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Robotics in Gastroenterology
Dr Louis Phee Associate Professor Head, Division of Mechatronics & Design School of Mechanical & Aerospace Engineering
Why Medical Robotics? The use of robotic and mechatronics technologies to aid the clinician in performing difficult and technically demanding surgical procedures.
Strengths of the Clinician: Good judgement. Strong hand eye co-ordination. Integrate extensive and diverse information. Very flexible and adaptable. Very dextrous at “human” level. Highly evolved. Easy to instruct. Easy to get verbal feedback.
Strengths of the Robot: Excellent geometric accuracy and repeatability. Untiring and stable. Immune to infection and radiation. Potentially high variety in size, shape and configuration to suit need. Can incorporate many sensors for information feedback and precise application (eg. of force). Creates better accessibility
Surgeon + Robot = •Enhances non invasive or minimally invasive surgical procedures •Eliminates or decreases technical difficulties faced by clinicians •Less pain and discomfort for patients •Lower surgical and hospitalization costs
Why Medical Robotics?
The Evolution of Surgery TRADITIONAL
SURGERY MINIMALLY INVASIVE SURGERY
Da Vinci CAS system
ENDOLUMINAL SURGERY
Endoscopic capsule Reconfigurable surgical system
Micro-endoscope for spinal cord
FETAL SURGERY
Force-feedback scissor for fetal surgery
CELL SURGERY
Artificial virus for cell therapy
The “Da Vinci” system
• Same hospitalization time
• Similar blood loss
• Same cauterization time
• Patient reported mean pain scores were almost identical
• Robotic surgery is expensive
• Robotic surgery has higher operative duration time
Robotic Surgery Vs Traditional Laparoscopy
The new challenge for surgeons and engineers
The real challenge for the future of robotics in surgery (and perhaps for surgery in general) is
to go beyond the mere imitation and substitution by a robot of conventional procedures and surgical gestures,
and rather to explore completely novel procedures that are possible only by means of robotic/mechatronic tools together with human surgeons.
Previous Projects: Colonoscopy Robot
•Colon cancers are one of the deadliest but most preventable malignancies •Kills 437 000 people worldwide each year •Curable 90% of the time, if detected and treated in the earlier stages •Death toll could drop by 50 to 75% with mass screening of the population •1 million colonoscopies performed in France each year, resulting in 52% of colorectal cancers cured •Colonoscopy tops the list of recommendations because the entire colon can be inspected and therapeutically treated as soon as ailments are discovered
Endoscopic View of fungating colon cancer
Mass screening of population for colon ailments would be desirable
Colon cancer is the one of the most common form of cancer in Singapore
Motivations
•Pain & discomfort for the patient
•Technical complexity for the surgeon
•Expensive; deters patient from examination
Previous Projects: Colonoscopy Robot
Objective: To develop a robot which can propel itself autonomously into the colon (anus to caecum) for inspection purposes
Understanding the Environment
2γε=σγ ≈ 5.0 MPa
Previous Projects: Colonoscopy Robot
Thermostatic support
Clamp
Controlled weight
Active surface
T
T
DC MotorLoad cell
Tissue
Controlled Speed Motor
Thermocouple
Known Weight
Tissue
Controlled Temperature Plate
The INCHWORM locomotion mechanism…
…”never let go of what you are holding until you are holding something else”
Analysis of the Solutions – The Inchworm
Understanding the Environment
Previous Projects: Colonoscopy Robot
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lll
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=∆+∆
∆=η
σ = stress ε = strain
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Prototyping
Previous Projects: Colonoscopy Robot
Previous Projects: Colonoscopy Robot
The future of colonoscopy?
Disposable
Current Gastroscopy
Master And Slave Transluminal Endoscopic Robot (MASTER)
Objectives
Nintendo Wii for Surgery
Master And Slave Transluminal Endoscopic Robot (MASTER)
Design: Overview
17
Conventional endoscopy system
Slave Robotic SystemPatient
Surgeon
Endoscopist
Master Console System
Microprocessor/ Motion Controller
Send signals
Assist
Stabilisedposition
Attend to
Control
Actuators housing
Control
Actuate
Perform treatment
Inside GI tract
Attach together
Provide visionfeedback
Distal endParameters changes
Changes proximalload cell readings
Control actuatortorque
Benefits for Clinicians •Enable endoscopist to perform intricate procedures otherwise normal performed by surgeons •Intuitive, easy to use, very short learning curve
Master And Slave Transluminal Endoscopic Robot (MASTER)
Benefits for Patients •Minimally invasive •No holes = no scars •Shorter hospitalization stays, if any •Lower costs
Master And Slave Transluminal Endoscopic Robot (MASTER)
Surgical Navigation System for NOTES
22
Force Feedback
Envisaged NOTES Platform
23
State-of-the-Art of Wireless Capsule Endoscopy
PillCam Colon 2
Inventors: Given Imaging Capability: Bi-directional communication, adaptive frame rate adjustment Specifications: 1.1cm in diameter and 3.1cm long; 4-35 frames per second
MiRo capsule
Inventors: Intelligent Microsystems Centre Capability: uses the human body as a conductive medium for data transmission Specifications: 10.8 mm in diameter and 24mm long; 2 frames per second
Magnetic Maneuverable Capsule
Inventors: University of Hamburg Capability: Controlled locomotion by using a handheld external magnet (magnetic disks are inserted inside one of the capsule's domes) Specifications: 1.1cm in diameter and 3.1cm long; 4 frames per second
Maneuverable Pill (Research)
Inventors: CRIM Lab at Scuola Superiore Sant’Anna and Katholieke Universiteit Leuven Capability: Controlled swimming using BLDC motors, Wireless power supply Specifications: 1cm in diameter and 4.5cm long; 2 frames per second
Magnetic Internal Mechanism capsule (Research)
Inventors: CRIM Lab, Scuola Superiore Sant’Anna Capability: gross positioning and precise control of the capsule orientation, tethered Specifications: 1.5cm in diameter and 4.8cm long
Hybrid locomotion (Research)
Inventors: CRIM Lab, Scuola Superiore Sant’Anna Capability: Hybrid locomotion (external magnetic dragging and internal actuating legged mechanism) Specifications: 1.4cm in diameter and 4.4cm long
‘Mermaid’ Pill
Inventors: Ryukoku University and Osaka Medical College Capability: Controlled swimming using fins in GI tract Specifications: 1cm in diameter and 4.5cm long; 2 frames per second
Innovative Imaging System
Rotatable camera (by using a micro-motor)
Self-focusing lenses with variable view angle
-Clearer images -Steerable vision -Longer operation duration
Tagging Device
Principle: - The capsule will inject a pre-determined volume of a solution into a desired
location of the small intestine/stomach sub-mucosal layer using a fine needle
- The tagged location could be recognized by X-Ray or by the physician during an open-surgery operation
Monitoring of Gastric Bleeding
Enabling Technologies: - Blood Sensor - Stop Mechanism (inflating balloon)
Weight Management
• Strong market for the clinical treatment of overweight and obesity
• Market forecast $6.4 billion globally by 2015
(c) Balloon inflates
(d) Balloon deflates (e) Removal (natural discharge)
(a) Capsule enters the stomach
(b) Resides in stomach
The Future Robots in your Body
Self Configurable Robot
… able to adapt its configuration to the specific site of intervention and to the task that must be executed
A customizable self assembled and self reconfigurable robot…
Learning from nature
Studying social insect colonies, e.g. ants and bees, to inspire solutions for collective behavior, mechanics and sensing systems of microrobots I-SWARM project: 1000 cooperating bio-inspired microrobots Technological challenges (*):
• size (3 3 3 mm3) • extremely low power limits onboard (< 1mW) • mass-fabrication and assembly through microtechnologies • swarm behavior algorithms on the base of the developed HW
(*) P. Valdastri, P. Corradi, A. Menciassi, T. Schmickl, K. Crailsheim, J. Seyfried, P. Dario, “Micromanipulation, Communication, Swarm Intelligence Issues in a Swarm Microrobotic Platform”
J. of Robotic and Autonomous Systems, Elsevier 2005)
http://www.i-swarm.org/
Micro/Nano Self Configurable Robots
Screening
Biopsy, surgery and other therapies
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