future of-surgery , a keyhole to the future
TRANSCRIPT
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Sao Paulo 2014
Innovations in surgerySameh Shehata
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Egypt
Sao Paulo 2014
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Alexandria
Sao Paulo 2014
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Alexandria
Sao Paulo 2014
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Children hosp Alexandria
Sao Paulo 2014
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EPSA
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10,011 KM
Sao Paulo 2014
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3000 years ago
Looking back !
Sao Paulo 2014
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Trepanning
Extraction of the stone of madness !
Sao Paulo 2014
Hieronymus Bosch
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Indications ?
• Epilepsy
• Mental disorders .
• Migraine
• Head trauma
Sao Paulo 2014
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the National History Museum (Lausanne, France).
Sao Paulo 2014
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• she survived the surgery !
Sao Paulo 2014
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Egypt 2345 BC
Sao Paulo 2014
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A keyhole to the future
Sao Paulo 2014
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In the future
• Incisions .
• Imaging .
• Training / simulation .
• Operating Room.
• Remote control.
Sao Paulo 2014
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In the future
• Brain machine interface
• Human Spare parts
• Anesthesia .
• Robots
Sao Paulo 2014
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Surgery and incisions !
Sao Paulo 2014
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• No surgery without incisions !!
Sao Paulo 2014
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Big surgeons,
big incisions .
Sao Paulo 2014
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Big surgeon
small multiple incisions
Sao Paulo 2014
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Big surgeon
small single incision
SILS
Sao Paulo 2014
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Big surgeon
No Incision
NOTES
Sao Paulo 2014
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Sao Paulo 2014
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Sao Paulo 2014
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Modified Endoscope for Transgastric Surgery
Courtesy of N Reddy, Hyperbad India 20005
Sao Paulo 2014
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Peroral Transgastric Endoscopic Surgery
Sao Paulo 2014
Need for development of modified accessories and endoscopes
Courtesy of N Reddy, Hyperbad India 2005
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Suture Devices
Sao Paulo 2014
Eagle ClawApollo ProjectOlympus, Tokyo.
Courtesy of N Reddy, Hyperbad India 20005
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Smart scalpel
• Lazer scalpel .• Shuts off at blood
vessels .• Smell cancer
tissue .
Sao Paulo 2014
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So What Next?
Sao Paulo 2014
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Classic Education and Examination
Sao Paulo 2014
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Sao Paulo 2014
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c. Laparoscopic Simulator with tactile feedback Courtesy Murielle Launay, Xitact, Lausanne Switzerland
b. Laparoscopic hysterectomy Courtesy Michael vanLent, ICT, Los Angeles, CA
a. LapSim simulator tasks - abstract & texture mapped Courtesy Andres Hytland, Sugical Science, Gothenburg, Sweden, 2000
SurgicalSimulators
Simulation and Objective Assessment
Sao Paulo 2014
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ENT Sinusoscopy Simulator Lockheed Martin 1999
HapticsFull System
Sao Paulo 2014
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“Red Dragon”“Blue Dragon” passive recording device
Courtesy Blake Hannaford, PhD University of Washington, Seattle
Sao Paulo 2014
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Hand motion tracking patterns Ara Darzi, MD. Imperial College, London, 2000
Novice
Intermediate
Expert
Objective Assessment
Sao Paulo 2014
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Geomagic: Practicing on Computers, Not Patients
Sao Paulo 2014
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Sao Paulo 2014
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Yale University study
• Training on simulators .
• Reduce time by 30%
• Reduce errors by 85%
Sao Paulo 2014
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The OR
Sao Paulo 2014
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Courtesy Eric LaPorte, MD Barcelona, Spain 2005Courtesy Takeo Kanade, PhD Pittsburg, PA 1999
l
“Black Box”
“Ubiquitous lights” and “Sea of Cameras”
Sao Paulo 2014
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The Operating Room of the Future
Sao Paulo 2014
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Total Integration of Surgical Care
Sao Paulo 2014 Joel Jensen, SRI International, Menlo Park, CA
Minimally Invasive Surgery
Pre-operative planning
Intra-operative navigation
Remote Surgery
Simulation & Training
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Where is my remote control ?
Sao Paulo 2014
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SATAVA 7 July, 1999DARPA
Fighter Pilots – until 2002 Fighter Pilots – Beyond 2003Predator 2003
Sao Paulo 2014
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Pilots never got into aircraft !!
Sao Paulo 2014
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How about surgeons?
Sao Paulo 2014
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Yes We Can !
• ROUTINE telesurgery from
• Hamilton to North Bay
• 300 mile distant
• Dr. Mehran Anvari, MD
• McMaster Univ, Toronto CANAD
Sao Paulo 2014Prof. Jacques Marescaux, IRCAD A
“Operation Lindberg”
First remote and trans-AtlanticTelesurgery procedure
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Recorded activity for intended movement to a briefly flashed target.
TARGET MOVEMENT
Time
PLAN
Courtesy Richard Andersen, Cal Tech, Pasadena, CA
Brain Machine Interface – Controlling motion with thoughts
Sao Paulo 2014
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Thoughts into Action
Miguel Nicholai, Duke University, 2002
Direct brain implant control of robot arm
Sao Paulo 2014
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Sao Paulo 2014
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Sao Paulo 2014
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Human spare parts !
Sao Paulo 2014
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Sao Paulo 2014
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a) Rheo Bionic knee Ossur, Reyknavik, Iceland b) C-leg Otto Bock, Minneapolis, MN
Intelligent Prostheses
Sao Paulo 2014
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Sao Paulo 2014
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Sao Paulo 2014
Artificial Retina
a) Multi-disciplinary team from USC Doheny Retinal Institute, Oak Ridge National Labs, North Carolina State University and Johns Hopkins University
Courtesy Jim Weiland, USC Doheny Retina Institute,Los Angeles, CA
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Ethical question
• Could we replace a “normal “ part
• With a better “mechanical “ one ???
Sao Paulo 2014
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Sao Paulo 2014
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Tissue Engineering
Liver Scaffolding
Artificial Blood VesselJ. Vacanti, MD MGH March, 2000
Sao Paulo 2014
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Artificial bladder
Sao Paulo 2014
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Genetic engineering
• transgenic genetic engineering .
• Extended abilities .
Sao Paulo 2014
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Can you see in the dark ?
Sao Paulo 2014
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• Who will get the advantage ?
• Enhanced individuals ??
Sao Paulo 2014
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Extending Longevity
A strain of mice that have lived . . .
. . . more than three normal lifespans
Should humans live 200 years?
Life extension
Life extension consists of attempts to extend human life beyond the natural lifespan. So far none has been proven successful in humans. Several aging mechanisms are known, and anti-aging therapies aim to correct one or more of these: Dr. Leonard Hayflick discovered that mammalian cells divide only a fixed number of times. This "Hayflick limit" was later proven to be caused by telomeres on the ends of chromosomes that shorten with each cell-division. When the telomeres are gone, the DNA can no longer be copied, and cell division ceases. In 2001, experimenters at Geron Corp. lengthened the telomeres of senescent mammalian cells by introducing telomerase to them. They then became youthful cells. Sex and some stem cells regenerate the telomeres by two mechanisms: Telomerase, and ALT (alternative lengthening of telomeres). At least one form of progeria (atypical accelerated aging) is caused by premature telomeric shortening. In 2001, research showed that naturally occurring stem cells must sometimes extend their telomeres, because some stem cells in middle-aged humans had anomalously long telomeres.
April 14, 2004
Sao Paulo 2014
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CAN I REPLACE MY
B O D Y ?
If I replace 95% of my body . . .
. . . Am I still “human”?
Artificial organs
Smart Prostheses
Genetic engineering
Regeneration
?Sao Paulo 2014
Can I replace my body ?
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What does it mean to be human ?
Sao Paulo 2014
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Any better way ?
Sao Paulo 2014
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Sep Oct Nov Dec Jan Feb Mar Apr Mayb
od
y t
em
pe
ratu
re (oC
)-5
0
5
10
15
20
25
30
35
40
45arctic ground squirrel
Brian M. Barnes, Institute of Arctic Biology , University of Alaska Fairbanks 11/02
Institute of Arctic Biology’s
Toolik Field Station,
Alaska's North Slope
SuspendedAnimation
Sao Paulo 2014
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metabolic rate 0.5 0.01 (2%)
active hibernating
body temp. 37oC -2oC
gene ongoing transcription function and translation suppressed
heart rate 300 3
resp. rate 150 <1 (breaths/min)
(beats/min)
(mlO2/g/h) Sao Paulo 2014
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Ideal situation for surgery !
• No heart beat .
• Slow circulation (bloodless surgery)
• No Pain
• No movement.
• Reversible .
Sao Paulo 2014
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Sao Paulo 2014
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Fetal surgery
Sao Paulo 2014
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Open Fetal Surgery
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EUROPEAN COLLABORATIVE PROGRAMME FOR INTRAUTERINE TREATMENT OF CDH
Fetoscopic access 26 - 27 w. gestation
SEVERE CONGENITAL DIAPHRAGMATIC HERNIA
Nose
Mouth
Intrauterin view
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SPINA BIFIDA
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Fetal Surgery OPEN SURGERY
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ROBOTS are coming !
Sao Paulo 2014
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Sao Paulo 2014
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Sao Paulo 2014
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“Penelope” – robotic scrub nurse
Michael Treat MD, Columbia Univ, NYC. 2003Sao Paulo 2014
Robotic Nurse
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I prefer classical !
Sao Paulo 2014
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Robotic Medical Assistant
Sao Paulo 2014 SATAVA 7 July, 1999DARPA
Nursing shortage crisis
Applicable at all levelsHospitalsClinicsNursing HomeAssisted living
Courtesy Yulun Wang, InTouch Technologies, Inc, Goleta, CA
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I see you !
Sao Paulo 2014
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………………………………………………………………………………………………………………………………………
……….
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Sao Paulo 2014
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Sao Paulo 2014
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Sao Paulo 2014
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To all of you
Sao Paulo 2014
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Sao Paulo 2014