The European Research Council (ERC), a European Union body that supports scientific excellence through highly competitive funding, has published the list of winning projects of the Synergy Grants, which award funding of 10 million euros for the next 6 years. Among the funded research is that of Prof. Alberto Arezzo, professor of the Department of Surgical Sciences of the University of Turin, who presented the project entitled “EndoTheranostics: Multi-sensor Eversion Robot Towards Intelligent Endoscopic Diagnosis and Therapy“. The research will allow us to redesign the diagnosis and treatment models in a single step for neoplasms of the digestive tract, with particular reference to the colorectal.

Colorectal cancer is one of the most common cancers worldwide, with over 1.9 million new cases and 935,000 deaths recorded in 2020. Despite advances in medical technology, surgeries are often performed during the last stages of disease development, leading to low patient survival rates or poor quality of life. The project was born from the observation that endoscopic screening programs are unfortunately largely ignored. In particular, colonoscopy is perceived as an invasive test, which the majority of people tend to undergo with regret or not at all. The research therefore imagined redesigning the entire process of diagnosis and therapy of colon and rectal cancers, re-discussing from the basis what the ideal characteristics should be for an instrument capable of offering diagnosis and possible local therapy at the same time.

“The idea – declares Prof. Arezzo – is to offer a system that replaces the current technology for flexible endoscopy (colonoscopy), which is actually only relatively flexible, with one that is more tolerated because it is made up of soft materials, a so-called soft -robot. This will also act as a vehicle inside the intestine for a microrobot, which, operated from the outside, will allow the removal of even large lesions in an appropriate manner in a sort of miniaturized operating room. Thanks to increasingly widespread screening programs, we expect to diagnose lesions more and more often, even if they are not small in size, but are susceptible to curative local excision, without having to resort to surgical resection of sections of the intestine. To do this, the microrobot will be equipped with newly developed sensors, capable of studying and characterizing large areas of tissue in a short time. The same sensors will be used to control the “surgical” gestures during the procedure to prevent possible errors and therefore complications, and at the same time, operating in partial autonomy, speed up the procedure itself”.

Competition for ERCs is extreme, only 8% of projects have been funded. The work presented by Prof. Arezzo is one of 37 international projects, out of a total of 395 proposals presented across Europe, including all disciplines. Synergy Grants fund teams of two to four principal investigators to jointly tackle ambitious and complex research problems that could not be addressed individually. The winning group, which includes Profs. Kaspar Althoefer (Queen Mary University of London), Bruno Siciliano (Federico II University of Naples) and Sebastien Ourselin, (King’s College London), bring together exceptional and complementary expertise to undertake pioneering research over the next 6 years to improve screening and treatment of colorectal cancer.

The group aims to revolutionize the screening and treatment of colorectal cancer through the development of an “eversion robot” with a soft sleeve structure that “unrolls” from the inside when insufflated, thus avoiding pressure and friction on the walls. The robot will be able to extend deep into the colon and sense the environment through imaging and sensing the surrounding environment using multimodal sensors. It will also act as a conduit to transfer miniaturized instruments to the remote site within the colon for diagnosis and therapy (theranostics). Current robotic devices have limited dexterity and are not suited to performing delicate tasks in remote locations, such as deep in the colon. In contrast, soft-robots demonstrate greater flexibility and adaptability in performing tasks, leading to greater safety when working around or within the human body.

Soft-robotics for diagnosis and therapy has the potential to mitigate unnecessary surgeries, increase survival rates, and improve the quality and length of life of people with colorectal cancer. To obtain translations of research in the healthcare sector it is essential to work in an interdisciplinary way and, through the international research group led by Prof. Arezzo, skills in surgery, endoscopy, movement control, artificial intelligence, sensors and robotics will be brought together to offer the best possible outcomes for patients.

“Obtaining this prestigious funding – concludes Prof. Arezzo – reflects the scientific excellence that the University of Turin represents. Prof Mario Morino’s group, of which I have the honor of being a part for many years now, and which I thank for the opportunities he has given me in recent years, is highly esteemed thanks to him in the international field, as he is a pioneer of minimally invasive techniques surgical and endoscopic. This research stems from my training in Germany at the University of Tuebingen, under Prof Gerhard Buess, inventor of transanal endoscopic microsurgery and robotic surgery, which have revolutionized our sector in recent decades. This project is only the natural evolution of the concepts that he successfully proposed 40 years ago, and that I and other students of his tried to collect after his untimely death. However, I want to conclude with an appeal to everyone to undergo screening tests for colorectal cancers as for any other pathology, because it is with prevention that the best results are achieved in the oncology field, and already today a lot can be done for many pathologies.”