Transcript
Robotics in surgeryPatrick A Finlay PhD CEng
Director and Chief Technical Officer, Prosurgics Ltd
History of Robotics800BC Homer describes walking tripods
1921 The term "robot" invented by Karel Capek
1938 Mechanical arm for spray-painting.
1942 Isaac Asimov: Three Laws of Robotics.
1961 First commercial robot
1965 CMU creates Robotics Institute
1973 Wabot built at Waseda University Tokyo
1982 Int’l Advanced Robotics Programme
1986 First surgical robot
Surgical Robotics: current status
~ 1200 surgical robots in regular clinical use worldwide.
Surgical robotics globally worth ~ $2B
Annual growth ~ 50% per annum
Small number of specialist companies
R&D in progress at over 100 universities world wide,
Commercial surgical robotics
Telemanipulators Image guided surgery
Surgical Robotics
MEDICAL ROBOTICS
Non surgical
The two branches of robotic surgery
Telemanipulator
(master-slave)Image guided
(true robot)
TelemanipulatorsMaster Slave systems
Single arm telemanipulators
endoscopic camera control
Single arm camera holder
EndoAssist, Prosurgics Ltd
Position anywhere around the table
Does not obstruct operation
Entry port can be in any position
Clinical benefits
Single arm camera holder
EndoAssist, Prosurgics Ltd
Head movement control
Pan,zoom or tilt the camera with a head gesture
Miniaturised camera holder
FreeHand, Prosurgics Ltd
Miniaturised camera holder in use
No obstruction of surgical access or screen sightline
Multi arm telemanipulator
Da Vinci
Intuitive Surgical Inc
Multi-arm telemanipulator
Da Vinci, Intuitive Surgical Inc
Motion scaling to micro-wrist
Multi-arm telemanipulator
Surgeon operates robot from a remote console
Telesurgery
Surgeon in New York Patient in Strasbourg
Pictures from Computer Motion Inc
Telesurgery applications
Image Guided RobotsExample: Neurosurgery
Robotic neurosurgery
1927 arteriography 2007 MR image
Image-guided surgery
Fusion of image modalities
MRI AngiographyCT
Fused images and Brain Atlas
The neurosurgeon’s quest
how to reach the target I’ve pinpointed on the scan
with the same accuracy that I can see it . . .
. . . but with minimal collateral damage . . .
. . .and simply, with a short procedure time . . .
. . .and without costing a fortune
Registration: key to accuracy
Stereotactic frame
Stereotactic frame targeting arc
Fiducial markers
Testing prior to surgery
Skin Markers used as artificial targets for confirming accuracy
Neurosurgery robot registration
Camera and light ring
camera in the robot’s wrist scans the patient
computer matches camera and CT scans
Sterile environment control
Deep Brain stimulation
Brain tumour biopsy
Robot guided biopsy needle insertion. Multiple biopsies are possible along a single trajectory
Epilepsy
Robotic 3-D positioning of depth electrodes to determine focus of epileptic seizure
Grid pattern tumour treatment
Magnetic nanoparticles
Modified virus
Stem cells
Interstitial radiotherapy
Convection enhanced delivery
New pharmaceuticals
Image Guided SurgeryApplications outside Neurosurgery
Early beginnings
RoboDoc Femoral reaming
ISS Inc
IGS trajectory control
Orthrobot
Dynamic hip screw placementArmstrong Healthcare (now Prosurgics Ltd)
IGS path control
Machining of femur and tibia for total knee replacement
CASPAR orthopaedic robot
URS GmbH
robot allows the surgeon to operate freely in the safe zone, but prevents entry elsewhere
Picture from Imperial College London
Active-constraint IGS
Total knee replacement
Photographs: Imperial College London
Active constraint IGS
Total knee replacement
Surgical Robots:The next generation
New generation surgical robotics
Telemanipulators Image guided surgery
Tactical Surgical Robotics
MEDICAL ROBOTICS
Strategic Surgical robots
(Dual guidance)
Micro mobile robots with autonomy
Non surgical
Miniaturisation
Praxiteles
Praxim SA
SpineAssist
Mazor Surgical Technologies Ltd
powered and passive DoFs Pedicle screw guidance
Parallel structure
Probe tip tracking
Ascension Technologies Inc
Electromagnetic tracking
Motion compensation
Kinemedic
DLR
Low inertia, high payload, force control robot
Real time imaging and modelling
University of Verona
New types of surgery
“NOTES”:
Natural orifice transgastric endoscopic surgery
New types of surgery
SCP NorwayVancouver Institute for Advanced Ceramics
CAD CAM dental implant
Custom hip implants
Free-roaming camera (pre-robotic)
Given Imaging, Israel
swallowable camera 2 frames/s for 6 hours
Crawling microrobots
swallowable camera with 6-legged propulsion
Roaming robot with camera and biopsy needle NOTES surgery of the abdomen
University of NebraskaCMU/ Korean Intelligent μsystems centre
Swimming microrobots
Swimming robot
Eyeball cavity, CSF, urinary system
Autonomous Swimmer.
Subarachnoid space of spine.
Pushmepullyou swimmer
Technion UniversityCarnegie Mellon University
Multi-segment snake arms
23 DoF holonomic snake arm
Nuclear maintenance
Tube crawling concertina snake
Disaster rescueExperimental flexible endoscopic manipulator
OC RoboticsLtd Johns Hopkins University Carnegie Mellon University
Biomimetics
Biomimetic lobster
goal–achieving behaviour
Artificial muscle actuators
Wood wasp ovipositor
Robot carp:
serpentine motion
Northeastern University MA Essex University
Intelligence
Evolutionary learning bipedal locomotion
I-SWARM
Co-operating robots
21 DoF fault tolerant snake arm for Space vehicles
Kahlsruhe University (leader) NASA JSC Chalmers University
A new safety paradigm
New approach: “intrinsically safe design; control for performance”
Old approach:
“rigid design for accuracy; active control for safety”
LE3 robotDLR
“Dependability”
Safety
reliability
maintainability
Availability
legibility – “the psychological ability of a user to understand what the robot is intending”
Architecture
Classical: “sense > plan > act”
Deliberative (eg NASA): “reason > model > react”
Subsumption (Brooks): behaviour based
Hybrid: high level deliberator <> mediator <> low level reactive executive
Intrinsically safe robot inertia
Stanford University
DM2 robot structureDuplicated actuators
Future surgical robots: in summary
Miniature
Physiologically registered
Sensuate
Dependable
Autonomous
. . . and UbiquitousNASA NEEMO
New surgical robots will be
SMALL, including intra-body.
Intelligent and sensuate
Semi- autonomous
Ubiquitous in surgical procedures
Today’s surgical robots are already
Clinically beneficial
Cost effective
Improving patient outcomes
Improving Safety
Lowering Costs
Enabling New procedures
Robotics in surgeryPatrick A Finlay PhD CEng
Director and Chief Technical Officer, Prosurgics Ltd
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