Surgical System based on Manufacturing Technologies

Utokyo Forum Biomedical and Mechatronics Engineering November 12th, 2013, Sao Paulo, Brazil

Mamoru MITSUISHI Department of Mechanical Engineering,

School of Engineering, The University of Tokyo

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1st generation

X-ray, CT, MRI (static image) (resolution: 0.1 mm) Endoscope (diameter: 10 mm) Forceps (diameter: 10 mm) Organ level therapy (mm order) Diagnosis and treatment are executed by a surgeon

Supermicrosurgery Process innovation in

the surgery Tele-surgery

0.02 mm

0.8 mm

8mm

0.5mm

70-150μm

24mm

Bone

Cutting tool Bone tissue

Roughness： 40 μm Temperature ：50℃ Efficiency：5 times

Flow type Crack type

8mm Pediatric surgery

Eye surgery

Neurosurgery

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2nd generation

Imaging in the body (micro meter order) Real-time continuous imaging of the motion and the

deformation for an internal organ and a heart (4D) Local and high precision non- and minimally-invasive

cell level target therapy (micro meter order) Integration of diagnosis and treatment

HIFU (High Intensity Focused Ultrasound)

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3rd generation

Shape analysis to function analysis for imaging

From surgical operation to dosage, regeneration, diagnosis and prophylaxis using tissue engineering (organ/vessel, bone, skin and nerve), nano diagnosis and treatment (nano immunity diagnosis, gene therapy and DDS)

Automatic diagnosis and treatment (Pathological diagnosis using medical image. Treatment is executed automatically.)

Capsule type diagnostic and treatment environment to keep clean, high oxygen density, low temperature and high pressure around the patient

Microrobot

Blood vessel diameter：3mm Flow speed：70 mm/s

Motion along the blood vessel

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Slave manipulator

Master manipulator

Curvature guide: Fixed point can be realized mechanically.

Magnification ratio: 40:1

Supermicrosurgery

VIDEO

Cannulation to the micro blood vessel with diameter 120 μm

Anastomosis of 0.3 mm artificial blood vessels (Neurosurgery)

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Manual System

Manual: 140 μm Developed system: 15 μm

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Conventional cutting tool

High efficiency and low temperature machining High precision machining Crack type Flow type

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r1

r2

Crack type cutting

Flow type cutting

Cutting tool which satisfies the requirements

To satisfy the 3 requirements at the same time

Realization of crack and flow type cutting in one process

2 different cutting types

Asymmetrically assigned 2 teeth

Remove the micro crack

- Preparation of 2 different radius teeth - Larger radius tooth generates the flow type cutting

Process innovation in the surgery (Proposal of new bone cutting method)

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Tele-surgery: Asynchronous presentation of visual and force information

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0 100 200 300 400Time difference [msec]

Com

pletion t

ime [

sec]

Earlier force presentation

Without force information

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0 100 200 300 400Time difference [msec]

Max

imum

forc

e [

N]

Earlier force presentation

Without force information

Task completion time Applied force to the target

No influence of the time difference on the operation time was observed. The maximum force on the target decreased when the force was presented earlier. (The significance level was 5 % when the time difference was 400 ms.)

Urethane rubber tube Inner diameter: 10 mm Outer diameter: 16 mm Height: 20 mm

Grasping task

50mm

50m

m

75mm

50mm

50m

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75mm

8 HIFU (High Intensity Focused Ultrasound):

Improvement of tracking Tracking mistake exists. Spike-type trajectory error exists.

Template with removal

x z

Tracking using a template without removal of high noise area

Tracking using a template with removal of high noise area

Selected area as a template

Tracking mistake does not exit. Template without removal

9 Microrobot: Target medical application

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It is difficult to operate a catheter externally, which is inserted from the femoral artery to the brain.

Coil

Catheter

1. Endovascular coiling

Cerebral aneurysm

SAH (Subarachnoid hemorrhage)

2. Surgical clipping

The robots fill up the knob and make a thrombus.

Micro robots

Treatment using a micro robot

Cerebral aneurysm

10 Conclusions

1. Future of the medical robots (1) 1st generation - Supermicrosurgery - Process innovation in the surgery - Tele-surgery (2) 2nd generation - Therapeutic system using HIFU (3) 3rd generation - Microrobot 2. To promote the practical use of medical devices - Patient model with sensors to provide quantitative

evaluation