Elsevier

Journal of Surgical Education

Volume 65, Issue 2, March–April 2008, Pages 155-161
Journal of Surgical Education

Review
For the Surgeon: An Introduction to Nanotechnology

https://doi.org/10.1016/j.jsurg.2007.11.006Get rights and content

Background

The study and application of nanoparticles is advancing rapidly within medicine and surgery. In this article, we review nanotechnology with a view as to its impact on surgery. We also review potential toxicity, current regulations, and ethical considerations.

Data Sources

A Medline review of nanotechnology and nanosurgery was performed. Important publications in the history of the science and demonstrated important concepts were selected for review.

Conclusion

Nanotechnology is a relatively new but fast evolving field. Its potential impact on medicine and surgery is expanding in areas from drug delivery to rudimentary nanosurgery at the cellular level. This review is written to give the surgeon an overview of the field particularly in reference to its potential surgical applications.

Introduction

With all of the intense work going on in all of the fields of nanoscience, it is easy to forget that one of the earliest visions in terms of the applications for nanotechnology was surgery. On December 29, 1959, Richard Feynman, the late preeminent physicist (Nobel Prize for Physics 1965), gave a talk at the annual meeting of the American Physical Society at the California Institute of Technology. This talk was remarkably prescient. In his speech, entitled “There's Plenty of Room at the Bottom, An Invitation to Enter a New Field of Physics,” he proposed employing “machine tools to make smaller machine tools, these in turn to be used in making still smaller machine tools and so on all the way down to the atomic level.” This discussion was the earliest vision of nanotechnology.

He credited a friend, Albert R. Hibbs, with the idea that they both thought of as “wild” at the time but that he proposed during that historic talk:

It would be very interesting in surgery  if you could swallow the surgeon. You could put the little mechanical surgeon inside the blood vessel and he goes into the heart and looks around (of course the information has to be fed out). He finds out which valve is the faulty one and slices it out. Other small machines may be permanently incorporated into the body to assist some inadequately functioning organ.

Feynman raised the question and encouraged the vision of the “manufacture of an object that can maneuver at the level of biological cells.”1 He freely admitted not knowing exactly how these objects would be achieved, but he put forward suggestions and his vision was, nonetheless, remarkable.

From an historical point of view, the first mention of nanotechnology was by J. C. Maxwell in 1867, when he proposed, as a thought experiment, a tiny entity that could handle individual molecules. A catalyst for the development of the modern field of nanoscience and technology was the discovery of particles smaller than the atom: subatomic particles. The work of G. J. Stoney and J. J. Thompson led to the discovery of electrons and to the development of the field of particle physics. This work led to enquiry into the nature and substance of small particles. In the 1920s, Irving Langmuir introduced the concept of a monolayer, which is a layer of material 1 molecule thick. Over the next half century, the development of various scanning microscopes enabled visualization and even manipulation of nanosized structures.

Section snippets

Overview

Today, broadly defined, nanotechnology refers to technological study and application involving nanoparticles. The term “nanotechnology” was first used by Taniguchi et al in 19742; they defined it as the processing, separation, consolidation, and deformation of materials by 1 atom or by 1 molecule. Drexler then popularized the field of nanotechnology by publishing 2 of the earliest books on the field: Engines of Creation: The Coming Era of Nanotechnology and Nanosystems and Molecular Machinery,

Classification

No standard classification exists, but most particles can be grouped into 1 of 2 major types, depending on the core material.5

Nanodevices

Two general approaches exist to creating nanodevices.6 These approaches are referred to as the “bottom-up method” and the “top-down method.”

General Applications

Applications are wide ranging, from imaging, where nanoparticles serve as contrast agents and fluorescent dyes, to biosensors and assays. Nanoscale devices have been used to study and create artificial molecular receptors.

One major area of application is drug delivery. The aim of the application of new science to the field of drug delivery is to improve contact between the drug and its target, which enables increased efficiency by the drug in order to combat the disease state adequately. A

Implantable Devices

With the advent of the flexibility that nanotechnology offers have come numerous implantable devices, which range from blood-pressure sensors to insulin pumps and intracranial devices. Biomimicry, or biomimetics, is the process of using the way in which nature successfully produces something to create a man-made material. For example, nanopatterned polymer scaffolds that mimic the way in which minerals are deposited are used to make bone and teeth implants. Most implantable devices, by

Future Potential Applications: Nanosurgery

Nanosurgery is a possible future application of nanoscience, with research still in the vey early stages. However, the rudimentary tools are already here.

Nanorobotics

Here is a futuristic potential application of nanoscience. These robots could operate independently or under direction within the human body, monitoring, and healing diseases.

Safety Concerns

To paraphrase Kipen, “Smaller is not always better: Nanotechnology yields nano-toxicity.”25

Regulation

Both the Food and Drug Administration (FDA) and the European Commission Health & Consumer Protection Directorate's expert body, the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) stress that conventional toxicological and ecotoxicological test methods may not suffice for nanoparticle characterization and that modifications to standard test designs may be needed. Need for additional research on the distribution and persistence of nanoparticles in the human organism

Ethical Considerations

“O brave new World, that has such people in't, let us start at once.”36, 37

As the promise of nanotechnology encourages us to aim toward scientific achievement that was unimaginable 50 years ago, as with all new technologies, the issue of what is ethical is raised again.

Lenk et al38 identified four main areas of ethical concern:

  • 1

    Risk assessment in medical research, diagnosis, and therapy.

  • 2

    Questions of personal and human identity; for example, surgery at the cellular level that alters DNA might

Conclusions

The application of nanotechnology to our current age has a long and illustrious history behind it, with contributions from many great minds. The potential applications are breathtaking and exciting, particularly as they pertain to medicine and surgery. As things currently stand, there is still a long way to go: This is a science that is still in its infancy, and more research is needed to harness fully the possibilities as well as to understand and prevent the potential for nanotoxicity.

References (38)

  • L. Chen-Zhong et al.

    Fluorescence properties of gold nanorods and their application for DNA biosensing

    Chem Commun

    (2005)
  • P. Pathak et al.

    Multifunctional nanoparticles and their role in cancer drug delivery—A review

    J Nanotech On

    (2007)
  • N.C. Seeman

    Nanoscale assembly and manipulation of branched DNA: a biological starting point for nanotechnology

  • R. Singh

    Binding and condensation of plasmid DNA onto functionalized carbon nanotubes: toward the construction of nanotube-based gene delivery vectors

    J Am Chem Soc

    (2005)
  • B. Klajnert et al.

    Dendrimers: properties and application

    Acta Biochimica Polonica

    (2001)
  • L.R. Hirsch et al.

    Nanoshell mediated near infrared thermal therapy of tumors under magnetic resonance guidance

    Proc Natl Acad Sci U S A

    (2003)
  • S. Rae et al.

    Manchester, Systemic trafficking of plant virus nanoparticles in mice via the oral route

    Virology

    (2005)
  • J.H. Kim et al.

    Relaxin expression from tumor-targeting adenoviruses and its intratumoral spread, apoptosis induction, and efficacy

    J Natl Cancer Inst

    (2006)
  • E. Tanaka et al.

    3Image-Guided oncologic surgery using invisible light: completed pre-clinical development for sentinel lymph node mapping

    Ann Surg Oncol

    (2006)
  • Cited by (24)

    • Structural insights into the binding behavior of NiO with myoglobin

      2022, Journal of Molecular Liquids
      Citation Excerpt :

      Some materials are reactive at the nanoscale while they are considered as inert materials on a larger scale. The second reason is the emergence of quantum effects at this scale, which alter the electrical, optical, and magnetic properties of the material [5]. Over the few recent decades, extensive research has been conducted on the interactions of nanoparticles with cells and biomolecules such as proteins and DNA to achieve therapeutic benefits and practical information in biotechnology and biomedicine.

    • Nanotechnology in Urology

      2009, Urologic Clinics of North America
    • Multi-morphological biodegradable PLGE nanoparticles and their drug release behavior

      2009, Biomaterials
      Citation Excerpt :

      Considering bio-safety is one of the most important requisite for each medical device, including medical applied NPs, it is urgent to develop bio-safe NPs. However, although many different morphological NPs had been fabricated and tried to apply in bio-medical fields, the potential bio-safety problems still exist since most of them had been fabricated by metals [8,9,12], metallic oxides [10], inorganic materials [14] and non-biodegradable polymers [17–20]. Potentially harmful NPs may therefore be deposited permanently in the tissues of the body, with possible translocation to major organs, thus limiting the medical uses of such materials.

    View all citing articles on Scopus
    View full text