"The future of surgery is not about blood and guts; the future of surgery is about bits and bytes.”
/Dr. Richard Satava/

Friday, July 31, 2015

CRAS deadline extended

Good news for the latecomers! The program committee of CRAS2015 decided to extend the submission deadline to August 7. Come and join the European CIS community--it will be a great event! 

Monday, July 27, 2015

GuidaBot: a new MR-compatible system

Prof. Tsekos' lab at the University of Huston have been developing various MR-compatible concepts for heart and needle procedures. Their latest device is now span off to GuidaBot LLC and gained a seed investment from Fannin Innovation
"GuidaBot LLC is developing a robotic manipulator designed to work within the powerful magnetic field of an MRI, allowing physicians to perform interventions using real-time MRI imaging for absolute precision.
GuidaBot’s force transmission mechanism and proprietary software component allow patients to remain in place within the MRI machine allowing for faster and more precise biopsy procedures. Currently, MRI-guided biopsy procedures call for the patient to be removed from the machine before placement of the needles can be made, increasing procedure time and costs.
“The company will initially focus on medical applications to treat several conditions, but interest from the energy industry has helped identify additional opportunities,” said Fannin managing partner Atul Varadhachary, M.D., Ph.D.
The technology was invented by University of Houston robotics expert and Director of the Medical Robotics Laboratory Dr. Nikolaos V. Tsekos. Backed by a $1.4 million National Science Foundation grant, research for the robotic system has been conducted in partnership with Houston Methodist."

Sunday, July 26, 2015

Unofficial comments on FDA's RASD discussion paper

A few weeks ago FDA released a Discussion Paper to facilitate the dialog of the upcoming Public Workshop (starting on Monday).
The document is a great starting point, and identifies key critical aspects of the field, however, it has some shortcomings that should be addressed to make the meeting and the overall dialogue most fruitful. 
  1.  The FDA Discussion Paper defines robotic surgery (p.2) as a classical master-slave teleoperational system. Later it confirms that it is only addressing "da Vinci type" robotic devices as RASD (p.8). This narrowing of the scope immediately creates a vast void on the imagined landscape of robotic surgery devices, since there are already a dozen different  systems cleared by the FDA (see our recent survey), and numerous other types are to come. Image-guided surgical robots (ROSA, neuromate, THINK Surgical (aka ROBODOC), iSYS, Mazor's SpineAssist), the catheter robots and other special types (e.g., ARTAS' hair restoration system) are all considered to be surgical robots. These systems' milestone achievements are all missing e.g. from the historical overview (p.4).
  2. Further NOTES devices, capsule robots, nanorobots and other emerging platforms should also be addressed by the workshop. 
  3. Energy delivering robots are not addressed either, such as CyberKnife or HIFU robots.
  4. While FDA uses the current ISO definition of Robots (ISO 8373:2013), this standard also defines "robotic devices", through which the scope of the definition can be extended. Most importantly, the ISO/TC 184/SC 2/JWG 9 is actively working on a Technical Report to define the "Degree of Autonomy", which is currently not defined. According to the current draft, kinematic capabilities (and master-slave teleoperation in general) will be considered to be a lower level of DoA, therefore da Vinci type systems are expected to clearly fall under the category of "robot".
  5. Haptic feedback (p.5) exists for some systems (e.g., MAKOplasty), yet the cost/benefit ratio should be established first for master-slave systems.
  6. Within design (p.6), usability is a key issue. The human-machine interface has a major importance in the case of master-slave systems, and current relevant standards are not detailed enough. 
  7. Standardization of robotic surgery training has advanced significantly in the past few years, this should be better presented in the paper: the R-FLS is now becoming a validated curriculum. 
  8. App1: Challenges and Opportunities1: since there yet exist no strict standard for any particular surgical procedure (only schools and basic protocols), it is extremely hard to test any RASD system against anything else than its own design specification.
  9. Testing a device is not enough, RASD should also be considered as a cyber-physical system, human and machine together! 
  10. Ch&Opp2: Medical imaging has gained a high level of standardization. Surgical planning and then executiong should also follow a similar path. 
  11. Ch&opp6: The technology transfer from academia to industry should be streamlined to enable better systems coming to the market. In the mean time, the fundamental problem of "competition vs. collaboration" affects largely the field, since the existing companies are profit proven. The value for patients vs. the value for shareholders must be balanced. 
Minor comments:
  1. Minor notice that the 3 components mentioned as key parts of a RASD (p.2) are only visible as 2 in the newer generation
  2. The K965001:1997 cited (p.4) refers to the "Mona" system.  

The statements above do not represent any official standing points or arguments, and solely form the professional opinion of the author of this post.

Friday, July 24, 2015

We need your help!

We want to hear your opinion! The ISO/IEC TC 184/SC 2 JWG35 is working on a new particular standard for surgical robots. For this, we need to define and practically delimit the filed of surgery. Help us by filling the form below

Thanks a lot!

Wednesday, July 22, 2015

Monday, July 20, 2015

Surgical Robots Archives--World's First Surgical Robot

Following a series of successful articles about the early days of surgical robotics (Vol.1, Vol.2, Vol.3, Vol.4), here is a post about the Beginning.

All the fame and all the glory goes to the "world's first". In medical/surgical robotics, it is typically hard to determine what was first. Different systems have been used for different purposes. There are many reports from assistive manipulator prototypes from the 1970s [Article], and we know the proposed surgical telemanipulator concept from Alexander et al from NASA, the early 1970s.  

Probably, the first robot used to assist with patients is the Arthrobot from 1983 (also called Heartthrob), and the scrub nurse robot used with it. It was developed by  Dr. James McEwen, Geof Auchinleck and Dr. Brian Day at University of British Columbia (Vancouver, BC). The very first surgical procedure with robot assistance happened March 12, 1984 at the UBC Hospital, and within a year, over 60 arthroscopic procedures were performed. [Reported in a Medical Post article from 1985]. Based on the patent submitted [Powered surgical retractor  US 5271384], this was an active supporting device, not treating the patient. Interestingly, the UBC group submitted another patent on their robot in 1985 [Advanced medical robot EP 0201883 A3], but it was withdrawn in 1991. Later, they developed the arm-holder version of the robot as well [Useful in surgery US 4807618].
Next stage was the much more documented neurosurgical trial in 1985 by Kwoh et al, when image guidance was first used in the OR. Yet, the PUMA robot was only used as a stereotactic targeting device. Parallel, in Japan percutaneous nephrostomy robot was developed, but no data is available on any clinical application.
The first robotic device to remove human tissue was the Probot, developed at Imperial College: Prof. Davies used the robot to remove a prostate in April 1991.
Next stage was ROBODOC, the first robot that actually treated a human patient in an autonomous (image-guided) manner Nov. 7, 1992, at Sutter General Hospital in Sacramento. Parallel with that came the Green Telepresence System and all the others...

Read more in our IEEE SACI paper.
Thanks to R.J. Webster III for the support!