Vascular disease is a major contributor to cardiovascular deaths in the Western world. The incidence of abdominal aortic aneurysms increases significantly with age - by over 300% for those at age 70 compared to those at age 50. With the demographic shift associated with the ageing population, there is a pressing need for early intervention and minimally invasive surgery. Endovascular therapy avoids major trauma associated with open operation, with clear advantages in terms of reduced morbidity and mortality, especially in patients unable to withstand traditional open surgery. It, however, has certain technical and anatomical constraints which are currently not addressed by the current manufacturing methods. Stent design and placement have a direct implication on the reintervention rate, which for endovascular repair is often higher than open repair. Side branches to the main artery require bespoke openings on the graft, which are expensive and time consuming to produce. The long delay in customised graft manufacturing can subject patients to the risk of aneurysm rupture and precludes treatment to patients with acute symptoms. Improved manufacturing of personalised stent-grafts is therefore an unmet clinical demand that requires innovative manufacturing solutions. This project aims to develop a novel robotic platform for personalised stent-graft manufacturing. It includes the development of a new stent graft sewing robot combined with a fully personalised aortic mould printed with the latest 3D printing technologies using patient-specific imaging data. It improves consistency, speed and quality of customised manufacturing of stent graft with complex geometries and represents an ideal example of the innovative use of robotics, additive manufacturing, and machine vision for small run, 'batch'-of-one personalised medical devices. The project is to be carried out by a multidisciplinary team with complementary research skills in robotics, sensing, imaging, and endovascular intervention, alongside two major industrial partners in medical devices and surgical robotics.

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.

As minimally invasive surgery is being adopted in a wide range of surgical specialties, there is a growing trend in precision surgery, focussing on early malignancies with minimally invasive intervention and greater consideration on patient recovery and quality of life. This requires the development of sophisticated micro-instruments integrated with imaging, sensing, and robotic assistance for micro-surgical tasks. This facilitates management of increasingly small lesions in more remote locations with complex anatomical surroundings. The proposed programme grant seeks to harness different strands of engineering and clinical developments in micro-robotics for precision surgery to establish platform technologies in: 1) micro-fabrication and actuation; 2) micro-manipulation and cooperative robotic control; 3) in vivo microscopic imaging and sensing; 4) intra-operative vision and navigation; and 5) endoluminal platform development. By using endoluminal micro-surgical intervention for gastrointestinal, cardiovascular, lung and breast cancer as the exemplars, we aim to establish a strong technological platform with extensive industrial and wider academic collaboration to support seamless translational research and surgical innovation that are unique internationally.