advances in telesurgery and surgical robotics
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- 1. Advances in Telesurgery and Surgical Robotics Dr Sanjoy Sanyal MBBS, MS (Surgery), ADPHA, ADHRD Presented at 9 thNational Medical Dental Conference in Seychelles, February 2006
2. Preface (added 2009)
- This PPT represents developments in the field during late 90s and early 2000s, in:
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- Stanford University School of Medicine
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- University of California Berkeley (UCB)
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- UC San Francisco (UCSF)
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- Massachusetts Inst. of Technology (MIT)
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- Escort Heart Institute Research Centre (EHIRC), New Delhi, India
- Telesurgery / surgical robotics has advanced considerably now.
3. The research pioneers
- Stanford Research Institute (SRI) @ Stanford University School of Medicine
- Human Machine Systems Lab (HMSL) @ MIT
- Robotic Intelligent Machines Laboratory (RIML)@ UC Berkeley
- Robotic Telesurgical Workstation for Laparoscopy (RTWL) @ UCSF
4. Worlds first telesurgery
- September 2001 : Tele- chole
- Prof Jacques Marescaux , New York & European Institute of Telesurgery, Strasbourg
- Round distance =14,000 km
- Round Trip Time= 200 msec; video and hi-speed fibre-optic link
- June 2001 : Johns Hopkins University, Baltimore & Rome Policlinico Casilino University
- http://news.bbc.co.uk/2/hi/science/nature/1552211.stm
5. Background
- Traditional surgery
- Tri-dimensional
- Cognitive input
- Tactile feedback
- Stereoscopic vision with depth perception
- Time lag -ve
- Telesurgery
- Two-dimensional
- Cognitive feedback limited
- Tactile feedback ve
- Binocular vision without depth perception
- Time lag +ve
6. Definitions
- Telepresence surgery : Computerized interface @ surgical workstationremote operative site; force feedback (haptic)
- Cooperative telesurgery : tele-surgeon / local (remote) assistant cooperation
- http://www2.telemedtoday.com/articles/telesurgery.shtml
- http:// web.mit.edu/hmsl/www/Telesurgery /
7. Definitions contd
- Telerobotics : Remote control with a robotic arm, in conjunction with a laparoscope
- http://www2.telemedtoday.com/articles/telesurgery.shtml
8. Definitions contd
- Telementoring : Experienced surgeon acts as tutor / instructor ( preceptor ) for remote surgeon via interactive video
- Teleproctoring( proctor=supervisor of exams ): Documentation of performance for privileging purposes
- http://www2.telemedtoday.com/articles/telesurgery.shtml
9. Technical aspects
- Image transmission : T1 transmission (H-320 compression standard)
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- Fibre-optic cable
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- Microwave
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- Satellite
- Lag time : should be 1mm
- Haptic : Force feedback
10. Haptic
- Force reflection / feedback; Graduated tactile input
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- resistance at remote site is transmitted to near site by servo motors @ both sites
11. Robotic vs. human arm
- DOF : Number of ways an arm can move
- Human arm : 7-DOF
- Human hand : >20-DOF
- Robotic arm : Like human hand, arm and moveable elbow - butwith a fused wrist
- Robotic arm : 4-6 DOF
12. Telesurg dynamics @ MIT
- Surgeons fingers placed in rings of instruments
- Rings are connected tomotors ,gearsandbelts
- Precisely translate surgeons hand / finger motions into digital signals
- Transmitted through computer- telecomm link
- To robotic arms @ remote surgical station
- Visual input : 2 remote CCD cameras (15 fps each-> 3-D effect )-> Surgeons monitor -> Mirror -> Optical3-D glasses (stereoscopic vision)
http:// web.mit.edu/hmsl/www/Telesurgery 13. Telesurg components @ MIT 14. Surgeons master tool handle @ MIT 15. Surgeons master tool handle @ MIT 16. Master phantom haptic interface arm 17. Slave phantom haptic interface arm 18. Tele-operation slave tool 19. Tele-operation slave tool 20. Tele-operational details Tool 21. Tele-operational details Interchangeable tool tips 22. Experimental task - grasp / transfer 23. Experimental task - Grasp and transfer with orientation 24. Experimental task - Clip application 25. Experimental task grasper / gripper and shear / scissors 26. Lap experiment box @ MIT 27. Lap simulator-1 @ MIT 28. Lap simulator-2 @ MIT 29. Dynamics of robotics @ UC
- Surgeon remote location TV console set of handheld controls ~ videogame joysticks
- Joystick :Pencil-sized; 1 for each hand
- Computer : Program translates surgeons movements
- End-effectors : Robotic instruments enter body to perform actual operation
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- Early models : 3-fingered hand
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- Present : Hydraulic-powered, single-digit, 3-4 x , 4-jointed (rotate, swivel, to-fro), 2-pronged end grasper
- Anthropomorphicmovements
http:// robotics.eecs.berkeley.edu /medical/ 30. Details of robots
- Robo-doc : 2 robots working in concert
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- Holding robots
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- Companion robots / milli-robots / robotic manipulators
31. Holding robots
- Pair of large robotic arms
- Hydraulic-actuated
- Sits on moveable platform
- Driven remotely by surgeons joysticks
- Performs like a surgeons shoulder, allowing positioning of its hydraulic arms
32. Holding robots contd
- Holds 2 ndrobot, wheels instruments into position by patients side
- Guides them through dexterity-requiring surgical procedures (suturing, dissection)
- Holds instruments steady while surgeon sutures and ties knots
33. Companion / Milli-robots / Robotic manipulators
- Sterile, disposable, steel, mm-scale, fingertip-sized
- Slender, jointed, finger-like tools
- Connected by wires and tubes to larger robot
- Pair of gripping forceps at one end to carry surgical tools
- Contains miniscule video-camera
34. Companion robot contd
- Inserted into body for actual surgical tasks (cutting, suturing) 10-20 mm incisions
- Inserts cameras
- Provide tactile feedback though force-deflecting joysticks
- Provides 7 DOF
35. Setup @ UC Berkeley 36. Equipment @ UCB 37. Robotic manipulator @ UCB 38. Mini robot controls @ UCB Roll-pitch-roll wrist, gripper and multi-fingered manipulators 39. Robotic endo-manipulator Endo-platform with biopsy forceps 40. Minute threading 41. Threaded robotic instruments knot tying 42. 2-G RTWL @ UCSF In a joint project betweenRIMLofUCBandDepartment of SurgeryofUniversity of California San Francisco( UCSF ), aRobotic Telesurgical Workstation for Laparoscopy (RTWL) was developed 43. Lap interface @ UCSF 44. 4-DOF lap haptic interface 45. Robotic Cardiac Surgery @ EHIRC
- Escort Heart Inst. Research Centre in New Delhi, India
- Implemented da Vinci Tele-manipulationsystem
- Intuitive Surgical Inc., Mountain View, CA, USA
- Computer enhanced system
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- Surgeons console
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- Cart-mounted robotic manipulators
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- http://www.ehirc.com/individuals/services/treatment/robotic_surgery.html#
46. Surgeons console @ EHIRC
- Display system : 3-D pictures of chest cavity
- Surgeonsits at console and gets 3-D view of chest interior
- Hand motions are captured, transformed and transmitted to tiny robotic manipulators
47. Robotic manipulators @ EHIRC
- Robot is not autonomous; surgeon-controlled
- Hold tiny instruments, which go inside the patient's chest.
- Surgeon's hand movements transmitted to these instruments
- CABG, mitral valve repair, ASD closure
48. IMA LAD CABG 49. Totally endoscopic CABG
- Advantages
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- Only 3-incisions, each 1 cm on the side and lower chest
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- Less pain
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- Faster healing and recovery
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- Short hospital stay
50. Technical innovations
- Teletactation (Tactile feedback)
- CyberGlove with CyberTouch
- Dextrous master glove
- Spatial cognition Hand assist
- Surgical simulations / Virtual reality
- Dextrous mini-robots
51. Teletactation Tactile feedback
- Sensing tactile information throughtactile sensorsthat transmit feel of tissue to surgeons finger
52. CyberTouch CyberGlove
- Vibro-tactile, thermal simulators on eachfingerandpalm
- Tactile feedback optionenables feelof virtual object
53. CyberGlove
- Flexible sensorsmeasure position/movementoffingersandwrist
54. Dextrous master glove
- Thumb ,index ,wristflexion sensors and wrist rotation sensor
- Senses positionsof surgeon's fingers/wrist
- Used as master to drive slave robotic hand
55. Spatial cognition Hand assist in telesurgery Non-dominant hand in-vivo possibly enhances spatial skills through tactile cues, which generate a more accurate 3-D representation of anatomy 56. Lap chole simulation Simulated fat and fascia Dissected away; cystic duct clipped 57. Lap chole simulation contd Cystic artery and duct divided successfully in simulated conditions 58. Karlsruhe Gynec endo surgery simulations 59. Gynec surgery simulations contd http://www- kismet.iai.fzk.de/VRTRAIN/phD_main.html http://www- kismet.iai.fzk.de/VRTRAIN/GIF/PHD/surgSim.jpg 60. Dextrous mini robots
- 1 Camera attachment
- 2 Equipped with a needle for biopsy
- 3 Moves around abdominal cavity spiral pattern moves without slipping
- http://news.bbc.co.uk/1/hi/health/4647258.stm
61. Summary
- Technically demanding, labor intensive, time consuming, expensive research
- Learning curve with similar characteristics
- Expensive installation, maintenance and infrastructure
62. Future applications
- Emergency trauma care
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- 1 stGolden Hour
- Battlefield surgery
- Remote area assistance
- One-to-many telementoring
- Space station surgery
63. Cutting edge research today, surgical technology tomorrow 64. Conclusion
- Science knows no country, because knowledge belongs to humanity, and is the torch which illuminates the world . Louis Pasteur
- Don't be afraid to take a big step. You can't cross a chasm in two small jumps .
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- David Lloyd George
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