Surgical Robotics: Future Technologies

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Surgical Robotics Future Technologies

• Victoria University
• August 2009
• Catherine Mohr, MD MSME
• Director, Medical Research
• Intuitive Surgical, Inc.

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• Innovation

The first transistor out of Bell Labs Dec 16,
1947
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• Innovation

The first headlamp used in surgery with Cushing
at Harvard (1930)
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• Innovation

The first da Vinci setup joint (1996)
Will this be the beginning? the end? just a
step along the way? How do you know?
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• Industrial Telepresence

Nuclear Telemanipulation Master-slave
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• Military Telepresence

Various mechanisms developed to both track
movement and reflect forces (FREFLEX 1994)
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• Early Surgical Robotics

Started with fixturing and cutting
PROBOT TURP 1984
Minerva neurosurgery 1985
RoboDoc hip replacement 1995
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• Growth of Surgical Robotics

• Numerous variations over the years both
  commercial and academic
• Computer Motion laparoscopy
• Image Guide CT needle guidance
• Microdexterity ophthamology
• StereoTaxis interventional catheter
• Hansen Medical interventional catheter
• NeoGuide colonoscopy
• Cardiorobotics epicardial arrythmia
• Toshiba/Terumo laparoscopy
• DLR/Brainlab/Kuka - spine
• Hitachi neurosurgery
• Mazor spine
• Mako Surgical knee replacement
• Armstrong Medical various

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• History of da Vinci

• Late 80s, DARPA funded a remote surgery program
  targeted for the battlefield
• SRI developed early technology around
  telepresence
• IBM developed remote center technology
• MIT developed cable-driven technology for low
  friction manipulators
• Intuitive licensed these technologies and started
  the long process of turning good ideas into a
  product

MIT
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The technology today
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So Where is the Next Innovation?

• In development
• Advanced instrumentation
• Energy
• Articulated stapling
• NIR vision
• Integrating Ultrasound

• Mid term (2-4 years)
• Image guidance?
• Haptics?
• NOTES?
• Focal therapy?

• Near Term (1-2 years)
• New robotic architectures
• Single-port
• Highly integrated
• Networking/telementoring
• Simulation

• Future (8 years)
• Automation?
• Procedure specific robots?

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Instruments

• Today
• Monopolar
• Bipolar
• RF
• Harmonic scalpel

• Tomorrow
• Laser
• Articulated stapling
• Plasma
• Powered Instruments

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Augmented Vision
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Intra-operative Imaging Ultrasound
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Telementoring/ Remote Proctoring
REMOTE PROCTOR INTERFACE
TILEPRO VIEW IN SURGEON CONSOLE
View sent to OR
Audio/video
INTERNET
Image files, video clips and Telestration
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Local Mentoring - Dual Console
Drivers Ed version of robotics where surgeons
can pass control back and forth or work
collaboratively
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Augmenting Vision

• Courtesy Blank Childrens Hospital

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Integrating Pre-op Information

• Augment the 3D visual field with real-time
  information that will improve patient and surgeon
  value
• High resolution pre-op images
• Intra-operative imaging
• Navigation

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Haptics

• Adding the sense of touch to the robot
• Question of what is surgically relevant
• Sensing differences - texture
• Resolving absolute forces

• Two problems to solve
• Sensing forces at a level that is surgically
  relevant
• Displaying forces that are easily integrated into
  surgery
• Feasibility shown in a lab setting with
  sensitivity in the range of 20 grams
• Robustness, cost, sterilizability, etc.

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Robotic Architectures

• Single Port
• Give da Vinci like performance through a single
  incision
• True multi-quadrant access
• Perhaps enable flexible devices for NOTES

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Robotic Architectures
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Robotic Architectures - NOTES robots
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Robotic Architectures - Microsurgical Robotics
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Microsuturing Results
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Further in the Future?

• How much of surgery will be automated and
  pre-planned at a workstation?
• What role will telesurgery play in global
  healthcare?
• How will we train young surgeons?
• Will we be able to guarantee outcomes?
• How will surgical robotics play with other
  emerging healthcare technologies?

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Surgical Robotics A Central Role
Tele-Mentoring
Tele-operation
Simulation
Pre-op Planning
Augmented Reality
Connectivity
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Questions?

• Taking surgical precision and technique beyond
  the limits of the human hand