Surgical Assist Devices & Systems aka Surgical Robots D. J. McMahon 150125 rev cewood 2018-01-19
Key Points Surgical Assist Devices & Systems: Understand why the popular name robot isn t accurate for Surgical Assist Devices Intuitive Surgical Corp s da Vinci, strongest in MIS: minimally invasive surgery The three components of a da Vinci S.A.D. Console Patient Cart / Gantry Vision Cart Typical number of arms (in addition to cameras) Know that there are specific robotic systems for orthopedics and neurosurgery Understand the advantages of SAD The Golem is a 16th Century animated anthropomorphic being, magically created entirely from inanimate matter. Jewish Synagogue & Museum with statue of Golem in small city Úštěk in north of Czech Republic https://en.wikipedia.org/wiki/golem
R.U.R. 1920 play by Karel Čapek In Czech, robota means forced labour of the kind that serfs had to perform on their masters' lands, and is derived from rab, meaning "slave."
Isaac Asimov's Three Laws of Robotics (1942) 1: A robot may not injure a human being or, through inaction, allow a human being to come to harm. 2: A robot must obey the orders given it by human beings except where such orders would conflict with the First Law. 3: A robot must protect its own existence as long as such protection does not conflict with the First or Second Laws. Handbook of Robotics, 56th Edition, 2058 A.D.
A better historical term might be: Waldo from Robert A. Heinlein s 1942 short story Remote manipulator or Waldo: A hand-like mechanism controlled by a human operator Master-Slave Manipulator Mk. 8, or MSM-8, Argonne National Laboratory 1945
There are no surgical robots! (yet) A robot is any electro-mechanical device that is programmed to perform a set of tasks autonomously, once it is started. A robot does not require constant human control. A surgical assist device is always under the direct control of a surgeon. The surgeon may be local (in the operating room) The surgeon may be remote; next door or around the world (telesurgery) A combination of the two (local control & remote supervision or remote control & local supervision.
Mediating Systems Between Input and Output: typewriter evolved through the recording typewriter to word processor piano evolved through player piano and MIDI to music synthesizer machine shop processes evolved through NC to CNC machining stage performance evolved through VTR & DVD to recorded video each evolution allows: storage of input, independent of output device correction and revision of input after recording one-to-many replication of output choices of output device review and optimization of input to create perfect output output can be physically and temporally remote from input When will that all happen to surgery?
Intuitive Surgical Corp s da Vinci Surgical System www.intuitivesurgical.com www.davincisurgery.com Strongest in MIS: minimally invasive surgery First FDA approval July 2000 for laparoscopic surgeries 3803 units in use worldwide, 2501 in the US (Sept 2016) The da Vinci is a telesurgical system. Surgeon controls remotely. Primary advantages: decreased surgical personnel (maybe) decreased physical fatigue for the surgeon better-than-human control of instrumentation filtering of muscle tremor ability to manipulate instruments with greater degree of freedom than human hands minimal surgical trauma for the patient Primary disadvantage: cost (~$2M currently, plus expendables)
Three components: Surgeon's Console Patient Cart / Gantry Vision Cart
Surgeon Console provides stereoscopic vision to the surgeon and haptic force feedback so the surgeon can feel what they are doing
Three-arm (plus cameras) gantry Patient Cart
Surgical Arms Dual cameras
Interchangeable Tools or Manipulators for Surgical Arms
Vision Cart (display & recording)
Minimal incision and blood loss --
Surgeon training: virtual simulation and practice items to manipulate, with haptic feedback http://www.intuitivesurgical.com/company/media/videos/simulator/index.html https://www.youtube.com/watch?v=knhgeykdxfw
Screen shots -
Two comparison studies: da Vinci vs open surgery for MIRP; Minimally Invasive Radical Prostatectomy Source: Intuitive Surgical site
Technical challenges for Biomed with the da Vinci System: > Connectivity - lots to go wrong - uses both copper and fiberoptic signalling > Hi res imaging can take a lot of tweaking > Mechanical issues at the patient cart > Power demand: High current draw for the system > Space! Ideally should be in a dedicated O.R. room Intuitive does not offer biomed training or inservicing; all tech support is provided by their FSE s.
Mako Surgical - (now a Stryker company) Surgical assist devices specifically for orthopedics - http://www.makosurgical.com/
Uses imaging files to precisely replace diseased bone with resurfacing inserts
The acetabulum is a concave surface of a pelvis. The head of the femur meets with the pelvis at the acetabulum, forming the hip joint.
Knee arthroplasty -
Single Port Orifice Robotic Technology (SPORT ) Surgical System http://www.titanmedicalinc.com/
Neurosurgical assist devices - Medtech Corp, France http://medtech.fr/en/home ROSA: RObotic Surgical Assistant; loads PACS images from MRI & CT, disconnects from network, inserts biopsy needle into brain, un-shields the needle, harvests biopsy, retracts. Surgeon s involvement is in initial planning; ROSA self-propels.
Renishaw, UK neuro mate stereotactic robot Applications: SEEG (stereoelectroencephalography) DBS (deep brain stimulation) Biopsy / neuroendoscopy http://www.renishaw.com/en/neurological-products-and-therapies--6332
Medtronic Surgical Navigation Systems StealthStation Spine Surgery Imaging and Surgical Navigation, Cranial StealthStation Navigation StealthMerge (CT & MRI) - most advanced surgical planning software, - instrument tracking technologies - intra-operative imaging
Surgery of the future