Advances in Telesurgery and Surgical Robotics

oregontrimmingAI and Robotics

Nov 2, 2013 (3 years and 9 months ago)

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Advances in Telesurgery and
Surgical Robotics

Dr S. Sanyal

World’s first telesurgery


September 2001
: Tele
-

chole



Prof Jacques Marescaux
,
New York & European Institute
of Telesurgery, Strasbourg



Round distance

=14,000 km



RTT

= 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/n
ature/1552211.stm

The research pioneers


SRI @ Stanford U School of Medicine


HMSL @ MIT


IMRL @ UC Berkeley and UCSF


Background

Traditional surgery


Tri
-
dimensional


Cognitive input


Tactile feedback


Stereoscopic vision
with depth perception


Time lag
-
ve

Telesurgery


Two
-
dimensional


Cognitive feedback limited


Tactile feedback

ve


Binocular vision without
depth perception


Time lag +ve

Definitions


Telepresence surgery
:
Computerized
interface @ surgical workstation


remote
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/




Definitions


cont’d


Telerobotics
: Remote control with a
robotic arm, in conjunction with a
laparoscope





http://www2.telemedtoday.com/articles/telesurgery.shtml


Definitions


cont’d


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


Technical aspects


Image transmission
: T1 transmission (H
-
320
compression standard)


Fibre
-
optic cable


Microwave


Satellite


Lag time
: should be
<

330 ms


VOR disruption (3
-
D vertigo; Simulator sickness within
20 minutes)


Movement scaling
: 1cm
→ 1mm


Haptic
: Force feedback



Haptic


Force reflection / feedback; Graduated
tactile input



resistance at remote site is transmitted to
near site by servo motors @ both sites


Robotic vs. human arm


DOF
: Number of ways an arm can move


Human arm
: 7
-
DOF


Human hand
: >20
-
DOF


Robotic arm
: Like human hand, arm and
moveable elbow
-

but
with a fused wrist



Robotic arm
: 4
-
6 DOF

Telesurg dynamics @ MIT


Surgeon’s fingers placed in rings of instruments


Rings are connected to
motors
,
gears

and
belts



Precisely translate surgeon’s 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
)
→ Surgeon’s monitor → Mirror →
Optical
3
-
D glasses (stereoscopic vision)

http://web.mit.edu/hmsl/www/Telesurgery

Telesurg components @ MIT

Surgeon’s master tool
handle @ MIT

Surgeon’s master tool
handle @ MIT

Master phantom haptic
interface arm

Slave phantom haptic
interface arm

Tele
-
operation slave tool

Tele
-
operation slave tool

Tele
-
operational details


Tool

Tele
-
operational details


Interchangeable tool tips

Experimental task
-

grasp /
transfer

Experimental task
-

Grasp
and transfer with orientation

Experimental task
-

Clip
application

Experimental task


grasper /
gripper and shear / scissors

Lap experiment box @ MIT

Lap simulator
-
1 @ MIT

Lap simulator
-
2 @ MIT

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 surgeon’s
movements


End
-
effectors
: Robotic instruments enter body to
perform actual operation


Early models
: 3
-
fingered hand


Present
: Hydraulic
-
powered, single
-
digit, 3
-
4” x ½”, 4
-
jointed (rotate, swivel, to
-
fro), 2
-
pronged end grasper


Anthropomorphic

movements

http://robotics.eecs.berkeley.edu/medical/


Details of robots



Robo
-
doc
’: 2 robots working in concert


Holding robots


Companion robots / milli
-
robots / robotic
manipulators


Holding robots


Pair of large robotic arms


Hydraulic
-
actuated


Sits on moveable platform


Driven remotely by surgeon’s joysticks


Performs like a surgeon’s shoulder,
allowing positioning of its hydraulic arms


Holding robots


cont’d


Holds 2
nd

robot, wheels instruments
into position by patient’s side


Guides them through dexterity
-
requiring surgical procedures
(suturing, dissection)


Holds instruments steady while
surgeon sutures and ties knots

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


Companion robot


cont’d


Inserted into body for actual surgical
tasks (cutting, suturing)


10
-
20 mm
incisions


Inserts cameras


Provide tactile feedback though force
-
deflecting joysticks


Provides 7 DOF

Setup @ UC Berkeley

Equipment @ UCB

Robotic manipulator @ UCB

Mini robot controls @ UCB

Roll
-
pitch
-
roll ‘wrist’, gripper and
multi
-
fingered manipulators

Robotic endo
-
manipulator

Endo
-
platform with biopsy forceps

Minute threading

Threaded robotic
instruments


knot tying

2
-
G RTWL @ UCSF

Lap interface @ UCSF

4
-
DOF lap haptic interface

Robotic Cardiac Surgery @
EHIRC


da Vinci Tele
-
manipulation

system


Intuitive Surgical Inc., Mountain View,
CA, USA


Computer enhanced system


Surgeon’s console


Cart
-
mounted robotic manipulators


http://www.ehirc.com/individuals/services/treatment/robotic_surgery.html#

Surgeon’s console @ EHIRC


Display system
: 3
-
D
pictures of chest cavity


Surgeon

sits at
console and gets 3
-
D
view of chest interior


Hand motions are
captured, transformed
and transmitted to tiny
robotic manipulators


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

IMA


LAD CABG

Totally endoscopic CABG


Advantages


Only 3
-
incisions, each 1 cm on the side and
lower chest


Less pain


Faster healing and recovery


Short hospital stay

Technical innovations


Teletactation (Tactile feedback)


CyberGlove
®

with CyberTouch


Dextrous master glove


Spatial cognition


Hand assist


Surgical simulations


Dextrous mini
-
robots




Teletactation

Tactile
feedback


Sensing tactile information through
tactile
sensors

that transmit feel of tissue to
surgeon’s finger

CyberTouch


CyberGlove
®


Vibro
-
tactile, thermal simulators on each
finger

and
palm


Tactile feedback option
enables feel

of
virtual object

CyberGlove
®


Flexible sensors
measure position

/
movement

of
fingers

and
wrist


Dextrous master glove


Thumb
,

index
,
wrist
flexion sensors and
wrist rotation sensor


Senses positions

of surgeon's fingers/wrist


Used as master to drive slave robotic hand

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

Lap chole simulation

Simulated fat and fascia

Dissected away; cystic duct clipped

Lap chole simulation


cont’d

Cystic artery and duct divided successfully in simulated conditions

Karlsruhe Gynec endo
surgery simulations

Gynec surgery simulations


cont’d

http://www
-
kismet.iai.fzk.de/VRTRAIN/phD_main.html


http://www
-
kismet.iai.fzk.de/VRTRAIN/GIF/PHD/surgSim.jpg


Dextrous mini robots


1


Camera attachment


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










Summary


Technically demanding, labour intensive,
time consuming, expensive research


Learning curve with similar
characteristics


Expensive installation, maintenance and
infrastructure

Future applications


Emergency trauma care


1
st

‘Golden
Hour’


Battlefield surgery


Remote area assistance


One
-
to
-
many telementoring


Space station surgery

Pre
-
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
.”





David Lloyd George

Conclusion