No-hole surgery: no keyhole, yet surgeons can now still operate under your skin (2023) | Hacker News Reader

No-hole surgery: no keyhole, yet surgeons can now still operate under your skin (2023)

nibib.nih.gov

107 pointsaniijbod38 comments

I think the bigger idea behind this research, which was not mentioned, is the fact that the pointing of the the multiple beams directed by the transducer can not only be used to heat up a specific point inside the body (which in their example was an "ink" that was used for creating 3D structures well below the tissue), but the fact that this could be used for things like removal of plaques, blockages, destruction of fat/lipid cells in vivo... So things like stents and angioplasty's which are currently used to open up clogged arteries in cardiac patients to prevent heart attacks, could be done in vivo, the same way they are describing in the article, but without the need to use an "ink"... So this technology definitely has multiple uses. It could also be used to target plaques in brain tissue embedded deep in the brain to directly remove amyloid plaques to treat dementia, depression, etc patients...Obviously also used to target tumor cells anywhere inside the body without using chemotherapy/radiation.

That is interesting, but where does it come from? It's not in the OP or in the research paper, at least not in the summary, abstract, or conclusion, or in other parts I skimmed.

https://www.science.org/doi/10.1126/science.adi1563

this reminds me of Intensity-modulated radiation therapy (IMRT) - a treatment of cancer using X-ray beams.

because a single beam damages both healthy and cancer tissue alike (and goes through entire body like jedi's lightsaber), IMRT creates many many low dosage beams around the body from different angles.

As a result, most of healthy tissue that surrounds tumor gets exposed to a minimum radiation, but cancerous tissue accumulates required x-ray exposure from many small beams.

They already do this to treat some kinds of Parkinson's

https://www.youtube.com/watch?v=XNk3UF488mg

Even as just a meme, no-hole surgery and the technology that makes it possible may have sufficient potential to perform a valid service to medical research simply by sparking the imagination of students: reduced invasiveness is a time-honoured aim in surgical procedures, so taking it to the next (or ultimate) level does look like it's worth encouraging: a key question to some extent becomes one of language: do we still call it surgery when nothing constituting an incision is involved? Yes, we make a (very small) hole when we inject the 'ink', but injections are never referred to as being surgery. So if no-hole surgery is not a type of surgery, then what the heck kind of thing should we call it?

I dislike the name "ink" for a plastic or resin compound with which we are going to saturate regions of our bodies. It reminds me of George Carlin talking about euphemisms.

I suppose "ink" because it's cognate with "printing". Also maybe the tattoo connotation of putting something in / under the skin

Ok, so can we and should we try to come up with a more suitable term?

This is fascinating - but the HN headline could be more informative:

3D printing technique builds structures through tissues

would suffice.

Agreed. To clarify, the OP's own headline is:

Getting under your skin: 3D printing technique builds structures through tissues

(2023)

Yes, the original headline was actually pretty good

Here is the paper.

Xiao Kuang et al. Self-enhancing sono-inks enable deep-penetration acoustic volumetric printing. Science 382, 1148-1155 (2023)

https://www.science.org/doi/10.1126/science.adi1563

And here is downloadable version of the paper:

https://www.researchgate.net/publication/376308676_Self-enha...

> The world of medicine would be transformed

Look I know I'm being obtuse, and a Dingus, but I'm so tired of the silly hype.

It wouldn't transform the whole world of medicine. It would maybe change a small part of specific surgeries.

I've never had an implant surgery and I do take pills and other medicines daily.

It would affect implant surgeries, it would not affect my vitamin d pill.

It's got 3 minute papers vibes. What a time to be alive!!!

I've seen what appear to me to be far less deserving papers get the same kind of perhaps excessively exuberant hype, but in this case, it's not looking quite that far off the mark, IMO

Maybe this will lead to a new kind of surgery that will allow you to stop taking pills.

How? This paper is so far off from anything like that. This kind of blind optimism is part of what gets to me.

Eh, are you sure? I don't think you can say it so decisively. I am not saying it will be a direct result - but one of the steps.

Agree. For example I’ve had 3 surgeries in the last couple of years. It would not affect/improve any of them. In one, robotic surgery[1] was used but they needed to take stuff out rather than put new structures in. In the other two, keyhole surgery was used and they needed to cut/grind stuff away rather than add something new. It might well be that certain surgeries would be significantly improved but not all.

[1] https://www.intuitive.com/en-us/products-and-services/da-vin... this is the thing they used, which is a genuinely amazing gadget and reminds me of the Hokkaido mission from “Hitman”.

It will be interesting to see such techniques for normal 3d printing without support structures.

Any ideas on what that would be like?

I heard about some resin 3d printers that work inside a resin instead of open air so that they don't need support.

Could they 3D print in such a way as to make pre-fabricated joint implants a thing of the past?

I think that the nature of the thing that was needing to be implanted would determine whether it was easier and safer to use a traditional incision. Hip replacements for instance use a titanium joint. However, seeing as the bone that it is replacing was not made of titanium, somehow nature has found a way to make bone strong enough to do the job. There is an important sense in which nature 'builds things using 3D printing' and does it without needing incisions, so even if we do manage to master doing 3D printing under the skin the way we do it now to an extent where we can replace things that currently need materials that are not suited to under skin 3D printing...

I'm no topologist, but I don't think they're going to be able to place that catheter without at least one hole.

Oh theres a hole, it’s just not the one you’d think of inserting something into… rule 33 aside.

Sorry to send dense, but it says No-hole surgery. How then, is the 'ink' delivered to the right location for this to work?

My guess is through an injection. Calling a needle injection site a surgery hole is excessively pedantic. A normal person would not call a vaccine injection or a blood test "surgery."

(2023)

tldr; they use a transducer (a gun that uses focused ultrasound) to solidify a special ink (injected beforehand) which is ultrasound and temperature sensitive allowing them to create solid structures/implants of desired shape

And they used the technique to demo a mock surgery inside a heart removed from a goat (left atrial appendage closure - basically seals off a portion susceptible to blood clots).

Atrial appendage occlusions are already performed without surgery via endovascular access from the groin.

Not sure what counts as surgery for everyone here, but having my femoral artery punctured counts if a <X>ologist does it to me.

that is definitely a surgical procedure done by a surgeon.. hrm

No, it's a procedure performed by an interventional cardiologist - who is not a surgeon.

Reminds me of vasalgel for male birth control.

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