectal tumor diagnosis: a prospective pilot study.Endoscopy. 2006; 38: 971-977Crossref PubMed Scopus (243) Google Scholar without relying on peristalsis for movement. At this stage, a trained nurse or assistant will control the claytronics suppository, remotely guiding it through the colon. This will eliminate the need for a doctor except for the final image analysis. These uses of Claytronics, and programmable matter in general, are at this point still very far in the future. Significant research in both the hardware and software is needed to create an ensemble of sub-millimeter robots. Currently, individual units are being fabricated from silicon using a process similar to that which makes computer chips (Figure 1). After the standard processes are complete, they are post-processed to create the 3-dimensional structure needed to create a unit that can move around and interact with neighboring units. The corresponding programming languages being developed allow one to write short, simple programs that can run on thousands or millions of units to control an ensemble working toward a common goal. Basic shape transformation algorithms have been demonstrated in simulation. Of course, even after the basic goals of claytronics are realized, getting them to work in the gastrointestinal tract will pose further challenges. Despite the hurdles, we believe that materials such as claytronics will transform our approach to medicine and expand our perception of information transfer. Katherine Smith is currently seeking her Bachelors of Science in Materials Science Engineering and Biomedical Engineering at Carnegie Mellon University. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJkMGZmOTI5MDQzNTkzZjM4ZGU3NTIxMjIyNjdiODc1OSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjkzNzc5OTU2fQ.HdZZWCSEuTSt4jO6NDnBflBKy95hlQhWbFf_4sKK2aIAe-xZ8_cpAH-kct3nqh8KRz0etn4acy37ae5fxk6EPrGh3PEjPSWlHg3KqL5nt1yEYjd9cos5QhOr9TbVNHC_RMKjUjFkCuuIkaVfnZ9h7H71e0KV_kg27FCgKr5bB9b_sYYd_35GfClQAMzfFtIqFlShdOJ4cepOm2cYK3cnopntQnhPssYzSD6sl6BFeKVmOJmQUVVBcsWqA_lZWQPLzCdmRYZ1hPubbmnnrjKJ6IOzi_ezxr5Z1KCA2H1GOawbqu3J180JRlgXAAvzScfmER3id7xJ6kyVtQpZYReJyA Download .mp4 (2.52 MB) Help with .mp4 files Video 1eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJiMDQ2NzgxMTE3YmVkMGRmOGZlNDA3YTJhN2QzYzc0YyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjkzNzc5OTU2fQ.WoLWnYCovWIsq-KOvGc_87sjbg6ktm9jOoNgFdylS1CbN_g5SKtN5YOz7E4BHhuxIJrL8RX42ODWwm5NHA1OsfU3bYCFy1kqrh9MVieGSKiKArqmIl0AMKW6ahGGFyD1dIGam1biV0Z2aJu9H7cCmVgXgulbV460jf8SmSLF75M-Miny-1VPZFxJR3eaKxT90H1QLQlol2sIZOwhYndI2BTeyTgkExeoncei5sWzg0aqYoEfj6HD24oLKIyH0RqS4h9gZB1c7BYBIKTDO1EQ5fRauxMudsvP09avXeqqU0xSeWwiEL_8nU1129uTWimlCidhi98JF-hoiDJRXExIwg Download .mp4 (6.55 MB) Help with .mp4 files Video 2