Remote magnetic navigation enables precision telesurgery

Magnetic Micro/nanorobots in Cancer Theranostics: From Designed Fabrication to Diverse Applications

Cancer poses a substantial threat and a serious challenge to public human health, driving the promotion of sophisticated technologies for cancer therapy. While conventional chemotherapy has bottlenecks such as low delivery efficiency, strong toxic side effects, and tumor enrichment barriers, magnetic micro/nanorobots (MNRs) emerge as promising therapeutic candidates that provide alternative strategies for cancer therapy. MNR is a kind of human-made machine that is micro- or nanosized, is reasonably designed, and performs command tasks through self-actuated or externally controlled propulsion mechanisms, which can be potentially applied in cancer theranostics. Here, this review first introduces the components that constitute a typical magnetic MNR, including the body part, the driving part, the control part, the function part, and the sensing part. Subsequently, this review elucidates representative fabrication methods to construct magnetic MNRs from top-down approaches to bottom-up approaches, covering injection molding, self-rolling, melt electrospinning writing, deposition, biotemplate method, lithography, assembling, 3D printing, and chemical synthesis. Furthermore, this review focuses on multiple applications of magnetic MNRs facing cancer diagnosis and treatment, encompassing imaging, quantification, drug release, synergy with typical therapies, cell manipulation, and surgical assistance. Then, this review systematically elaborates on the biocompatibility and biosafety of magnetic MNRs. Finally, the challenges faced by magnetic MNRs are discussed alongside future research directions. This review is intended to provide scientific guidance that may improve the comprehension and cognition of cancer theranostics through the platform of magnetic MNRs, promoting and prospering the practical application development of magnetic MNRs.

Nanozyme-Shelled Microcapsules for Targeting Biofilm Infections in Confined Spaces

Bacterial infections in irregular and branched confinements pose significant therapeutic challenges. Despite their high antimicrobial efficacy, enzyme-mimicking nanoparticles (nanozymes) face difficulties in achieving localized catalysis at distant infection sites within confined spaces. Incorporating nanozymes into microrobots enables the delivery of catalytic agents to hard-to-reach areas, but poor nanoparticle dispersibility and distribution during fabrication hinder their catalytic performance. To address these challenges, a nanozyme-shelled microrobotic platform is introduced using magnetic microcapsules with collective and adaptive mobility for automated navigation and localized catalysis within complex confinements. Using double emulsions produced from microfluidics as templates, iron oxide and silica nanoparticles are assembled into 100-µm microcapsules, which self-organize into multi-unit, millimeter-size assemblies under rotating magnetic fields. These microcapsules exhibit high peroxidase-like activity, efficiently catalyzing hydrogen peroxide to generate reactive oxygen species (ROS). Notably, microcapsule assemblies display remarkable collective navigation within arched and branched confinements, reaching the targeted apical regions of the tooth canal with high accuracy. Furthermore, these nanozyme-shelled microrobots perform rapid catalysis in situ and effectively kill biofilms on contact via ROS generation, enabling localized antibiofilm action. This study demonstrates a facile method of integrating nanozymes onto a versatile microrobotic platform to address current needs for targeted therapeutic catalysis in complex and confined microenvironments.

Telesurgery and the importance of context

Telesurgery has the potential to overcome geographical barriers in surgical care, encouraging its deployment in areas with sparse surgical expertise. Despite successful in-human experiments and substantial technological progress, the adoption of telesurgery remains slow. In this Review, we analyze the reasons for this slow adoption. First, we identify various contexts for telesurgery and highlight the vastly different requirements for their realization. We then discuss why procedures with high urgency and skill sparsity are particularly suitable for telesurgery. Last, we summarize key research areas essential for further progress. The goal of this Review is to provide the reader with a comprehensive analysis of the current state of telesurgery research and to provide guidance for faster adoption of this exciting technology.

Magnetically driven bionic nanorobots enhance chemotherapeutic efficacy and the tumor immune response via precise targeting

We developed magnetically driven bionic drug-loaded nanorobots (MDNs) to accurately target tumors and deliver chemotherapy agents using a customized three-dimensional (3D) magnetic manipulation platform (MMP) system to precisely control their movement mode. MDNs were based on polyethylene glycol-modified homogeneous ultrasmall iron oxide nanoparticles (7.02 ± 0.18 nm). Doxorubicin (12% ± 2% [w/w]) was encapsulated in MDNs by an imide bond. MDNs could imitate the movement mode of a school of wild herrings (e.g., re-dispersion/arrangement/vortex/directional movement) to adapt to the changing and complex physiological environment through the 3D MMP system. MDNs overcame blood flow resistance and biological barriers using optimized magnetic driving properties according to in vivo imaging (magnetic resonance imaging and fluorescence) and histopathology. The performance of fabricated MDNs was verified through cells and tumor-bearing mouse models. The MDNs showed high efficiency of drug delivery and targeting at the tumor site (>10-fold), lower toxicity than free doxorubicin (5 mg/kg body weight), activated immune response in the tumor site, and significantly lengthened survival for mice. The synergistic interaction between MDNs and the 3D MMP system underscores the immense potential of this drug delivery system, indicating a potential revolution in the field of tumor chemotherapy.

Multi-Section Magnetic Soft Robot with Multirobot Navigation System for Vasculature Intervention

Magnetic soft robots have recently become a promising technology that has been applied to minimally invasive cardiovascular surgery. This paper presents the analytical modeling of a novel multi-section magnetic soft robot (MS-MSR) with multi-curvature bending, which is maneuvered by an associated collaborative multirobot navigation system (CMNS) with magnetic actuation and ultrasound guidance targeted for intravascular intervention. The kinematic and dynamic analysis of the MS-MSR's telescopic motion is performed using the optimized Cosserat rod model by considering the effect of an external heterogeneous magnetic field, which is generated by a mobile magnetic actuation manipulator to adapt to complex steering scenarios. Meanwhile, an extracorporeal mobile ultrasound navigation manipulator is exploited to track the magnetic soft robot's distal tip motion to realize a closed-loop control. We also conduct a quadratic programming-based optimization scheme to synchronize the multi-objective task-space motion of CMNS with null-space projection. It allows the formulation of a comprehensive controller with motion priority for multirobot collaboration. Experimental results demonstrate that the proposed magnetic soft robot can be successfully navigated within the multi-bifurcation intravascular environment with a shape modeling error 3.62 ± 1.28 ∘ and a tip error of 1.08 ± 0.45 mm under the actuation of a CMNS through in vitro ultrasound-guided vasculature interventional tests.

A Human-Scale Clinically Ready Electromagnetic Navigation System for Magnetically Responsive Biomaterials and Medical Devices

Magnetic navigation systems are used to precisely manipulate magnetically responsive materials enabling the realization of new minimally invasive procedures using magnetic medical devices. Their widespread applicability has been constrained by high infrastructure demands and costs. The study reports on a portable electromagnetic navigation system, the Navion, which is capable of generating a large magnetic field over a large workspace. The system is easy to install in hospital operating rooms and transportable through health care facilities, aiding in the widespread adoption of magnetically responsive medical devices. First, the design and implementation approach for the system are introduced and its performance is characterized. Next, in vitro navigation of different microrobot structures is demonstrated using magnetic field gradients and rotating magnetic fields. Spherical permanent magnets, electroplated cylindrical microrobots, microparticle swarms, and magnetic composite bacteria-inspired helical structures are investigated. The navigation of magnetic catheters is also demonstrated in two challenging endovascular tasks: 1) an angiography procedure and 2) deep navigation within the circle of Willis. Catheter navigation is demonstrated in a porcine model in vivo to perform an angiography under magnetic guidance.

Sensor-Based Measurement Method to Support the Assessment of Robot-Assisted Radiofrequency Ablation

Digital surgery technologies, such as interventional robotics and sensor systems, not only improve patient care but also aid in the development and optimization of traditional invasive treatments and methods. Atrial Fibrillation (AF) is the most common cardiac arrhythmia with critical clinical relevance today. Delayed intervention can lead to heart failure, stroke, or sudden cardiac death. Although many advances have been made in the field of radiofrequency (RF) catheter ablation (CA), it can be further developed by incorporating sensor technology to improve its efficacy and safety. Automation can be utilized to shorten the duration of RF ablation, provided that the interactions between the tissue and the RF tools are well understood and adequately modeled. Further research is needed to develop the optimal catheter design. This paper describes the systematic methodology developed to support robot-assisted RF CA characterization measurements. The article describes the custom instruments developed for the experiments, particularly the contact force limiter, the measurement procedure, and the evaluation of the results, as enablers for new results. The aim was to establish an objective, repeatable, robust measurement method and adjacent procedure.