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Medical Robotics

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Medical Robotics History, current and future applications Existing surgical systems(6) Da Vinci Surgical system by Intuitive Surgical, Inc. Surgical Console - 3D ... – PowerPoint PPT presentation

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Title: Medical Robotics


1
Medical Robotics
  • History, current and future applications

2
Overview
  • Introduction
  • Classification
  • Application of Medical Robotics
  • Design of Robotic Telesurgery
  • Historic Companies and Systems
  • Existing surgical systems
  • Strengths and Limitations
  • Ethical and Safety Considerations
  • Challenges, Future and Conclusion

3
Introduction(1)
  • Definition Robotic systems for surgery
  • There are computer-integrated surgery (CIS)
    systems first, and medical robots second. The
    robot itself is just one element of a larger
    system designed to assist a surgeon in carrying
    out a surgical procedure.. Taylor, 2003

4
Introduction(2)
  • CIS
  • Information flow in CIS

5
Introduction(3)
  • Motivation
  • Started with the weaknesses and strengths of
    minimally invasive surgery (MIS)
  • Smaller incisions, shorter post-operative time,
    reduced infection, faster rehabilitation, lesser
    pain, better cosmetics, ...
  • Eye-hand coordination, difficulty in moving arms,
    degree of motion

6
Introduction(4)
  • MIS
  • Minimally invasive surgery uses techniques of
    surgical access and exposure that significantly
    reduce trauma to the body compared to traditional
    incisions.

7
Classification
  • Depending on the degree of surgeon interaction
    during the procedure
  • Supervisory-controlled
  • Telesurgical
  • Shared-control

8
Application of Medical Robotics(1)
  • Laboratory Robots
  • For pre-programmed tasks
  • High repetitions
  • Perform multiple-tests in parallel
  • Manufacturers include, Thermo Electron Corp,
    Hamilton Co, Central Research Laboratories (CRL),
    A Dover Diversified Co etc.

9
Application of Medical Robotics(2)
  • Telesurgery
  • Surgeon sits at a console
  • Has controls to move the robotic arms
  • Does not operate on the patient directly
  • Mainly used in minimally invasive surgeries

10
Application of Medical Robotics(3)
  • Surgical Training
  • Robots used as surgical training simulators
  • Used for medical resident students
  • Residents lack expertise and this helps in
    avoiding legal, social and economic problems
  • The Second Generation Robotic Telesurgical System
    for Laparoscopy during tests in the Experimental
    Surgery Lab at UC San Francisco

11
Application of Medical Robotics(4)
  • Telemedicine and Teleconsultation
  • Telecommunciation channels to communicate with
    other physicians/patients
  • Control an external camera which in turn controls
    an endoscopic camera used to share images with
    a remote surgeon

12
Application of Medical Robotics(5)
  • Rehabilitation
  • Assistive robots
  • Wheelchair with intelligent navigational control
    system

13
Application of Medical Robotics(6)
  • Remote surgery
  • Surgeon can be anywhere in the world
  • Remotely controls the robotic surgical system
  • Very useful for treating wounded people in
    battlefields

14
Application of Medical Robotics(7)
  • Laparoscopic Surgery
  • Performed in the abdominal cavity using MIS
  • Abdomen cavity is expanded using CO2
  • Uses Laparoscopic instrument
  • Fiber optic channels to illuminate the inside of
    abdominal cavity
  • Lens optics to transmit image
  • CCD camera at the outer end
  • Image displayed on high resolution TV

15
Application of Medical Robotics(8)
  • Laparoscopic Surgery
  • Traditional laparoscope instruments have
    limitations
  • Has 4 DOFs - Arbitrary orientation of instrument
    tip not possible
  • Reduction in dexterity
  • Reduction in motion reversal due to fulcrum at
    entry point
  • Friction at air tight trocar reduction in force
    feedback
  • Lack of tactile sensing

16
Design of Robotic Telesurgery(1)
  • Minimally Invasive Surgery
  • Surgery performed by making small incisions lt
    10mm dia
  • Reduces post-operative pain and hospital stays
  • Form of telemanipulation
  • Instruments have a camera attached to transmit
    inside image to the surgeon

17
Design of Robotic Telesurgery(2)
  • The Concept
  • Telerobotics is a natural tool to extend
    capabilities in MIS
  • The goal is to restore the manipulation and
    sensation capabilities of the surgeon
  • Using a 6 DOF slave manipulator, controlled
    through a spatially consistent and intuitive
    master

18
Design of Robotic Telesurgery(3)
  • The Concept
  • Telesurgical system concept

19
Design of Robotic Telesurgery(4)
  • Considerations
  • Compatibility
  • Backdrivabilit
  • Actuators impedance
  • Actuators receive tool-to-tissue force
  • Loss of power can lead to dropping of a heavy
    tool and undesirable high accelerations in the
    actuator

20
Design of Robotic Telesurgery(5)
  • Considerations
  • Human-Machine Interface
  • Video system used to capture images inside the
    patient
  • Backlash-loss of motion between a set of movable
    parts
  • Choose the appropriate mechanism for the required
    transmission
  • Choose passive gravity balance over active
    gravity balance

21
Design of Robotic Telesurgery(6)
  • Haptic Feedback
  • Sensation of touch lost in robotic surgery
  • Receiving haptic information and using it to
    control the robotic manipulators
  • Needed to achieve high fidelity
  • Types
  • Force (kinesthetic) feedback
  • Tactile (cutaneous) feedback

22
Design of Robotic Telesurgery(7)
  • Haptic Feedback
  • Hand tie tradition suturing mechanism
  • Instrument tie estimate of performance (same
    type of feedback as resolved-force feedback)
  • Robotic tie suturing task performed by da Vinci

23
Design of Robotic Telesurgery(8)
  • Haptic Feedback
  • Experimental results
  • Accuracy cannot be improved to the level of hand
    ties by using force feedback
  • Hand tie had the lowest NSD. Repeatability can be
    improved by using force feedback in robotic
    surgical systems
  • Both instrument and robot reduces the performance
    margin between expert and novice users

24
Design of Robotic Telesurgery(9)
  • Haptic Feedback
  • Fidelity ability to detect compliance
    variations in the environment
  • P (Position error) FF (kinesthetic force
    feedback) control architecture to determine if
    the use of force sensor on slave manipulator will
    provide fidelity

25
Historic Companies and Systems(1)
  • First Robotic assisted surgery 1988
  • PUMA 560
  • Light duty industrial robotic arm to guide
    laser/needle for sterostactic brain surgery

26
Historic Companies and Systems(2)
  • First Robotic urological surgery 1992
  • PROBOT-assisted TURP in Guys Hospital in
    London leaded by Wickham

27
Historic Companies and Systems(3)
  • First commercially available robotic system, 1992
  • ROBODOC for orthopaedic hip surgery

28
Historic Companies and Systems(4)
  • First RCT of transatlantic telerobotics surgery
  • Between Guys and John Hopkins Hospitals
  • PAKY-RCM percutaneous access robot (Kavoussi
    group developed in 1996)

29
Existing surgical systems(1)
  • AESOP (Computer Motion), 1994
  • Automated Endoscopic System for Optimal
    Positioning a voice-activated robotic arm for
    camera holder
  • First approved surgical robotic system by FDA

30
Existing surgical systems(2)
  • AESOP

31
Existing surgical systems(3)
  • ZEUS (Computer Motion)
  • Marketed in 1998

32
Existing surgical systems(4)
  • Da Vinci (Intuitive Surgical)
  • Initially developed by US Department of Defence
    in 1991
  • Intuitive Surgical acquired the prototype and
    commercialized the system
  • Approved by FDA in July 2000

33
Existing surgical systems(5)
  • Da Vinci Surgical system by Intuitive Surgical,
    Inc.

34
Existing surgical systems(6)
  • Da Vinci Surgical system by Intuitive Surgical,
    Inc.
  • Surgical Console - 3D display and master control
  • Patient side cart - two or three instrument arms
    and one endoscope arm
  • EndoWrist Instrument - 7 DOFs, quick-release
    levers
  • InSite Vision System - high resolution 3D
    endoscope and image processing equipment

35
Existing surgical systems(7)
  • Da Vinci Surgical system by Intuitive Surgical,
    Inc.

36
Existing surgical systems(8)
  • Da Vinci Surgical system by Intuitive Surgical,
    Inc.
  • Video

37
Existing surgical systems(9)
  • Advantages of Da Vinci Surgical
  • Technically
  • Patented Endowrist 6 degrees of movement
  • 3-D vision (Dual channel endoscopy) and
    magnified view (x12)
  • Tremor suppression and scaling of movement
  • Surgeon
  • Ergonomic advantage
  • Shorter learning curve
  • Patient
  • Better outcome

38
Existing surgical systems(10)
  • Advantages

39
Existing surgical systems(11)
  • 6 degree movements

40
Existing surgical systems(12)
  • Da Vinci surgical system in a general procedure
    setting

41
Existing surgical systems(13)
  • da Vinci Surgical System U.S. Installed Base
    1999 2008

42
Strengths and Limitations(1)
  • Strengths
  • Physical separation
  • Wrist action
  • Tremor elimination
  • Optional motion scaling
  • Three-dimensional stereoscopic image
  • Electronic information transfer (Telesurgery)

43
Strengths and Limitations(2)
  • Limitation
  • Reluctance to accept this technology (trust)
  • Additional training
  • Fail proof?
  • Most of the sensors use IR transmission
  • Highly efficient visual instruments are needed
  • Cannot be pre-programmed
  • Task-specific robots are required
  • Latency in transmission of mechanical movements
    by the surgeon
  • Longer operating time

44
Strengths and Limitations(3)
  • Limitation
  • Cost for the Da Vinci system
  • The average base cost of a System is 1.5 million
  • Approximately 160,000 maintenance cost a year
  • Operating room cost, 150 per hour
  • Hospital stay cost, 600 per day
  • Time away from work, 120 per day

45
Ethical and Safety Considerations
  • When there is a marginal benefit from using
    robots, is it ethical to impose financial burden
    on patients or medical systems?
  • If a robot-assisted surgery fails because of
    technical problems, is it the surgeon who is
    responsible or others?

46
Challenges, Future and Conclusion
  • Haptic feedback
  • A safe, easy sterilizable, accurate, cheap and
    compact robot
  • Reliable telesurgical capabilities
  • Compatibility with available medical equipment
    and standardizing
  • Autonomous robot surgeons

47
Reference
  • Robotics in surgery history, current and future
    applications. New York Nova Science Pub-.
    lishers 2007
  • J.E. Speich, J. Rosen, 'Medical Robotics,' In
    Encyclopedia of Biomaterials and Biomedical
    Engineering, pp. 983-993, Marcel Dekker, New
    York, 2004.
  • http//robotics.eecs.berkeley.edu/medical/laparobo
    t.html
  • http//biomed.brown.edu/Courses/BI108/BI108_2005_G
    roups/04/index.html
  • http//faculty.cs.tamu.edu/dzsong/teaching/fall200
    5/cpsc689/

48
Thanks!
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