GIFT-Surg project

Recently, the GIFT project went through some changes, and now  King’s College London is in the lead of this great initiative:
"Teams at UCL and KCL are looking at ways in which the Kuka arm and other surgical robots can be incorporated to advance research understandings and capabilities. A research project called Guided Instumentation for Fetal Therapy and Surgery (GIFT-Surg) is working on applying these new technologies to fetal surgery. GIFT-Surg is led by UCL and KCL in collaboration with KU Leuven in Belgium, Great Ormond Street Hospital, University College London Hospital NHS Foundation Trust and UZ Leuven.

A particular fetal condition that the GIFT-Surg team are using surgical robotics to assist with is twin-to-twin transfusion syndrome (TTTS). TTTS is a complication affecting 10-15% of identical twins who share the same placenta. The disease is caused by the presence of abnormal blood vessels (anastomising vessels) in the shared placenta leading to an imbalance in the blood circulation between the twins. The condition results in uneven transfusion meaning that the donor twin is often underweight and anaemic due to deprivation of blood, whilst the recipient twin’s heart is strained by overload of blood.

TTTS is currently treated in minimally invasive surgery through the insertion of a foetoscope to identify the anastomising vessels, followed by the cauterisation of these vessels with a laser coagulator (see image below). One of the primary challenges of this surgery is the limited field view of the fetoscopic video guidance, worsened by the cloudy amniotic fluid in the womb and instability of imaging caused by movement. The poor visibility hinders surgeons’ ability to accurately locate and cauterise all abnormal vessels. GIFT-Surg researchers are developing technology that combines novel image analysis techniques with advancements in surgical robotics. Using mosaicking it will generate a full 3D model of the placenta from a series of limited 2D fetoscopic images, enabling more accurate navigation and cauterisation."

Technological Workpackages:

Workpackages of the project:

•     WP1: Surgical planning and visualisation. This WP is about the creation and development of the software that will run the hardware and imaging systems. It is reliant on software developers and medical imaging specialists.
•     WP2: Intra-operative sensing – This WP involves the physical building of the camera and development of the photoacoustics system that will be used on the new tool to create 3D images. Most of this work will be carried out by Medical Physicists and Medical Engineers.
•     WP3: Surgical instrumentation is about the creation of the new tool itself. The design incorporating the flexibility and small size needed, will be developed by experienced Medical Engineers.
•     WP4: Intra-operative data fusion: is about linking the information provided from different channels in real-time during the procedure, for example by co-registering intra-operative ultrasound and pre-operative MR.
•     WP5: Clinical validation. This package is about testing the technical achievements in a preclinical and eventually clinical environment. It relies heavily upon the skills of clinicians and surgeons.
•     WP9: System Integration will take place throughout the complete project. This is about linking up all the various software and hardware components and robustly testing them

Clinical Workpackages:

•     WP6:  Regenerative medicine: is about using the steps accomplished in WP1-5 and applying it to the breakthrough improvements in regenerative medicine.
•     WP7: Efficacy and Acceptability of Fetal surgery. This WP is about the ethics and economics of fetal surgery. It relies on clinical consultants as well as medical economists, and the general public by way of patient groups.
•     WP8: Clinical training and assessment is about training and ensuring medical professionals have the proficiency to use the new systems and equipment safely and flawlessly.

Source: GIFT project