Vascular disease is the most common precursor to ischaemic heart disease and stroke, which are two of the leading causes of death worldwide. Advances in endovascular intervention in recent years have transformed patient survival rates and post-surgical quality of life. Compared to open surgery, it has the advantages of faster recovery, reduced need for general anaesthesia, reduced blood loss and significantly lower mortality. However, endovascular intervention involves complex manoeuvring of pre-shaped catheters to reach target areas in the vasculature. Some endovascular tasks can be challenging for even highly-skilled operators. The use of robot assisted endovascular intervention aims to address some of these difficulties, with the added benefit of allowing the operator to remotely control and manipulate devices, thus avoiding exposure to X-ray radiation. The purpose of this work is to develop a new robot-assisted endovascular platform, incorporating novel device designs with improved human-robot control. It builds on our strong partnership with industry aiming to develop the next generation robots that are safe, effective, and accessible to general NHS populations.

There is a pressing need to improve the precision, control and selectivity of surgical procedures addressing several high-incidence cancers. For example in the UK, the incidence of basal cell carcinoma (BCC) has increased by approximately 250% since the 1990s, with 137,000 new cases of BCC each year. Bowel cancer is the 4th most common cancer and is the second most common cause of cancer death. Some 15% of new bowel cancer cases are early stage and amenable to potential endoluminal surgery; this proportion is increasing with national screening programs. Delayed diagnosis and incomplete excision of tumours are key drivers of patient morbidity, and squander limited surgical resources. Streamlining screening and early diagnosis processes is now even more important with more patient backlog caused by Covid-19. The default surgical practice is to remove cancers wherever possible, along with a margin of healthy tissue. Leaving cancer cells behind leads to reoccurrence, but removing too much healthy tissue increases both the risk of complications and the loss of normal function. Trying to optimise this balance is a global challenge. For example, BCCs often spread out beneath the surface of the skin such that their entirety cannot be detected until surgery. Moh's micrographic surgery is the gold standard for treating BCCs: the tumour is removed section by section and examined under the microscope until no further tumour can be seen. This is both time consuming and traumatic for the patient, typically resulting in larger skin grafts than expected. If the extent of the tumour could be accurately determined, using terahertz (THz) imaging prior to surgery, the procedure would be faster, and grafts better planned. Similarly, if a diagnostic THz imaging capability could be added to a flexible endoscope, more colorectal tumours could be identified in situ and resected without waiting for histology results (typically 2 weeks) and a follow-up procedure. In this programme, a highly interdisciplinary team consisting of investigators at Universities of Warwick, Exeter and Leeds in Physics, Engineering and Medicine, and at the University Hospital of Coventry and Warwickshire and the Leeds Teaching Hospitals NHS Trust, join forces to optimise patient diagnosis and treatment. The team is supported by industry partners including TeraView Ltd, Intuitive Surgical, Kuka (world leader of industrial robots), QinetiQ, the National Physical Laboratory and Lubrizol (an international cosmetics company). THz light is non-ionising, uses low power levels such that thermal effects are insignificant and is consequently safe for in vivo imaging of humans. It is very sensitive to intermolecular interactions such as hydrogen bonds, and probes processes that occur on picosecond timescales. Owing to the high sensitivity of THz light to tissue hydration and composition, THz spectroscopic imaging can help locate and diagnose lesions that cannot be seen by other imaging modalities. In Terabotics, we will integrate THz technology into robotic probes to develop improved platforms for cancer detection and surgical removal. We will develop probes that can be used on the skin as well as in the abdominal cavity and, by miniaturising the technology, we will also develop a new flexible probe for robotic colonoscopy. In this way the project will lead to more efficient cancer diagnosis and surgery, saving surgeons' operating time and reducing the number of surgeries needed. This is because accurately determining the extent of cancers prior to surgery will enable better surgical planning and reduce the need for a second surgery. Being able to diagnose cancers in situ will also give a faster diagnosis to treatment time. These factors will reduce trauma, costs, patient backlog and waiting lists, and improve patient outcomes. In short, our breakthrough in developing in situ diagnosis will bring step changes in the detection and treatment of cancer for many years to come.

Our vision is to challenge the mind-set of pancreatic cancer being a prognosis of extremely limited options and to enable revolutionary future treatments that will save lives and allow patients to live without major side-effects. Novel engineering and physical science has an essential contribution to make against what is currently the deadliest form of cancer (mortality 95% <2yrs). This research will centre around the creation of new minimally-invasive technologies based on microscale, magnetically-driven, soft continuum robots. These will newly enable non-destructive access to the intricate sensitive internal anatomy of the pancreas and allow targeted treatments to be delivered. These new technologies will tackle current clinical challenges in pancreatic cancer, while also providing the treatment methods that will be required as possibilities for earlier diagnosis emerge in the future.

The range of surgical tools for interventional procedures that dissect or fragment tissue has not changed significantly for millennia. There is huge potential for ultrasonic devices to enable new minimal access surgeries, offering higher precision, much lower force, better preservation of delicate structures, low thermal damage and, importantly, enabling more procedures to be carried out on an out-patient or day surgery basis. To realise this potential, and deliver our vision of ultrasonics being the technology of choice for minimal access interventional surgery, a completely new approach to device design is required, to achieve miniaturisation and to incorporate both a cutting and healing capability in the devices. By integrating with innovative flexible, tentacle-like surgical robots, we will bring ultrasonic devices deep into the human body, along tortuous pathways to the surgical site, to deliver unparalleled precision. Unsurpassed precision in challenging neurological, skull-base and spinal procedures as well as in general surgery is attainable through tailoring the robotic-ultrasonic devices to deliver the exact ultrasonic energy to the exact locations required to optimise the surgery. We will achieve this by quantifying the effects of the ultrasonic excitations typical of surgical devices in tissues, at and surrounding the site of surgery, in terms of precision cutting, tissue damage (mechanical damage, thermal necrosis, cavitation) but also the potential to aid regeneration. We will make world-leading advances in ultra-high speed imaging measurements and biophysical analysis, complementing advances in histology and clinical assessment, to develop a combined approach to the characterisation of both damage and regeneration of tissue. Through this holistic approach to device design, we will create integrated robotic-ultrasonic surgical devices tailored for optimised surgery.