A snake is probably the last thing you'd ever want crawling around your heart. But in the case of a new American-Israeli invention called the CardioARM, this medical "snake" device may one day save your life. The new Israeli-American invention came by way of some brainstorming between Israel's Dr. Alon Wolf and his American colleague Prof. Howie Choset, when Wolf was working as a researcher at Carnegie Mellon University in the US. "Both Howie and myself are experts in snake robotics," says Wolf, who is now based at the Technion-Israel Institute of Technology in Haifa. "We are working with robotic snakes for search and rescue operations. So we started in the back of our minds thinking: If we can send snakes to crawl inside buildings to look for survivors, then why can't we send the same snake inside our body to fix it?" A few weeks later, Choset and Wolf had a eureka moment, and found a way to design a robotic snake small enough, strong enough and flexible enough to fit inside the human body. They partnered with the world-renowned Italian surgeon Prof. Marco Zenati, now at the University of Pittsburgh School of Medicine, and formed Cardiorobotics and their first snake-based device, the CardioARM. A minimally invasive bypass "It cuts down the need for any 'open' surgery," Wolf says. "More and more surgery done today is done in minimally invasive ways. Tools in operation rooms are not flexible. The CardioARM is flexible enough for remote and hard to reach anatomies. The heart is a good example... now we don't have to cut the person open." The CardioARM has been used to treat the hearts of pigs, and clinical trials on human patients are expected to start this year. While robotic devices that enable specialists to perform heart operations in a minimally invasive way do exist, the technology has not been refined enough to let more than an expert perform the task. What the new CardioARM does is open up a whole new world, a field where open-heart surgeries can be done with a small incision; where recovery time will be reduced and hospital-related infections and complications due to surgery drastically cut down. Most of all, though, Wolf suspects, it will allow specialists to perform more complex medical procedures. "There are specialists and there are surgeons. In between specialists and surgeons there is a twilight zone - we are trying to bridge this zone," he says. In the United States alone, there are over one million cardiac procedures performed annually which could benefit from the CardioARM. But it will take some years before the robotic snake makes an appearance at a hospital near you. New medical devices take time until they pass through regulatory bodies in America. Conservatively speaking, it will take a few years until this new CardioARM is widely used, says Wolf, but it paves the wave for the day when doctors will never have to cut open the body during surgery. Snaking through the body like nothing else Other surgical assistants in the market have severe limitations, says the company. One, called the da Vinci system, needs five or six entry points and cannot squeeze through tight locations. "We are working to just have a single port in the body and from that point being able to reach any location," said Zenati in an interview. "There is no technology that allows one to do that. The only one is the CardioARM." Besides bypass surgeries on the heart, the CardioARM, or a modification of it, could be applied in the areas of laparoscopy, colonoscopy, and arthroscopy, say developers. Like playing a video game, the CardioArm is controlled by a joystick and gives 103 degrees of freedom, and can wrap around organs like the heart until it finds the problematic tissue. The central element of the CardioARM technology is a tele-operated probe which is highly flexible, either assuming the shape of its surroundings, or reshaped according to the surgeon's needs. As it moves through the body, it is programmed to "remember" where it was in space and time, to avoid harming delicate tissues as it retracts from any point. A working channel inside the body of the "snake" allows surgeons to pass tools to deep regions inside the body, behind organs, to reach places that were otherwise impossible to access without a scalpel and saw. A modification of the robotic arm can also make the device applicable in abdominal surgery, as well as in the mouth. The company hopes to one day allow the CardioARM to be inserted through one location, with several arms like tentacles, so each arm could operate in unison on a different part of the body. "In the future, 100 percent of the surgeries will be done in a non-invasive way," says Wolf. "Who knows when, maybe 100 or 200 years from now. Our device is one of the steps toward this and will allow surgeons to do the things they cannot do today." The original version of this article first appeared in Israel 21c.