Presented by Dr Sanjoy Sanyal Surgeon in Victoria Hospital, Ministry of Health, Seychelles, and Associate Professor of Surgical Anatomy and Neuroscience (then), at 9th National Medical Dental Conference in Seychelles, February 2006. It talks of remote surgery using Internet.
- 1. Advances in Telesurgery and Surgical Robotics Dr Sanjoy
Sanyal MBBS, MS (Surgery), ADPHA, ADHRD Presented at 9 thNational
Medical Dental Conference in Seychelles, February 2006
2. Preface (added 2009)
- This PPT represents developments in the field during late 90s
and early 2000s, in:
-
- Stanford University School of Medicine
-
- University of California Berkeley (UCB)
-
- Massachusetts Inst. of Technology (MIT)
-
- Escort Heart Institute Research Centre (EHIRC), New Delhi,
India
- Telesurgery / surgical robotics has advanced considerably
now.
3. The research pioneers
- Stanford Research Institute (SRI) @ Stanford University School
of Medicine
- Human Machine Systems Lab (HMSL) @ MIT
- Robotic Intelligent Machines Laboratory (RIML)@ UC
Berkeley
- Robotic Telesurgical Workstation for Laparoscopy (RTWL) @
UCSF
4. Worlds first telesurgery
- September 2001 : Tele- chole
- Prof Jacques Marescaux , New York & European Institute of
Telesurgery, Strasbourg
- Round distance =14,000 km
- Round Trip Time= 200 msec; video and hi-speed fibre-optic
link
- June 2001 : Johns Hopkins University, Baltimore & Rome
Policlinico Casilino University
- http://news.bbc.co.uk/2/hi/science/nature/1552211.stm
5. Background
- Stereoscopic vision with depth perception
- Cognitive feedback limited
- Binocular vision without depth perception
6. Definitions
- Telepresence surgery : Computerized interface @ surgical
workstationremote operative site; force feedback (haptic)
- Cooperative telesurgery : tele-surgeon / local (remote)
assistant cooperation
- http://www2.telemedtoday.com/articles/telesurgery.shtml
- http:// web.mit.edu/hmsl/www/Telesurgery /
7. Definitions contd
- Telerobotics : Remote control with a robotic arm, in
conjunction with a laparoscope
- http://www2.telemedtoday.com/articles/telesurgery.shtml
8. Definitions contd
- Telementoring : Experienced surgeon acts as tutor / instructor
( preceptor ) for remote surgeon via interactive video
- Teleproctoring( proctor=supervisor of exams ): Documentation of
performance for privileging purposes
- http://www2.telemedtoday.com/articles/telesurgery.shtml
9. Technical aspects
- Image transmission : T1 transmission (H-320 compression
standard)
10. Haptic
- Force reflection / feedback; Graduated tactile input
-
- resistance at remote site is transmitted to near site by servo
motors @ both sites
11. Robotic vs. human arm
- DOF : Number of ways an arm can move
- Robotic arm : Like human hand, arm and moveable elbow - butwith
a fused wrist
12. Telesurg dynamics @ MIT
- Surgeons fingers placed in rings of instruments
- Rings are connected tomotors ,gearsandbelts
- Precisely translate surgeons hand / finger motions into digital
signals
- Transmitted through computer- telecomm link
- To robotic arms @ remote surgical station
- Visual input : 2 remote CCD cameras (15 fps each-> 3-D
effect )-> Surgeons monitor -> Mirror -> Optical3-D
glasses (stereoscopic vision)
http:// web.mit.edu/hmsl/www/Telesurgery 13. Telesurg components
@ MIT 14. Surgeons master tool handle @ MIT 15. Surgeons master
tool handle @ MIT 16. Master phantom haptic interface arm 17. Slave
phantom haptic interface arm 18. Tele-operation slave tool 19.
Tele-operation slave tool 20. Tele-operational details Tool 21.
Tele-operational details Interchangeable tool tips 22. Experimental
task - grasp / transfer 23. Experimental task - Grasp and transfer
with orientation 24. Experimental task - Clip application 25.
Experimental task grasper / gripper and shear / scissors 26. Lap
experiment box @ MIT 27. Lap simulator-1 @ MIT 28. Lap simulator-2
@ MIT 29. Dynamics of robotics @ UC
- Surgeon remote location TV console set of handheld controls ~
videogame joysticks
- Joystick :Pencil-sized; 1 for each hand
- Computer : Program translates surgeons movements
- End-effectors : Robotic instruments enter body to perform
actual operation
-
- Early models : 3-fingered hand
-
- Present : Hydraulic-powered, single-digit, 3-4 x , 4-jointed
(rotate, swivel, to-fro), 2-pronged end grasper
http:// robotics.eecs.berkeley.edu /medical/ 30. Details of
robots
- Robo-doc : 2 robots working in concert
-
- Companion robots / milli-robots / robotic manipulators
31. Holding robots
- Pair of large robotic arms
- Sits on moveable platform
- Driven remotely by surgeons joysticks
- Performs like a surgeons shoulder, allowing positioning of its
hydraulic arms
32. Holding robots contd
- Holds 2 ndrobot, wheels instruments into position by patients
side
- Guides them through dexterity-requiring surgical procedures
(suturing, dissection)
- Holds instruments steady while surgeon sutures and ties
knots
33. Companion / Milli-robots / Robotic manipulators
- Sterile, disposable, steel, mm-scale, fingertip-sized
- Slender, jointed, finger-like tools
- Connected by wires and tubes to larger robot
- Pair of gripping forceps at one end to carry surgical
tools
- Contains miniscule video-camera
34. Companion robot contd
- Inserted into body for actual surgical tasks (cutting,
suturing) 10-20 mm incisions
- Provide tactile feedback though force-deflecting joysticks
35. Setup @ UC Berkeley 36. Equipment @ UCB 37. Robotic
manipulator @ UCB 38. Mini robot controls @ UCB Roll-pitch-roll
wrist, gripper and multi-fingered manipulators 39. Robotic
endo-manipulator Endo-platform with biopsy forceps 40. Minute
threading 41. Threaded robotic instruments knot tying 42. 2-G RTWL
@ UCSF In a joint project betweenRIMLofUCBandDepartment of
SurgeryofUniversity of California San Francisco( UCSF ), aRobotic
Telesurgical Workstation for Laparoscopy (RTWL) was developed 43.
Lap interface @ UCSF 44. 4-DOF lap haptic interface 45. Robotic
Cardiac Surgery @ EHIRC
- Escort Heart Inst. Research Centre in New Delhi, India
- Implemented da Vinci Tele-manipulationsystem
- Intuitive Surgical Inc., Mountain View, CA, USA
-
- Cart-mounted robotic manipulators
-
-
http://www.ehirc.com/individuals/services/treatment/robotic_surgery.html#
46. Surgeons console @ EHIRC
- Display system : 3-D pictures of chest cavity
- Surgeonsits at console and gets 3-D view of chest interior
- Hand motions are captured, transformed and transmitted to tiny
robotic manipulators
47. Robotic manipulators @ EHIRC
- Robot is not autonomous; surgeon-controlled
- Hold tiny instruments, which go inside the patient's
chest.
- Surgeon's hand movements transmitted to these instruments
- CABG, mitral valve repair, ASD closure
48. IMA LAD CABG 49. Totally endoscopic CABG
-
- Only 3-incisions, each 1 cm on the side and lower chest
-
- Faster healing and recovery
50. Technical innovations
- Teletactation (Tactile feedback)
- CyberGlove with CyberTouch
- Spatial cognition Hand assist
- Surgical simulations / Virtual reality
51. Teletactation Tactile feedback
- Sensing tactile information throughtactile sensorsthat transmit
feel of tissue to surgeons finger
52. CyberTouch CyberGlove
- Vibro-tactile, thermal simulators on eachfingerandpalm
- Tactile feedback optionenables feelof virtual object
53. CyberGlove
- Flexible sensorsmeasure position/movementoffingersandwrist
54. Dextrous master glove
- Thumb ,index ,wristflexion sensors and wrist rotation
sensor
- Senses positionsof surgeon's fingers/wrist
- Used as master to drive slave robotic hand
55. Spatial cognition Hand assist in telesurgery Non-dominant
hand in-vivo possibly enhances spatial skills through tactile cues,
which generate a more accurate 3-D representation of anatomy 56.
Lap chole simulation Simulated fat and fascia Dissected away;
cystic duct clipped 57. Lap chole simulation contd Cystic artery
and duct divided successfully in simulated conditions 58. Karlsruhe
Gynec endo surgery simulations 59. Gynec surgery simulations contd
http://www- kismet.iai.fzk.de/VRTRAIN/phD_main.html http://www-
kismet.iai.fzk.de/VRTRAIN/GIF/PHD/surgSim.jpg 60. Dextrous mini
robots
- 2 Equipped with a needle for biopsy
- 3 Moves around abdominal cavity spiral pattern moves without
slipping
- http://news.bbc.co.uk/1/hi/health/4647258.stm
61. Summary
- Technically demanding, labor intensive, time consuming,
expensive research
- Learning curve with similar characteristics
- Expensive installation, maintenance and infrastructure
62. Future applications
- One-to-many telementoring
63. Cutting edge research today, surgical technology tomorrow
64. Conclusion
- Science knows no country, because knowledge belongs to
humanity, and is the torch which illuminates the world . Louis
Pasteur
- Don't be afraid to take a big step. You can't cross a chasm in
two small jumps .