- 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:
-
- Stanford University School of Medicine
-
- University of California Berkeley (UCB)
-
- Massachusetts Inst. of Technology (MIT)
-
- 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
- Stereoscopic vision with depth perception
- Cognitive feedback limited
- Binocular vision without depth perception
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)
10. Haptic
- Force reflection / feedback; Graduated tactile input
-
- 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
- Robotic arm : Like human hand, arm and moveable elbow - butwith
a fused wrist
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
-
- Early models : 3-fingered hand
-
- Present : Hydraulic-powered, single-digit, 3-4 x , 4-jointed
(rotate, swivel, to-fro), 2-pronged end grasper
http:// robotics.eecs.berkeley.edu /medical/ 30. Details of
robots
- Robo-doc : 2 robots working in concert
-
- Companion robots / milli-robots / robotic manipulators
31. Holding robots
- Pair of large robotic arms
- 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
- Provide tactile feedback though force-deflecting joysticks
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
-
- Cart-mounted robotic manipulators
-
-
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
-
- Only 3-incisions, each 1 cm on the side and lower chest
-
- Faster healing and recovery
50. Technical innovations
- Teletactation (Tactile feedback)
- CyberGlove with CyberTouch
- Spatial cognition Hand assist
- Surgical simulations / Virtual reality
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
- 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
- One-to-many telementoring
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 .