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Robotic Surgery and Surgical Simulation Roger Smith, PhD Chief Technology Officer Florida Hospital Nicholson Center for Surgical Advancement [email protected] Slides Available at: http://www.modelbenders.com/ Approved for Public Release.
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Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Mar 12, 2018

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Page 1: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Robotic Surgery and Surgical Simulation

Roger Smith, PhD

Chief Technology Officer

Florida Hospital

Nicholson Center for Surgical Advancement

[email protected]

Slides Available at: http://www.modelbenders.com/

Approved for Public Release.

Page 2: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Nicholson Center for Surgical Advancement

• Surgical Education

– Robotic Surgery

– Laparoscopic Techniques

– Orthopedic Equipment

• Surgical Research

– Robotic Surgery– Robotic Surgery

– Telesurgery

– Simulation Applications

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Page 3: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Open Surgery

• “An open surgery means cutting skin and tissues so the surgeon has a

direct access to the structures or organs involved. The structures and

tissues involved can be seen and touched, and they are directly exposed

to the air of the operating room.”

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Page 4: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Minimally Invasive Surgery

• “A minimally invasive procedure is less invasive than open surgery used

for the same purpose. It typically involves use of laparoscopic devices and

remote-control manipulation of instruments with indirect observation of the

surgical field through an endoscope or similar device, and is carried out

through the skin or through a body cavity or anatomical opening. “

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Page 5: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Laparoscopic Surgery

• “A type of minimally invasive surgery in which a small incision is made in

the abdominal wall through which an instrument called a laparoscope is

inserted to permit structures within the abdomen and pelvis to be seen.

The abdominal cavity is distended and made visible by the instillation of

absorbable gas, typically, carbon dioxide.”

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Page 6: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Robotic Surgery

• “Robot-assisted surgery was developed to overcome limitations of

minimally invasive surgery, Instead of directly moving the instruments the

surgeon uses a computer console to manipulate the instruments attached

to multiple robot arms. The computer translates the surgeon’s movements,

which are then carried out on the patient by the robot.”

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Page 7: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Mechanical Turk, 1770

7http://en.wikipedia.org/wiki/The_Turk

Page 8: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Early Robotic Surgical Systems

AESOP: Automated Endoscopic System

for Optimal PositioningZEUS Telesurgery Robotic system

http://www.websurg.com/robotics/history.php

Page 9: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

World’s First Robotic Telesurgery

• September 2001: Tele- chole (gall bladder removal)

• Surgeon in New York, Patient in France

• Round trip distance = 8,700 miles

• Round trip data time = 200 ms

• Collaborators: Prof Jacques Marescaux, New York & European Institute of Telesurgery, Strasbourg

• http://news.bbc.co.uk/2/hi/science/nature/1552211.stm

Page 10: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

da Vinci Surgical Robot

10Intuitive Surgical Inc. http://www.intuitivesurgical.com/index.aspx

Page 11: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Essential Robotic Components

Stereo Vision

Stereo Mag Endoscope

7-DOF Instrument

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7-DOF Instrument

Diverse, Small Instruments Fine ControlErgonomic Station

Page 12: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Intuitive Surgical’s da Vinci Robot

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Page 13: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Mimic dV-trainer for the da Vinci Robot

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Page 14: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

MIMIC dV Trainer

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Page 15: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

MIMIC Thread the Rings

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Page 16: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Modeling the World

Hard Objectstanks, helos, ships

Fluid Dynamicswater, air flow

Human Bodyliving

tissue

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Hard Objects are Easy, Soft Objects are Hard

Page 17: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Unique Surgical Simulation Challenges

Geometry•Complex

•Non-linear

•Non-uniform

Appearance•Layered

•Translucent

•Dense

Dynamics•Nerve movement

•Blood flow

•Elasticity

17Center for Research in Education and Simulation Technologies, Rob Sweet, MD

Page 18: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

DoD Research Project

Robotic Curriculum Simulation Telesurgery

Consensus Conference:

•Define Robotic Surgery outcomes

•Develop Robotic Surgery curriculum

•Develop specific training tasks

Curriculum Validation:

•Validate training tasks

•Identify testing measures

•Set passing criteria

Military-use Validation:

•Identify military constraints

•Validate simulator for environment

•Define deployable package

Surgical Rehearsal:

•Develop test cases

•Conduct experiments

•Measure performance delta

Communication Latency:

•Measure latency between cities

•Map surgical procedure to latency

•Redesign procedures for telesurgery

•Introduce instruments for safety

Automatic Surgery:

•Input simulated surgery data

•Execute data on da Vinci robot

•Measure accuracy of surgery

Page 19: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Nicholson Research Hypotheses

1. Telesurgery: (a) For the foreseeable future, telesurgery will contend with telecommunication

delays that affect the ability of the surgeon to execute a traditional surgical procedure in a

telesurgery environment. We hypothesize that surgical movements can be modified to be

effective and safe in a communication environment that contains predictable levels of delay.

(b) Further, the data collected from a simulation event in Hypothesis 2 can be used as the

basis for driving automatic robotic telesurgery with real equipment, which presents future

possibilities for overcoming the communication latency problem.

2. Simulation: (a) We hypothesize that existing robotic surgery simulators can be used to retain

and regain proficiency in robotic surgery. If validated, then deployed military surgeons can and regain proficiency in robotic surgery. If validated, then deployed military surgeons can

use these simulators while in a warzone to improve their ability to transition back into

civilian practice. (b) Further, rehearsal of procedures with these simulators immediately

before surgery will improve patient outcomes and will provide data which can be used to

drive the automatic surgery experiments in Hypothesis 1.

3. Robotic Curriculum: We hypothesize that the methods used to establish the Fundamentals

of Laparoscopic Surgery (FLS) curriculum in the previous decade can be applied to the

robotic environment, creating a nationally accepted training curriculum for the

Fundamentals of Robotic Surgery (FRS).

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Page 20: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Outcomes

&Curriculum

Development

Simulator

Development

Validation

Studies

Implement:

SurveyIssue

Certification

Content Updates

The Metrics Drive the ProcessW

HA

T

Fundamentals of Robotic Surgery

&

MetricsDevelopment Development Studies

Survey

Training

Certification

Certification

Consensus

Conference

Standard

Curriculum

Template

Engineering

Physical

Simulator

Standard

Validation

Template

Current

Procedures

Issue

Mandates

And

Certificates

ABS

SAGES

ACS

Specialty

Societies

SAGES

ACS

Societies

Academia

Industry

with

Academia

Medical Input

ACS

SAGES,

Participating

Societies

FLS

SAGES/ACS

ABS

or

Certifier

WH

AT

HO

WW

HO

Page 21: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Military-use Validation

Robotic Surgery

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Robotic Surgery

Skills Retention

Page 22: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Surgical Rehearsal

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Page 23: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Internet

Communication Latency & Surgical Redesign

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•Change Pace

•Change Movement

•Add Instruments•Eliminate Movement

Page 24: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Automatic Surgery

Page 25: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Components of a Surgical Simulator (Harders, 2008)

Clinical

Expertise

Model

Generation Vascular

Structures

Bleeding

Simulation

Tissue

Parameters

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Tissue Cutting

Tissue

Deformation

Collision

Detection Fluid

Simulation

Immersive OR

Haptic

Interface

Organ

Texturing

Page 26: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Summary

• Surgical Robotics & Simulation are complimentary research

• Surgical Simulation presents unique problems from other

Medical Simulation tools

• Modeling Soft Tissue is a unique new science

• Surgical Simulation architecture is evolving

• Simulation as a significant part of the surgical education

curriculum is an emerging field

– Not currently accepted

– Only recently technically viable

– Big culture shift required

– Government policies will be a significant force

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Page 27: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Reference Books

• Harders, M. (2008). Surgical Scene Generation for Virtual Reality-

Based Training in Medicine. Springer Publishing.

• Kyle, R & Murray, W. (2008). Clinical Simulation: Operations,

Engineering and Management. Academic Press.

• Riley, R. (2008). Manual of Simulation in Healthcare. Oxford Press.

• Satava, R. et al. (2007). Emerging Technologies in Surgery. Springer

Publishing.

• Smith, R. (2009). Game Technology in Medical Education.

Modelbenders Press.

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Page 28: Robotic Surgery and Surgical Simulation - … Center for Surgical Advancement • Surgical Education – Robotic Surgery – Laparoscopic Techniques – Orthopedic Equipment • Surgical

Presentation Available

Slides at:

http://www.modelbenders.com/papers

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Videos at: Da Vinci Overview

http://www.youtube.com/watch?v=ozyv3x1ivts

MIMIC Simulator

http://www.mimic.ws/resources

Ross Simulator

http://www.youtube.com/watch?v=bICtjMCeXmQ