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Nanotechnology, Nanomedicine and Nanosurgery
The ability to build complex diamondoid medical nanorobots to molecular precision, and then to build them cheaply enough in sufficiently large numbers to be useful therapeutically, will revolutionize the practice of medicine and surgery.
Originally published in International Journal of Surgery
(2005). Reprinted with permission on KurzweilAI.net February
13, 2006.
An exciting revolution in health care and medical technology looms
large on the horizon. Yet the agents of change will be microscopically
small, future products of a new discipline known as nanotechnology.
Nanotechnology is the engineering of molecularly precise structures—typically
0.1 microns or smaller—and, ultimately, molecular machines.
Nanomedicine1-4 is the application of nanotechnology
to medicine. It is the preservation and improvement of human health,
using molecular tools and molecular knowledge of the human body.
Present-day nanomedicine exploits carefully structured nanoparticles
such as dendrimers,5 carbon fullerenes (buckyballs)6
and nanoshells7 to target specific tissues and organs.
These nanoparticles may serve as diagnostic and therapeutic antiviral,
antitumor or anticancer agents. But as this technology matures in
the years ahead, complex nanodevices and even nanorobots will be
fabricated, first of biological materials but later using more durable
materials such as diamond to achieve the most powerful results.
Early Vision
Can it be that someday nanorobots
will be able to travel through the body searching out and clearing
up diseases, such as an arterial atheromatous plaque?8
The first and most famous scientist to voice this possibility
was the late Nobel physicist Richard P. Feynman. In his remarkably
prescient 1959 talk “There’s Plenty of Room at the Bottom,” Feynman
proposed employing machine tools to make smaller machine tools,
these to be used in turn to make still smaller machine tools, and
so on all the way down to the atomic level, noting that this is
“a development which I think cannot be avoided.”9
Feynman
was clearly aware of the potential medical applications of this
new technology. He offered the first known proposal for a
nanorobotic surgical procedure to cure heart disease: “A friend
of mine (Albert R. Hibbs) suggests a very interesting possibility
for relatively small machines. He says that, although it is a very
wild idea, it would be interesting in surgery if you could swallow
the surgeon. You put the mechanical surgeon inside the blood vessel
and it goes into the heart and looks around. (Of course the information
has to be fed out.) It finds out which valve is the faulty one and
takes a little knife and slices it out. ...[Imagine] that we can
manufacture an object that maneuvers at that level!... Other small
machines might be permanently incorporated in the body to assist
some inadequately functioning organ.”9
Medical Microrobotics
There
are ongoing attempts to build microrobots for in vivo medical
use. In 2002, Ishiyama et al at Tohoku University developed tiny magnetically-driven
spinning screws intended to swim along veins and carry drugs to
infected tissues or even to burrow into tumors and kill them with
heat.10 In 2003, the “MR-Sub” project of Martel’s
group at the NanoRobotics Laboratory of Ecole Polytechnique in Montreal
tested using variable MRI magnetic fields to generate forces on
an untethered microrobot containing ferromagnetic particles, developing
sufficient propulsive power to direct the small device through the
human body.11 Brad Nelson’s team at the Swiss Federal Institute of Technology in
Zurich continued this approach. In 2005 they reported the
fabrication of a microscopic robot small enough (~200 microns) to be injected into the body through a syringe.
They hope this device or its descendants might someday be
used to deliver drugs or perform minimally invasive eye surgery.12
Nelson’s simple microrobot has successfully maneuvered through a
watery maze using external energy from magnetic fields, with different
frequencies able to vibrate different mechanical parts on the device
to maintain selective control of different functions. Gordon’s group
at the University of Manitoba has also proposed magnetically-controlled
“cytobots” and “karyobots” for performing wireless intracellular
and intranuclear surgery.13
Manufacturing
Medical Nanorobots
The greatest
power of nanomedicine will emerge, perhaps in the 2020s, when we
can design and construct complete artificial nanorobots using rigid
diamondoid nanometer-scale parts like molecular gears and bearings.14
These nanorobots will possess a full panoply of autonomous
subsystems including onboard sensors, motors, manipulators, power
supplies, and molecular computers. But getting all these nanoscale
components to spontaneously self-assemble in the right sequence
will prove increasingly difficult as machine structures become more
complex. Making complex nanorobotic systems requires manufacturing
techniques that can build a molecular structure by what is called
positional assembly. This will involve picking and placing molecular
parts one by one, moving them along controlled trajectories much
like the robot arms that manufacture cars on automobile assembly
lines. The procedure is then repeated over and over with all the
different parts until the final product, such as a medical nanorobot,
is fully assembled.
The positional assembly of diamondoid
structures, some almost atom by atom, using molecular feedstock
has been examined theoretically14,15 via computational
models of diamond mechanosynthesis (DMS). DMS is the controlled
addition of carbon atoms to the growth surface of a diamond crystal
lattice in a vacuum manufacturing environment. Covalent chemical
bonds are formed one by one as the result of positionally constrained
mechanical forces applied at the tip of a scanning probe microscope
apparatus, following a programmed sequence. Mechanosynthesis using
silicon atoms was first achieved experimentally in 2003.16
Carbon atoms should not be far behind.17
To be practical, molecular manufacturing
must also be able to assemble very large numbers of medical nanorobots
very quickly. Approaches under consideration include using
replicative manufacturing systems or massively parallel fabrication,
employing large arrays of scanning probe tips all building similar
diamondoid product structures in unison.18
For example, simple mechanical
ciliary arrays consisting of 10,000 independent microactuators on
a 1 cm2 chip have been made at the Cornell National Nanofabrication
Laboratory for microscale parts transport applications, and similarly
at IBM for mechanical data storage applications.19 Active
probe arrays of 10,000 independently-actuated microscope tips have
been developed by Mirkin’s group at Northwestern University for
dip-pen nanolithography20 using DNA-based “ink”. Almost
any desired 2D shape can be drawn using 10 tips in concert. Another
microcantilever array manufactured by Protiveris Corp. has millions
of interdigitated cantilevers on a single chip. Martel’s group has
investigated using fleets of independently mobile wireless instrumented
microrobot manipulators called NanoWalkers to collectively form
a nanofactory system that might be used for positional manufacturing
operations.21 Zyvex
Corp of Richardson TX has a $25 million, five-year, National
Institute of Standards and Technology (NIST) contract to develop
prototype microscale assemblers using microelectromechanical systems.
This research may eventually lead to prototype nanoscale assemblers
using nanoelectromechanical systems.
Respirocytes and Microbivores
The ability to build complex
diamondoid medical nanorobots to molecular precision, and then to
build them cheaply enough in sufficiently large numbers to be useful
therapeutically, will revolutionize the practice of medicine and surgery.1
The first theoretical design study of a complete medical nanorobot
ever published in a peer-reviewed journal (in 1998) described a hypothetical
artificial mechanical red blood
cell or “respirocyte” made of 18 billion precisely arranged structural atoms.22 The
respirocyte is a bloodborne spherical 1-micron diamondoid 1000-atmosphere
pressure vessel with reversible molecule-selective surface pumps powered
by endogenous serum glucose. This nanorobot would deliver 236
times more oxygen to body tissues per unit volume than natural red
cells and would manage carbonic acidity, controlled by gas concentration sensors and
an onboard nanocomputer.
A 5 cc therapeutic
dose of 50% respirocyte saline suspension containing 5 trillion nanorobots
could exactly replace the gas carrying capacity of the patient’s entire
5.4 liters of blood. Nanorobotic
artificial phagocytes called “microbivores” could patrol the bloodstream,
seeking out and digesting unwanted pathogens including bacteria, viruses,
or fungi.23 Microbivores would achieve complete
clearance of even the most severe septicemic infections in hours or
less. This is far better than the weeks or months needed for antibiotic-assisted
natural phagocytic defenses. The nanorobots don’t increase the risk
of sepsis or septic shock because the pathogens are completely digested
into harmless sugars, amino acids and the like, which are the only
effluents from the nanorobot.
Surgical Nanorobotics
Surgical nanorobots could be introduced into the body through the
vascular system or at the ends of catheters into various vessels and
other cavities in the human body. A surgical nanorobot, programmed
or guided by a human surgeon, could act as an semi-autonomous on-site
surgeon inside the human body. Such a device could perform various
functions such as searching for pathology and then diagnosing and
correcting lesions by nanomanipulation, coordinated by an on-board
computer while maintaining contact with the supervising surgeon via
coded ultrasound signals. The earliest forms of cellular nanosurgery
are already being explored today. For example, a
rapidly vibrating (100 Hz) micropipette with a <1 micron tip diameter
has been used to completely cut dendrites from single neurons without
damaging cell viability.24 Axotomy of roundworm
neurons was performed by femtosecond
laser surgery, after which the axons functionally regenerated.25
A femtolaser acts like a pair of “nano-scissors” by vaporizing
tissue locally while leaving adjacent tissue unharmed. Femtolaser
surgery has performed: (1) localized nanosurgical ablation of focal
adhesions adjoining live mammalian epithelial cells,26
(2) microtubule dissection inside yeast cells,27 (3) noninvasive
intratissue nanodissection of plant cell walls and selective destruction
of intracellular single plastids or selected parts of them,28
and even (4) the nanosurgery of individual chromosomes (selectively
knocking out genomic nanometer-sized regions within the nucleus of
living Chinese hamster ovary cells29). These procedures
don’t kill the cells upon which the nanosurgery was performed. Atomic
force microscopes have also been used for bacterium cell wall dissection
in situ in aqueous solution, with 26 nm thick twisted strands
revealed inside the cell wall after mechanically peeling back large
patches of the outer cell wall.30 Future
nanorobots equipped with operating instruments and mobility will be
able to perform precise and refined intracellular surgeries which
are beyond the capabilities of direct manipulation by the human hand.
We envision biocompatible31 surgical nanorobots that can
find and eliminate isolated cancerous cells, remove microvascular
obstructions and recondition vascular endothelial cells, perform “noninvasive”
tissue and organ transplants, conduct molecular repairs on traumatized
extracellular and intracellular structures, and even exchange new
whole chromosomes for old ones inside individual living human cells.
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