Newsletter No. 498

08 # 4 9 8 | 1 9 . 0 5 . 2 0 1 7 歐國威教授 Prof. Samuel Au • 機械與自動化工程學系 Department of Mechanical and Automation Engineering • 達芬奇單創口手術平台共同發明者 Co-inventor of the da Vinci Single-Site surgical platform 你是二十年前中大機械與自動化工程學系的首批學生。回想起來， 哪個時刻是你求學階段的轉捩點？ 在本科的最後一學期， 徐揚生 教授〔現中大（深圳）校長〕剛好加入學系。 我還記得第一次上徐教授的課時，他播放了許多影片，展示外國發明家設 計的精密機械人。影片令我對外國先進的機械人發展歎為觀止，嚮往自己 也能參與其中。這一課也促使我及後選擇徐教授為碩士導師。如果說我 今天略有小成的話，那都得感激他在各方面給我的深遠影響。 那你是怎樣走上發明醫療用機械人的路？ 我在波士頓麻省理工學院唸博士的七年間，與MIT媒體實驗室的主管 Hugh Herr 教授合作，研發出機械腳踝義肢，能模擬人腳踝的動作，破天 荒讓膝下截肢者踏出自然步態。這項發明在2007年獲《時代》雜誌評為 年度最佳發明之一。 經過參與這項目，我開始對設計醫療用機械人產生真正興趣，覺得將機 械人學與醫學結合很奇妙，也意識到機械輔助手術的前景無限，能大大 推進醫療科技發展。 請談談你參與發明的達芬奇單創口手術機械臂及其獨特之處。 畢業後，我加入一所加州醫療器械公司Intuitive Surgical，參與研發達芬 奇單創口手術平台。它成為了首個獲美國食品藥物管理局認證的單創口 機械手術設備。 傳統的機械臂手術需要在病人身上開三至五個孔，而達芬奇單創口手術 只需在肚臍上方開一個小創口，讓機械臂和鏡頭循此進入體內。外科醫 生安坐在旁邊的電腦控制台，觀看病人體內的3D高清影像，操控機械臂 切割或縫合。最終結果是術後幾乎零疤痕。這對女病人是一大福音，因 為手術後有待癒合的傷口由三個減少到只有一個。 在美國成就斐然，為甚麼選擇在2016年回流香港，到母校任教？ 我希望透過教授進階機械人學以及機械電子學，幫助大學彌合研究樣 本與商業產品之間的鴻溝。我在業界工作了接近十年，深知這道鴻溝非 同小可，在醫療器械研發領域尤甚。有了好主意，也未必能研發出好的 產品。 要令象牙塔的研究轉化成有市場價值的產品，必須把目光放遠，在意念 孕育的初階就得評估自己的想法是否合乎現實，預測在生產階段會衍生 甚麼問題。這種前瞻能力是我最想傳授給學生的。 目前你有在研究甚麼新式機械人嗎？ 我正在嘗試實現真正的無創機械輔助手術。到目前為止，機械微創手術 至少還需要在肚臍附近開個小孔，讓堅硬的內窺鏡入體內施手術。我參 與研發中的一款新型機械導管則無需開任何創口，就能輕易鑽進人體天 然孔道，到達目標器官。這是最終極的機械手術，也是研發難度最高的， 但看來在不久將來就可以實現。 機械人會淘汰外科醫生嗎？ 不。我相信機械人不會取代醫生。相反，機械人會成為外科醫生不可或缺 的夥伴，幫助醫生突破體能局限，提升手術效能。機械人能承擔勞神費力 的工序，但沒有判斷力。醫生在手術期間每分每秒的判斷和調整關乎生 死，這點連最先進的機械人也難以勝任。醫生能決定為何做手術、做甚 麼手術，而機械人能輔助怎樣做手術。這種機械人與醫生的夥伴關係能 做出更優質、更穩定的手術結果，也能開闢更新、更複雜的手術。 口 談 實 錄 / V iva V oce Photo by ISO Staff Two decades ago you enrolled in CUHK’s Mechanical and Automation Engineering (MAE) programme as its first batch of students. In retrospect, when was the turning point in your academic pursuit? My final undergraduate semester at MAE coincided with Prof. Xu Yangsheng ’s [currently President of CUHK(SZ)] joining the department. I remember the first time I attended his class he played an array of videos showing sophisticated robot designs by foreign inventors. I was enthralled by the advanced robotic development in other parts of the world, and aspired to making my way to the top game. This episode also led me to choose Professor Xu as my MPhil advisor. He continued to influence me in more ways than one and has made me who I am today. How did you land on the path of designing robot-assisted medical devices? During my seven years of PhD studies at the Massachusetts Institute of Technology in Boston, my supervisor at the MIT Media Lab Prof. Hugh Herr and I invented the robotic ankle-foot prosthesis, which mimics the action of a biological ankle and, for the first time, provides transtibial amputees with a natural gait. This invention was named one of the Best Inventions by TIME magazine in 2007. It was through this project that I began to take real interest in designing robot-assisted medical devices. I found it fascinating to combine robotics with medicine, and realized robot-assisted surgery was an unexplored field which would greatly boost medical technology. Tell us about the da Vinci Single-Site robot you co-invented and its uniqueness. Upon graduation, I joined a California-based company called Intuitive Surgical where I co- invented the da Vinci Single-Site surgical platform. It became the first ever FDA-approved robotic platform to support single incision surgery. Unlike traditional robotic surgeries requiring three to five incisions, da Vinci Single-Site surgery requires only a single, small incision in the belly button, through which the robotic arms and camera enter. A surgeon sits at a computer console viewing a 3D high-definition image of the patient’s anatomy, and guides the robotic arms to do the cutting and stitching. The end result is virtually scarless surgery. It is especially well received by female patients, because with this procedure there’s only one wound to heal, rather than three. Having achieved so much in the US, why did you return to Hong Kong in 2016 to teach at your alma mater? By teaching Advanced Robotics and Mechatronics at the MAE Department, I wish to help the University to bridge the gap between research prototype and commercial product. I’ve spent almost a decade in the industry and know such a gap is bigger than imagined. This is particularly true for medical device development. More often than not, a good idea does not necessarily lead to an impactful product. To translate benchside research into bedside products, you have to begin with the end in mind. You need to be able to predict right at the beginning whether your concept strategically makes sense or not, and what problems will emerge in the manufacturing stage. Such foresight is what I want most to impart to my students. Are you at present working on any new robotic project? I am trying to make bona fide scarless robotic surgery possible. Current robotic keyhole surgeries still require at least a small cut at the navel to enable a rigid robotic endoscope to enter and do the surgery. A new flexible robotic system, now in development, does not require any external incision and allows the machine to easily navigate through body orifices into target organs. It’s the ultimate robotic surgery and also the hardest to achieve, but it will be realized in the not-so-distant future. Will robots make surgeons obsolete? No. I don't believe robots will ever take over from the surgeons. On the contrary, robots will become indispensable partners of surgeons to help them overcome their physical limitations and enhance their performance. Robots assist surgeons with technically demanding, repetitive tasks, but they are incapable of exercising judgement. Surgeons will have to make the kinds of minute-to-minute adjustments that can mean the difference between life and death, which even the most perfectly programmed robot can’t do. Doctors can decide why to operate and what to do, while machines can help with the ‘how’. This robot-surgeon partnership will produce better and more consistent surgical outcome and open up new and complex procedures.