Medical Robots and Surgery Applications

Ingo Schulz 21. Januar 2010

Medical Robots and Surgery Applications Introduction Clinical context
diagnostic and therapy procedures tend to be less invasive
quality controls become more and more important
reproducability of results becomes mandatory
growing amount of data handled for each patient
reduction of the costs of healthcare

2

Medical Robots and Surgery Applications Introduction added value robots...









to to to to to to to to

realize complex geometric tasks handle heavy tools provide a third hand to the clinician be remotely controllable offer scaling capabilities (motions or forces) filter undesired movements track moving organs be introduced in the patient


gerneral: only be used to enhance the capabilities of the best trained surgen

3

Medical Robots and Surgery Applications Introduction Definition Robotic Surgery is defined as a surgical procedure or technology that adds a computer-technology-enhanced device to the interaction between the surgeon and the patient during a surgical operation and assumes some degree of freedom of control usually completly reserved for the surgeon. reference: SAGES-MIRA Robotic Consensus Group

Synonyms: Computer Assisted medical interventions (CAMI), augmented surgery, computer-assisted surgery, image guided surgery, medical robotics, surgical navigation... 4

Medical Robots and Surgery Applications Introduction Perception – Decision - Action
data aqcuisition and processing
pre- or intra-operatively
computed tomography, magnetic resonance imaging, digital radiography, ultrasound imaging, endoscopic video, video cameras, 3D localizers, optical shape sensors
multimodality is necessary
calibration of specific sensors
must enable the transformation from image coordinates to spatial coordinates
must enable the correction of distortions

5

Medical Robots and Surgery Applications Introduction Perception – Decision - Action
building an integrated numerical model of the patient
data provided by the sensors
priori medical knowledge (statistical data about organ shapes, biomechanical models of the limbs)
data fusion (registration): representing all information in a single reference frame to make optimal use of the information possible
building a model of the action
interactive tools
optimization tools
simulators could provide help for the clinical outcome 6

Medical Robots and Surgery Applications Introduction Perception – Decision - Action





guiding the selected strategy while it is performed the virtual reality meet the real world operator is provided with augmented reality different levels of assistance

7

Medical Robots and Surgery Applications Robot categories robotic categories in surgery
passive robots
semiactive robots
active robots
telemanipulators
simulators

8

Medical Robots and Surgery Applications Robot categories passive robots
navigators
action is under total control of the surgeon
visual realtime sensory information


surgical tools are tracked to enable the surgeon the adjustment of their position

9

Medical Robots and Surgery Applications Robot categories semi active robots
autonomous surgical instrumentation positioning
under „control“ of the surgeon (planned preoperatively)
human operator performs the final part
stereotaxic neurosurgery: to target a a small spot into the brain / Neuromate (in 1989)
urologic surgery: to perform prostate brachytherapy / TectoDart
microsurgery: SurgiScope

10

Medical Robots and Surgery Applications Robot categories semi active robots: Neuromate

11

Medical Robots and Surgery Applications Robot categories semi active robots: Neuromate
was distributed by Innovative Medical Machines International (France)
first neurosurgical device to get CE mark in Europe and FDA approval in USA (1997)
used for surgical assistance with biopsy and tumor removal.
combined with pre-operational images the system provides real-time visualization to give the surgeon precise location of a tumor.
in the first years 25 systems were installed in USA, Japan, Europe
now acquired by by Schaerer Mayfield NeuroMate AG (France)
reappearence on the market is possible 12

Medical Robots and Surgery Applications Robot categories active robots
the robot autonomous drives an active surgical tool
without any control of the surgeon
after specific preoperative planning
orthopaedic surgery: to drill cavities meant for hip an knee prothesis implantation / Robodoc (in 1992) and Caspar
oncology: to move all around the patient in order to deliver the right amount of radiotherapy on selected hotspots / Cyberknife (1994)

13

Medical Robots and Surgery Applications Robot categories active robots: Cyberknife

14

Medical Robots and Surgery Applications Robot categories active robots: Cyberknife
distributed by Accuracy Inc. (USA)
1994 at Stanford Medical Centre
134 installed systems, 40.000 patients treated mostly for brain, lung, prostate liver or pancreas tumors (May2008)
stereotactic radiosurgery system
IGS with robotic positioning
leight-weight photon device is mounted on a KUKA industrial manipulator (6 DOF)
X-Ray cameras track the spatial displacement of the patient
intra-corpuscular markers and infrared cameras track the patient‘s moving body surface
compensates motions 15

Medical Robots and Surgery Applications Robot categories telemanipulators
„supplant“ the surgeon in the OR
remote controlled robotized device
surgeon is absolutely in charge of the motion of the robot
consists of 3 components:
master controller
slave manipulators
vision system
in the 1990s the project HAZBOT
Aesop (in 1989) to manipulate a laparosopic surgical camera
Zeuss (in 1995) several arms to bear surgical instruments
DaVinci 16

Medical Robots and Surgery Applications Robot categories telemanipulators: DaVinci

17

Medical Robots and Surgery Applications Robot categories telemanipulators: DaVinci
most successful surgical robot
distributed by Intuitive Surgical Inc. (USA)
founded in 1995
1997: first animal trials, first human trials
2000: FDA approval
2005: second version / DaVinci S
2009: latest version / DaVinci Si
only complete teleoperation surgical robot currently available
investment about: 500 M USD
perform komplex surgical procedures with laparoscopic technique
remotly guided by a surgeon
1.111 units sold until Dezember 2008
over 300.000 procedures performed 18

Medical Robots and Surgery Applications Robot categories simulators
education and teaching
master controls of common teleoperators can be used

as joysticks to simulate surgical procedures
performing surgical tasks without putting the patient‘s security at stake

19

Medical Robots and Surgery Applications thinking about new applications specific issues
human environment
close collaboration with clinician
specific interfaces (head movements, voice control, foot pedals)
safety issues are mandatory
hardware & software
special control mechanisms
special design & materials
sterial cleaning
electro magnetic compatible 20

Medical Robots and Surgery Applications

Wireless reconfigurable Modules for Robotic Endoluminal Surgery

21

Medical Robots and Surgery Applications The Future: Wireless & reconfigurable modules background / motivations


capsule endoscopy with successfull outcomes
methods of locomotions have been studied
new surgical procedure: NOTES ... but
implementable functions are limited
poor dexterity because of small force

22

Medical Robots and Surgery Applications The Future: Wireless & reconfigurable modules advantages
precise positioning of the vision and tools
robust and adaptive to the environment
no strict constraints of the number of modules

23

Medical Robots and Surgery Applications The Future: Wireless & reconfigurable modules clinical settings
clinical target: entire GI tract
esophagus, stomach, small intestine, colon
clinical task: biopsy of early cancer
stomach cancer is 2nd leading cause of death
worse outcome in the 5-year survival ratio
early diagnosis may lead to a better prognosis
stomach is good for demonstrating the modular approach
1400 ml is the working space for the robot
conventional endosopic capsules can‘t reach the upper side of the stomach
functional modules would allow precise surgical tasks 24

Medical Robots and Surgery Applications The Future: Wireless & reconfigurable modules constraints
module size should be small enough
to be swallowed
to pass through the entire GI tract
11 mm in diameter
26 mm in length

25

Medical Robots and Surgery Applications The Future: Wireless & reconfigurable modules robotic scheme homogeneous scheme – heterogeneous scheme modules are identical (except one or two surgical or diagnostic modules)
advantages: - simplicity in assembly - determining the topology of the robot - control
disatvantage: - only for simple tasks

26

Medical Robots and Surgery Applications The Future: Wireless & reconfigurable modules robotic scheme homogeneous scheme – heterogeneous scheme each module can be different
advantages: - may provide more dexterous manipulation
disatvantage: - assembly process is more difficult

27

Medical Robots and Surgery Applications The Future: Wireless & reconfigurable modules robotic scheme - heterogeneous scheme possible topologies of the modular robot in the stomach using structural and functional modules and one central module

28

Medical Robots and Surgery Applications The Future: Wireless & reconfigurable modules proposed surgical procedures 1. distent the stomach up to 1400 ml 2. patient ingests up to 15 modules 3. modules complete the assembling process (permanent magnets) 4. liquid drains away 5. robot configure its topology by repeated docking and undocking 6. intervention 7. reconfiguration to a snake-like shape or total disassembling 8. ... 29

Medical Robots and Surgery Applications The Future: Wireless & reconfigurable modules proposed surgical procedures
control via bidirectional communication
additional modules (tools, batteries, to replace broken modules) can be added to the robotic structure during the whole process
no longer needed modules can be detached and discarded

30

Medical Robots and Surgery Applications The Future: Wireless & reconfigurable modules design and prototype of the structural module
15.4 mm in diameter, 36.5 mm in length
weight: 5.6 g

31

Medical Robots and Surgery Applications The Future: Wireless & reconfigurable modules components of the structural module

32

Medical Robots and Surgery Applications The Future: Wireless & reconfigurable modules components of the structural module a) Li-Po Battery - capacity: 17 minutes (full speed, continious driving) b) custom made motor control board - capable of wireless conrol - 9.6 mm in diameter, 2.5 mm of thickness, 0.37g) - CC2430 microcontroller (Texas Instruments) - 3 A3901 dual bridge motor drivers (Allegro Microsystem Inc.) c) brushless DC motor (4mm in diameter and 17.4 mm in length) - fabricated in Japan by Namiki Precision Jewel Co. d) casing of acryl plastic (fabricated by a 3D printing machine) e) 2 permanent magnets - fabricated in Switzerland by Webcraft GmbH - hexagonal shape to restrict the rotation motion after docking 33

Medical Robots and Surgery Applications The Future: Wireless & reconfigurable modules design and prototyping of the biopsy module - one worm and 2 spur gears - wide opening of the grasping part - parts can be hidden in the case - generates more force than conventional endoscopic forceps

34

Medical Robots and Surgery Applications The Future: Wireless & reconfigurable modules assembled robot

35

Medical Robots and Surgery Applications The Future: Wireless & reconfigurable modules future works
miniturazition to a swalloable size
the docking / undocking task
using a module
using a mechanical mechanism
electric connection between the modules
power management
development of a configuration planner
development of an adequate and intuitive interface

36

Medical Robots and Surgery Applications

37