6 Progress in Minimally Invasive Surgery2

8/13/2019 6 Progress in Minimally Invasive Surgery2

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Progress in Minimally

Invasive Surgery

An Evolution


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St

rategy

Unit

Trends with a high potential impact, which are more certain are:

Rising patient expectations

E health and the use of IT networks

Widespread use of intelligent devices and expert systems

Miniaturisation of diagnostic tools

Ageing population and increase in chronic disease

Common use of remote consultations and home monitoring for patients

Ageing labour force and reducing participation rates

New ways of working and changing health professions

Major pharmaceutical innovation reaching market

The widespread use of genetic screening and mainstream use ofpharmacogenomics

Trends with a high potential impact, which are more uncertain are:

Expert Patients generating a significant increase in self care

Emergence of new infectious disease

Trends with a lower potential impact, which are more certain are:

Further use of Minimally Invasive Surgery

Use of robotics

Trends with lower potential impact, which are more uncertain are:

Use of stem cell technology to regrow body parts and repair injury

(Re-) Emergence of infectious disease

Wild Cards

High Impact

High Uncertainty

High Impact

Low Uncertainty

Low Impact

Low Uncertainty

Low Impact

High Uncertainty

Some trends will have greater impact than others


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2005 Health Technology Center

Shift to Earlier Interventions

Drives Delivery SystemReconfiguration

Smarter, Smaller Surgical

Devices Drives Volume to

Minimally Invasive Surgery

Patients Embrace the

"Bionic Man" Model

Cancer is Tamed but Not

Conquered

Inpatient Cardiac Services No

Longer a Top Revenue Generator

End-Stage Care Transforms to

Long-Term Disease

Management

Access to 24x7

Healthcare Becomes a

Reality

Blockbuster Drugs Wilt asCustomized Therapies

Blossom

IT Takes Center Stage

Workforce Shortages

Soothed by Technology

Deployment

Top 10 Technology Trends


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Where Neuroscience Research Is Taking Us

Neurosurgery:

Less invasive approaches to neurosurgical diseases Aneurysms, AVMs, pituitary tumors, some spine

Successful molecular treatments for neoplastic diseases

CML, medulloblastoma, meningioma, ALL

Will eliminate skull base surgery for tumors, and othergrossly invasive approaches for neoplasms

Imaging indicating functional significance of every part ofbrain.

damage to cognitive brain functions by standard

neurosurgical procedures Will change neurosurgery to a minimally invasive

technical specialty


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Gallbladder Surgery

Washington State Hospital Association Health Information Program

Improved Outcomes:

Open Laparoscopic

Hospital Stay* 3-7 days 0-1 dayAvg return to work** 6 weeks 2 weeks

Incision length* 5-8" 4 tiny incisions

Laparoscopic

gal lb ladder

surgery has

led to shorterho sp ital stay,

faster return

to work, and

less inc is ionpain and

scarr ing

*Healthcommunities.com, Surgery Channel, Cholecystectomy.

http://www.surgerychannel.com/cholecystectomy/preop.shtml#post

**Glavic Z, Begic L, Simlesa D, Rukavina A. Treatment of acute cholecystitis: A

comparison of open vs laparoscopic cholecystectomy. Surg Endosc 2001 Apr; 15(4):398-

401
http://www.surgerychannel.com/cholecystectomy/preop.shtmlhttp://www.surgerychannel.com/cholecystectomy/preop.shtml


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Knee Replacement


Total Knee Replacement:Allarticulating surfaces of the knee joint are

replaced with synthetic prosthesis

Partial Knee Replacement: Only aportion of the knee joint is replaced

Minimally Invasive Partial Knee

Replacement: A partial kneereplacement done with a smaller incision

to reduce post-operative pain and improve

the recovery period

Of those

individuals

who require

knee

replacement

surgery, about

30-40%...can

benefit from a[partial] knee

replacement--The Rush Arthritis and

Orthopedics Institute

Techno log ical Advances:


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Knee Replacement


Improved Outcomes:

Total KneeReplacement

Minimally

InvasivePartial

Hospital Stay 3-5 days 1-2 days

Avg return to walking 4-12 wks 1-2 wks

Incision length 7-8" 3-3.5"

Minimal ly

invasive

part ial knee

replacement

has a sho rter

ho sp ital stay,

faster return

to walking ,

and less

inc is ion pain

and scarr ing

Source: University of Washington Department of Orthopaedics and Sports Medicine.

Minimally-Invasive Knee Replacement Edited by Seth S. Leopold, M.D.

http://www.orthop.washington.edu/faculty/Leopold/miniknee/print
http://www.orthop.washington.edu/faculty/Leopold/miniknee/printhttp://www.orthop.washington.edu/faculty/Leopold/miniknee/print


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Coarctation repair byrobotic surgery

QuickTime an d a

YUV420 codec decompressorare needed to s ee this picture.

Tal Geva 2/04


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Trend 2: Smarter, Smaller Surgical DevicesDrive Volume to MIS

Where is the grow thoccur r ing?

Trends: productivity, turf

wars, costs (plans), outcomes


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PAST: Cut, then see


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PRESENT: See, then cut


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FUTURE: Combine, see,minimally cut

t


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Compu ter-based sys tems to enhancethe surgeons dexter i ty, visual

feedback , and info rmat ion integrat ion

Trend towards minimally invasive surgery:

laparoscopy, endoscopy, minimal incisions

Computer plays a key role in:

3D visualization, model construction

quantitative integration of information

preoperative planning and intraoperative execution

Medical CAD/CAM -- a paradigm shift!

omputer e urgery(CAS)


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Current practice


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Computer-based technologies


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Elements of a CAS system


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Salisbury

Endoscopic, Minimally Invasive Surgery (MIS)

Elimination of

large incisions

Dramatic decreasein post-op pain

A revolution in

surgical technique


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Salisbury

Why Use Robotically Aided Surgery?

Precision

Enhance Dexterity

Enables work in confined spaces

Enable Remote Participation

Eliminates hand tremor


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Salisbury

Medical Robotics - the second wave

Illustration courtesy Dr. Akhil Madhani

Computer-enhanced surgical dexterity through telemanipulation


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Salisbury

Surgeons Console

3D visual immersion

Eye - hand alignment

7 DOF haptic interface


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Salisbury

Eye - Hand Alignment

Image of instrumentsappears in place of hands

Hand motions replicatedinside patient

Scaled and indexed motion

Camera and cautery control


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Teaching Tool Kit

Technology Tools Digitized Lectures

CD ROMS

Video-streaming

Blackboard Class Materials

Virtual Student Groups/e-Learning Options

Telecommunication/Tele-education Classes

Tips for Success

Relationships, Proactive Approach, Etiquette


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Robots in Surgery

Definition

Surgical assisting

devices

Surgeon-computer-instrument interface

Minimally invasive

surgery


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Da Vinci surgical system

NASA Amesresearch centre -space surgery

DARPA battlefieldsurgery

1994 first robotic

operation

intestinalanastomosis


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Minimally Invasive Robotic Surgery
http://d/IAMIS%2015052006/Progress%20in%20Minimally%20Invasive%20Surgery/MIRS.ppthttp://d/IAMIS%2015052006/Progress%20in%20Minimally%20Invasive%20Surgery/MIRS.ppt


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Minimally Invasive Paediatric Surgery
http://d/IAMIS%2015052006/Progress%20in%20Minimally%20Invasive%20Surgery/CANAPedsMinimallyInvasiveNevins.ppthttp://d/IAMIS%2015052006/Progress%20in%20Minimally%20Invasive%20Surgery/CANAPedsMinimallyInvasiveNevins.ppt


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Robotics Revisited
http://d/IAMIS%2015052006/Progress%20in%20Minimally%20Invasive%20Surgery/Robotic%20surgery.ppthttp://d/IAMIS%2015052006/Progress%20in%20Minimally%20Invasive%20Surgery/Robotic%20surgery.ppt


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Paediatric MIS revisited
http://d/IAMIS%2015052006/Progress%20in%20Minimally%20Invasive%20Surgery/Peds%20MIS.ppthttp://d/IAMIS%2015052006/Progress%20in%20Minimally%20Invasive%20Surgery/Peds%20MIS.ppt


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6 Progress in Minimally Invasive Surgery2