The Future of Medicine – Biotechnology and Miniature Robots

Technology is used increasingly in health care every day, and its contributions, from imaging techniques to treatment options, have made it indispensable in medicine. We can no longer think of medical research and developments independently of technology, and a new concept is thus finding its place at the very center of our lives: biotechnology!

What is biotechnology?

Biotechnology is the science that combines the natural sciences with computer, mechanical and electrical-electronics engineering to identify proteins, enzymes and genes affecting human health and produce molecules or devices for use in diagnosis and treatment.

Biotechnology encompasses many activities, such as producing diagnostic technologies including DNA and genetic analysis, advanced vaccines, recombinant antibodies and peptides, and artificial organs. It also plays an important role in preventing infectious and genetic diseases and developing the pharmaceutical sector. It would be wrong to say biotechnology is used only in health care, because it also serves agriculture through improving food products and producing artificial fertilizers and new vegetables and fruits, and the environment through growing crops in arid regions. Drugs produced through biotechnology have more specific effects, because recombinant DNA or genes produced by biotechnology can reach their target regions more easily when they enter the body. They also have fewer side effects than other synthetic drugs and can work at smaller doses. Cytokines (hormone-like substances secreted by relevant cells in response to a disease), interferons (substances effective against uncontrolled cell proliferation), interleukins (substances transmitting messages between leukocytes), immunoglobulins (substances binding to organs and initiating reactions), recombinant growth factors and recombinant hormones are some products biotechnology has brought to medicine for treating various diseases. Some recombinant peptides and lipids and various developed vaccines are used in gene therapies. Advances in biotechnology have also brought many new treatments currently under investigation. Alongside its many benefits, biotechnology has harmful aspects. Some biotechnological work can pollute the environment, kill many living organisms and disrupt the food chain and ecosystem. This technology also has a dark side in enabling the production of biological weapons. How biotechnology is used is therefore very important, because misuse will do us more harm than good.

Robotic surgery is advancing at a dizzying pace, but how extensively will surgery be used in medicine in the future?

Treatments also change as technologies develop. For example, laparoscopic or robotic surgery is used instead of conventional surgery for some operations. These 2 newly developing types of surgery can perform procedures through millimeter-sized incisions. This damages healthy tissue less than conventional surgery and shortens recovery. Laparoscopic surgery (endoscopic surgery) performs procedures by introducing medical instruments (manipulators) into the body through an incision approximately 10 millimeters in diameter. In these operations, the surgeon operates using these instruments inserted into the body. The surgical camera also magnifies microscopic images and transmits them to the surgeon, enabling more delicate work. Such operations are used in orthopedics, ophthalmology, microsurgery, neurosurgery, general surgery, radiotherapy and some oncological operations. Some studies have found less bleeding and fewer complications in patients undergoing laparoscopy, as well as increased disease-free survival. The use of robotic surgery has only recently begun to increase. It is currently used in fields such as urology, gynecology, general surgery, cardiovascular surgery, obesity surgery and oncology. Robotic surgery has 3 main arms. The surgeon operates these arms from a console beside the patient. Pressure sensors were subsequently added to this console and these arms, developed by modeling surgeons’ hands and wrists. This enabled the surgeon to perceive features such as softness and hardness in the body from the console. It gave the robot sensitivity and increased the surgeon’s likelihood of success… The dizzying advances in robotic surgery greatly impress observers and practitioners alike; but how would you feel if you heard that in the future surgery would hardly ever be performed except in emergencies?! Better understanding and manipulation of the immune system, early diagnosis, less invasive techniques, micro / miniature robots and advances in radiotherapy technologies will make many operations performed today unnecessary in the future.

Miniature robots are coming to medicine

One of the new, groundbreaking biotechnological developments that will bring major changes to medicine when it enters clinical practice is micro / miniature robots. At the event we organized on 14-16 November 2019, the Summit of Those Who Left Their Mark on Oncology, one of the first names that comes to mind in the scientific world in this field, Prof. Metin Sitti, virtually mesmerized us with his presentation entitled "Miniature Robots in Cancer Diagnosis and Treatment."

The miniature robots developed by Prof. Sitti and his team, prepared in capsule shapes or other forms, are swallowed or introduced into the body intravenously and can be guided very successfully using a magnetic field. These robots can carry drugs to cancer cells and even perform biopsies. Capsule robots can exit spontaneously after the procedure (this does not apply to robots that perform biopsies, because the tissue obtained must subsequently be examined, so these robots are removed at the end of the procedure).

These developments are thought to make early diagnosis possible using capsule robots for cancers such as pancreatic and biliary cancers that are diagnosed late. These advances demonstrate how good the results can be when many scientific disciplines are used together. Biotechnology is also a subject that young people planning their future careers should definitely know about. We are now seeing the benefits of developing technology and artificial intelligence more clearly in health care. Many aspects, from diagnosis to treatment, develop or change every day. This creates hope that diseases currently without treatment may have treatments in the future.

Who is Metin Sitti?

Prof. Metin Sitti received his undergraduate and master’s degrees from the Department of Electrical-Electronics Engineering at Boğaziçi University and his doctorate in 1999 from the Department of Electrical Engineering at the University of Tokyo. In the USA, he worked at the University of California, Berkeley from 1999-2002 as a postdoctoral researcher and faculty member, and at Carnegie Mellon University from 2002-2016 as a professor. Since 2014, he has been a director at the Max Planck Society’s Institute for Intelligent Systems in Germany. Since 2018, he has also been a part-time professor in the medical and engineering faculties of Koç University. His research encompasses a wide range of topics within microrobotics and intelligent systems, such as medical microrobots and devices, nature-inspired miniature robots and soft robots. To commercialize the microfiber adhesives he invented, inspired by the foot hairs of gecko lizards, he founded the startup nanoGriptech Inc. in the USA in 2009. This highly innovative adhesive has been used in many products on the market since 2018.

Among Metin Sitti’s many awards and titles are the Rahmi Koç Medal of Science in 2018, an ERC Advanced Grant Award in 2019, the Best Paper Award at the Robotics Science & Systems Conference in 2019, the title of IEEE Fellow in 2014, the IEEE/ASME Best Mechatronics Paper Award in 2014, the SPIE Nanoengineering Pioneer Award in 2011 and the National Science Foundation CAREER Award in 2005. He has more than 450 papers in peer-reviewed journals and conferences. More than 250 journal articles have appeared in leading journals including Nature, Nature Materials, Nature Communications, Proceedings of the National Academy of Sciences, Science Robotics, Science Advances and Advanced Materials. These articles have received more than 22,000 citations to date. His latest book, “Mobile Microrobotics,” was published by MIT Press in 2017. He has given more than 200 invited talks at major conferences, universities and companies in his field. He also serves as editor-in-chief of Progress in Biomedical Engineering and Journal of Micro-Bio Robotics.

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Let us conclude our article with the words on biotechnology of author and historian Yuval Noah Harari, one of the most influential people of our age:

"People must understand that humanity now faces three existential threats that cannot be solved at the national level. The problems can only be solved globally. These threats are nuclear war, climate change and technological disruption, particularly the rise of artificial intelligence (AI) and bioengineering. Artificial intelligence and biotechnology could destroy humanity. If we enter an arms race in artificial intelligence or genetics, it guarantees humanity’s extinction. It does not matter who wins the race; humanity will be the loser.

I am very afraid. I think technology now makes it possible to create the most totalitarian regimes we have ever seen in human history. Far beyond what George Orwell imagined. Orwell imagined a totalitarian regime that constantly follows you, but only in the external world: what you do, where you go, whom you meet. Now we have technology capable of monitoring everyone 24 hours a day, even what is happening inside their bodies. A combination of biometric sensors, artificial intelligence and biotechnology makes this possible. For example, there are schools in China where students wear biometric bracelets. They say they are currently using them for educational purposes. If you are sleepy, bored or struggling, the teacher knows. But the same technology can be used for political purposes. In the 20th century, what we saw with Stalin, Hitler or Mao will pale into insignificance compared with the kinds of machines now beginning to be built.

If we do not use biotechnology correctly, it will be used to enable a small elite group to rise by acquiring superhuman traits, leaving most people behind. Humanity will therefore be divided into different species; for the first time in history, the rich will be a different species from the poor. This is the greatest inequality in history. Many jobs will disappear, but new jobs will emerge. The real problem will not be an absolute lack of jobs, but retraining people. People will have to change their jobs again and again, learning throughout their lives. The current education system does not prepare them for this. The only way to deal with it is global cooperation."