Robotics in surgery Patrick A Finlay Ph. D CEng Director and Chief Technical Officer, Prosurgics Ltd
History of Robotics 800 BC Homer describes walking tripods 1921 The term "robot" invented by Karel Capek 1938 Mechanical arm for spray-painting. 1942 Isaac Asimov: Three Laws of Robotics. 1961 First commercial robot 1965 CMU creates Robotics Institute 1973 Wabot built at Waseda University Tokyo 1982 Int’l Advanced Robotics Programme 1986 First surgical robot
Surgical Robotics: current status § ~ 1200 surgical robots in regular clinical use worldwide. § Surgical robotics globally worth ~ $2 B § Annual growth ~ 50% per annum § Small number of specialist companies § R&D in progress at over 100 universities world wide,
Commercial surgical robotics MEDICAL ROBOTICS Surgical Robotics Telemanipulators Non surgical Image guided surgery
The two branches of robotic surgery Telemanipulator (master-slave) Image guided (true robot)
Telemanipulators Master Slave systems
Single arm telemanipulators endoscopic camera control
Single arm camera holder Endo. Assist, Prosurgics Ltd
Single arm camera holder Clinical benefits Position anywhere around the table Does not obstruct operation Entry port can be in any position Endo. Assist, Prosurgics Ltd
Head movement control Pan, zoom or tilt the camera with a head gesture
Miniaturised camera holder Free. Hand, Prosurgics Ltd
Miniaturised camera holder in use No obstruction of surgical access or screen sightline
Multi arm telemanipulator Da Vinci Intuitive Surgical Inc
Multi-arm telemanipulator Motion scaling to micro-wrist Da Vinci, Intuitive Surgical Inc
Multi-arm telemanipulator Surgeon operates robot from a remote console
Telesurgery Surgeon in New York Patient in Strasbourg Pictures from Computer Motion Inc
Telesurgery applications
Image Guided Robots Example: Neurosurgery
Robotic neurosurgery
Image-guided surgery 1927 arteriography 2007 MR image
Fusion of image modalities MRI CT Angiography
Fused images and Brain Atlas
The neurosurgeon’s quest § how to reach the target I’ve pinpointed on the scan § with the same accuracy that I can see it. . . § . . . but with minimal collateral damage. . . § . . . and simply, with a short procedure time. . . § . . . and without costing a fortune
Registration: key to accuracy
Stereotactic frame
Stereotactic frame targeting arc
Fiducial markers
Testing prior to surgery Skin Markers used as artificial targets for confirming accuracy
Neurosurgery robot registration Camera and light ring camera in the robot’s wrist scans the patient computer matches camera and CT scans
Sterile environment control
Deep Brain stimulation
Brain tumour biopsy Robot guided biopsy needle insertion. Multiple biopsies are possible along a single trajectory
Epilepsy Robotic 3 -D positioning of depth electrodes to determine focus of epileptic seizure
Grid pattern tumour treatment Magnetic nanoparticles Modified virus Stem cells Interstitial radiotherapy Convection enhanced delivery New pharmaceuticals
Image Guided Surgery Applications outside Neurosurgery
Early beginnings Robo. Doc Femoral reaming ISS Inc
IGS trajectory control Orthrobot Dynamic hip screw placement Armstrong Healthcare (now Prosurgics Ltd)
IGS path control Machining of femur and tibia for total knee replacement CASPAR orthopaedic robot URS Gmb. H
Active-constraint IGS Total knee replacement robot allows the surgeon to operate freely in the safe zone, but prevents entry elsewhere Picture from Imperial College London
Active constraint IGS Total knee replacement Photographs: Imperial College London
Surgical Robots: The next generation
New generation surgical robotics MEDICAL ROBOTICS Non surgical Strategic Surgical robots Micro mobile robots with autonomy Tactical Surgical Robotics Telemanipulators Image guided surgery (Dual guidance)
Miniaturisation powered and passive Do. Fs Pedicle screw guidance Parallel structure Praxiteles Spine. Assist Praxim SA Mazor Surgical Technologies Ltd
Probe tip tracking Electromagnetic tracking Ascension Technologies Inc
Motion compensation Low inertia, high payload, force control robot Kinemedic DLR
Real time imaging and modelling University of Verona
New types of surgery “NOTES”: Natural orifice transgastric endoscopic surgery
New types of surgery CAD CAM dental implant Vancouver Institute for Advanced Ceramics Custom hip implants SCP Norway
Free-roaming camera (pre-robotic) Given Imaging, Israel swallowable camera 2 frames/s for 6 hours
Crawling microrobots Roaming robot with camera and biopsy needle NOTES surgery of the abdomen swallowable camera with 6 -legged propulsion CMU/ Korean Intelligent μsystems centre University of Nebraska
Swimming microrobots Swimming robot Autonomous Swimmer. Eyeball cavity, CSF, urinary system Subarachnoid space of spine. Pushmepullyou swimmer Carnegie Mellon University Technion University
Multi-segment snake arms 23 Do. F holonomic snake arm Nuclear maintenance OC Robotics. Ltd Tube crawling concertina snake Experimental flexible endoscopic manipulator Johns Hopkins University Disaster rescue Carnegie Mellon University
Biomimetics Biomimetic lobster Wood wasp ovipositor goal–achieving behaviour Artificial muscle actuators Robot carp: serpentine motion Northeastern University MA Essex University
Intelligence I-SWARM Co-operating robots 21 Do. F fault tolerant snake arm for Space vehicles Kahlsruhe University (leader) NASA JSC Evolutionary learning bipedal locomotion Chalmers University
A new safety paradigm Old approach: “rigid design for accuracy; active control for safety” New approach: “intrinsically safe design; control for performance” LE 3 robot DLR
“Dependability” § Safety § reliability § maintainability § Availability § legibility – “the psychological ability of a user to understand what the robot is intending”
Architecture § Classical: “sense > plan > act” § Deliberative (eg NASA): “reason > model > react” § Subsumption (Brooks): behaviour based § Hybrid: high level deliberator <> mediator <> low level reactive executive
Intrinsically safe robot inertia DM 2 robot structure Duplicated actuators Stanford University
Future surgical robots: in summary § Miniature § Physiologically registered § Sensuate § Dependable § Autonomous §. . . and Ubiquitous NASA NEEMO
Today’s surgical robots are already Clinically beneficial Cost effective Improving patient outcomes Improving Safety Lowering Costs Enabling New procedures New surgical robots will be § SMALL, including intrabody. § Intelligent and sensuate § Semi- autonomous § Ubiquitous in surgical procedures
Robotics in surgery Patrick A Finlay Ph. D CEng Director and Chief Technical Officer, Prosurgics Ltd
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