Background: The aim of this study was to develop and evaluate a deep learning-based automated segmentation method for hepatic anatomy (i.e., parenchyma, tumors, portal vein, hepatic vein and biliary tree) from the hepatobiliary phase of gadoxetic acid-enhanced MRI. This method should ease the clinical workflow of preoperative planning. Methods: Manual segmentation was performed on hepatobiliary phase MRI scans from 90 consecutive patients who underwent liver surgery between January 2020 and October 2023. A deep learning network (nnU-Net v1) was trained on 72 patients with an extra focus on thin structures and topography preservation. Performance was evaluated on an 18-patient test set by comparing automated and manual segmentations using Dice similarity coefficient (DSC). Following clinical integration, 10 segmentations (assessment dataset) were generated using the network and manually refined for clinical use to quantify required adjustments using DSC. Results: In the test set, DSCs were 0.97+/-0.01 for liver parenchyma, 0.80+/-0.04 for hepatic vein, 0.79+/-0.07 for biliary tree, 0.77+/-0.17 for tumors, and 0.74+/-0.06 for portal vein. Average tumor detection rate was 76.6+/-24.1%, with a median of one false-positive per patient. The assessment dataset showed minor adjustments were required for clinical use of the 3D models, with high DSCs for parenchyma (1.00+/-0.00), portal vein (0.98+/-0.01) and hepatic vein (0.95+/-0.07). Tumor segmentation exhibited greater variability (DSC 0.80+/-0.27). During prospective clinical use, the model detected three additional tumors initially missed by radiologists. Conclusions: The proposed nnU-Net-based segmentation method enables accurate and automated delineation of hepatic anatomy. This enables 3D planning to be applied efficiently as a standard-of-care for every patient undergoing liver surgery.

Small-scale robots offer significant potential in minimally-invasive medical procedures. Due to the nature of soft biological tissues, however, robots are exposed to complex environments with various challenges in locomotion, which is essential to overcome for useful medical tasks. A single mini-robot often provides insufficient force on slippery biological surfaces to carry medical instruments, such as a fluid catheter or an electrical wire. Here, for the first time, we report a team of millirobots (TrainBot) that can generate around two times higher actuating force than a TrainBot unit by forming a convoy to collaboratively carry long and heavy cargos. The feet of each unit are optimized to increase the propulsive force around three times so that it can effectively crawl on slippery biological surfaces. A human-scale permanent magnetic set-up is developed to wirelessly actuate and control the TrainBot to transport heavy and lengthy loads through narrow biological lumens, such as the intestine and the bile duct. We demonstrate the first electrocauterization performed by the TrainBot to relieve a biliary obstruction and open a tunnel for fluid drainage and drug delivery. The developed technology sheds light on the collaborative strategy of small-scale robots for future minimally-invasive surgical procedures.

Primary sclerosing cholangitis (PSC) is a rare disease wherein altered bile acid metabolism contributes to sustained liver injury. This paper introduces REMEDI, a framework that captures bile acid dynamics and the body's adaptive response during PSC progression that can assist in exploring treatments. REMEDI merges a differential equation (DE)-based mechanistic model that describes bile acid metabolism with reinforcement learning (RL) to emulate the body's adaptations to PSC continuously. An objective of adaptation is to maintain homeostasis by regulating enzymes involved in bile acid metabolism. These enzymes correspond to the parameters of the DEs. REMEDI leverages RL to approximate adaptations in PSC, treating homeostasis as a reward signal and the adjustment of the DE parameters as the corresponding actions. On real-world data, REMEDI generated bile acid dynamics and parameter adjustments consistent with published findings. Also, our results support discussions in the literature that early administration of drugs that suppress bile acid synthesis may be effective in PSC treatment.

The biliary tree is a network of tubes that connects the liver to the gallbladder, an organ right beneath it. The bile duct is the major tube in the biliary tree. The dilatation of a bile duct is a key indicator for more major problems in the human body, such as stones and tumors, which are frequently caused by the pancreas or the papilla of vater. The detection of bile duct dilatation can be challenging for beginner or untrained medical personnel in many circumstances. Even professionals are unable to detect bile duct dilatation with the naked eye. This research presents a unique vision-based model for biliary tree initial diagnosis. To segment the biliary tree from the Magnetic Resonance Image, the framework used different image processing approaches (MRI). After the image's region of interest was segmented, numerous calculations were performed on it to extract 10 features, including major and minor axes, bile duct area, biliary tree area, compactness, and some textural features (contrast, mean, variance and correlation). This study used a database of images from King Hussein Medical Center in Amman, Jordan, which included 200 MRI images, 100 normal cases, and 100 patients with dilated bile ducts. After the characteristics are extracted, various classifiers are used to determine the patients' condition in terms of their health (normal or dilated). The findings demonstrate that the extracted features perform well with all classifiers in terms of accuracy and area under the curve. This study is unique in that it uses an automated approach to segment the biliary tree from MRI images, as well as scientifically correlating retrieved features with biliary tree status that has never been done before in the literature.

Torrey Smith, Co-Founder of Endiatx, is changing the reputation endoscopies have for being uncomfortable. At Endiatx, they are developing a pill-sized robot that you swallow, which will then livestream your digestive system for a doctor to view. Our interviewer Abate dives in. Torrey Smith Torrey Smith is the Co-Founder & CEO of Endiatx, a medical robotics company that manufactures tiny robotic pills capable of active movement inside the human stomach with control over internet protocol. Prior to launching Endiatx, he developed medical devices in the areas of endometrial ablation, atherectomy, therapeutic hypothermia, sleep apnea, and vascular closure. An aerospace engineer by training, he takes a keen interest in the deep tech sector and is a proud mentor of up-and-coming founders at the Founder Institute. He is also the principal founder of the international arts collective known as Sextant, and he has had his art featured in the Smithsonian. Abate De Mey: Welcome to the robo hub podcast. Super excited to have you on here. So Torrey, could you introduce yourself a little bit? Well, you know, I originally originally studied aerospace engineering because my goal was to build the future of science fiction that I had read about as a kid. I had some relatives you know, come down with some gnarly health conditions. I lost an aunt to a brain cancer. I became very passionate about the world of medical devices and maybe more importantly, just health and technology and how we can merge those. Because I, I think if you asked a 14 year old kid who reads science fiction, what they think the future of healthcare looks like, they would probably say, oh, it's going to be like nano robots. That would go in like an army of tiny machines and kill any tumor. And then if you ask a doctor, Hey, I've got a glioblastoma. The doctor's going to say, well, we're going to cut an incision over here. I'm going to cut out a piece of your skull and put it in a steel dish. Then I'm going to go in and do my best to remove some of this brain tumor. And we're going to put you back together. We're going to put you on drugs. You know, we'll put you on chemo and you know, in six to nine months, you're going to be dead. And my question is simple.