Doctors at the Tokyo Women’s Medical University – Waseda University Joint Institution for Advanced Biomedical Sciences (TWIns) recently performed a groundbreaking brain surgery to treat essential tremor, a neurological disorder. It was the first clinical use of the latest version of the institution’s Smart Cyber Operating Theater (SCOT). Hyper SCOT, as it’s known, brings robotics and AI into the operating theater so that patients can have better post-surgical outcomes. It’s an impressive example of the many forms of open collaboration driving innovation in Japan.
A new frontier in surgery
Walking into the Hyper SCOT operating room at Tokyo Women’s Medical University, one gets the feeling of entering Sick Bay aboard the starship Enterprise from Star Trek. Silver doors slide open to reveal a sleek white room illuminated by variable-color lights. In the center are a pair of robots: an operating bed that swivels to position a patient under a large MRI scanner nearby, and a dual-armed industrial-style robot that can support a surgeon’s arms while operating. On the wall are high-resolution images of a patient’s brain. Surgeons can gesture to zoom in or change the images’ orientation, a feature inspired by the Tom Cruise film Minority Report.
Hyper SCOT is designed to transform surgery from an analog process, where standalone equipment is not connected, into a digital process where data are shared. It can support surgical teams by providing them with a rich stream of data from networked medical tools as well as AI-powered advice on surgical options. SCOT also aims to improve precision by helping brain surgeons accurately navigate to a tumor site. Although MRI had only been available to surgeons before an operation, Hyper SCOT would enable them to get scans during the procedure, which could dramatically improve outcomes.
“If we have many kinds of information, we need some kind of strategy desk, like Mission Control at NASA,” says SCOT project leader Yoshihiro Muragaki, a professor in Tokyo Women’s Medical University’s Institute of Advanced Biomedical Engineering and Science. “Our moonshot is to make new eyes, brains and hands for surgeons. With SCOT, we can perform precision-guided therapy.”
A neurosurgeon himself, Muragaki conceived of the SCOT project and has spearheaded it since its inception in 2000. Back then it was known as the Intelligent Operating Theater, a version now known as Classic SCOT. Supported by a grant from the Japan Agency for Medical Research and Development (AMED), the system began as an initiative to enhance interoperability among devices used in the medical theater, but the development team later added features such as multiple surgery cameras that can send imagery to remote consultants, usually senior surgeons. These advisors have a bird’s-eye view of the action as well as near-real time data streams of patients’ vital statistics. Since 2000, the technology has been used in some 1,900 cases, mostly brain surgeries. MRI has been key in detecting residual tumor tissue that escaped surgeons’ notice during operations.
“Even under a microscope, it’s very difficult to detect where brain tumor tissue ends and healthy tissue begins,” says Muragaki. “That’s why we need MRI during surgery. It’s a very powerful tool for removing tumors. But that also means we can only use MRI-compatible devices in the operating room and we must choose them carefully.”
Fruits of teamwork
With over 100 researchers, SCOT is the result of a complex collaboration between academia and the private and public sectors. Aside from the two universities in TWIns, Muragaki and colleagues are working with Hiroshima University and Shinshu University, where versions of SCOT are being evaluated in clinical settings. High-tech companies are also helping to develop SCOT, including Hitachi, Canon Medical, and Air Water. Another participant is Denso. It developed a medical-equipment middleware called OpeLiNK that is based on factory automation technology as well as ORiN, a platform created with the support of the New Energy and Industrial Technology Development Organization (NEDO), a leading Japanese state-backed research center. Orchestrating all these players was essential in creating SCOT.
“If one company tried to do this alone, it would want to use its own technology and keep rivals out,” says Muragaki. “That company wouldn’t succeed in integrating all the various technologies. That’s why public institutions are vital for this kind of open innovation project. They act like the frame in a traditional sensu Japanese folding fan, keeping everything together as the project unfolds.”
The collaborations that gave birth to SCOT were recently recognized when it picked up the Minister of Health, Labour and Welfare Award as part of the first Japan Open Innovation Prize. Sponsored by the Japanese government, the accolade was set up to promote initiatives that can serve as future role models for open innovation. In Japan, companies traditionally kept R&D in-house, even in recent years. But the public and private sectors have been pushing open innovation as a vehicle for enhancing competitiveness. Collaborations between government labs, corporations and universities are now flourishing. Major telecom carrier KDDI, for instance, launched the first of a series of Open Innovation Funds in 2012, aimed at investing in IT startups in Japan and overseas.
“There’s a growing recognition that if a company categorizes itself as a camera company, for instance, it is limiting itself,” Keiichiro Koumura, an official with major real estate company Mitsui Fudosan, recently told attendees at an open innovation seminar at Mitsui Fudosan’s Base Q in Tokyo. “Because as technology changes, cameras have become smartphones. One way to address this is open innovation.”
Looking to the future
As for SCOT, Muragaki hopes to spread the technology to other hospital facilities such as intensive care units, and apply it to other forms of surgery such as vascular operations. He also hopes to take the technology overseas.
“Most doctors are resistant to change. Before they try SCOT, surgeons don’t regard it as something that’s necessary but once they give it a go, their view changes,” says Muragaki. “After brain surgeries, we want to try the technology on bone tumors, and keep going. If you could do all surgeries with SCOT, it would decrease risks and increase benefits. That’s something we can work toward.”
To find out more about SCOT, visit the university’s website here.
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