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

Friday, August 28, 2015

Surgical robotics archives vol.7

Following a series of successful articles about the early days of surgical robotics (Vol.1, Vol.2, Vol.3, Vol.4, Vol.5, Vol.6), here is another forgotten story.
Remember NeuroMate? It was the first neurosurgical robot to receive CE mark and FDA approval. (Now it's part of Renishaw's product portfolio.) Here are some details about the first development of the system:
 "Fig. 1 shows the design of the system tested under clinical conditions. The head of the patient is put into a stereotactic frame, within the range of a pair of Xray systems (a film holder is put in 2 positions that are nearly orthogonal).The X-ray images are processed on a digitizing board connected to an IBM PC-AT which controls the motions of a 6 joint manipulator. At the beginning of each operation, the robot carries a calibration cage made of two pairs of plexiglass planes containing 9 metallic balls, and places it around the head in order to obtain reference X-ray images (Fig. 2). Equations linking the 3D coordinates of each landmark with the corresponding image coordinates are used in a least-squares fitting method. This provides matrices which are used later on to position the robot with respect to a pair of X-ray images. Then, the surgeon selects a target and a trajectory with the help of angiograms, ventriculograms and NMR or CT sections manually matched together. To help his decision, the surgeon has the opportunity to use anatomy based routine procedures stored in the PC (functional neurosurgery). He can also ask to align the cylindrical guide held by the robot with X-rays so that the projection of the guide on an X-ray image is a small circle on which the presence of a vessel is easily checked. Finally, the system looks for a trajectory that avoids the obstacles (mainly the stereotactic For many reasons, the introduction of robots in the medical world raises some specific problems (2). In our case, the accuracy and safety problems have been studied. We use a kinematics robot modelling based on a division of the configuration space and on the assumption that the robot is "simple" in each of the 8 sub-spaces. Specific calibration procedures based on the non-linear least-squares fitting of our model with experimental 3D measurements have been performed. As we only use relative motions with respect to the plexiglass calibration cage, we have easily obtained an overall accuracy of +/- 1 mm in each direction, and we think that a more complicated model will still increase this accuracy (3). Moreover, the position of the guide is always checked on X-ray images before being accepted, and interactive small motions are easily performed when necessary. The reduction ratios of each articulation have been modified so that the motions are slow and that hardware and mechanical breakdowns become unlikely. But most of all, when the robot is in position, the motors' supply is cut off so that no incident may occur when a tool is implanted in the brain of the patient. So far, the system has been successfully used in 16 clinical cases: 3 were stimulating electrode implants (fig 3), 12 were biopsies of tumors (fig 4), and one was a radioactive iodine seed implant."

Source:  IEEE A new system for computer assisted neurosurgery

Monday, August 24, 2015

Tianjin's Micro Hand S performs successful clinical trials


After a long silence, here are some fresh news on the Chinese Micro Hand S robot (formerly called Micro Hand A).
"The minimally invasive surgery (MIS) robot system “Micro Hand S”, invented by Tianjin University (TJU) with independent intellectual property rights, was recently used to perform surgery on three Changsha patients. This success indicates the official opening of the next stage of clinical trials for the robot, with hopes for mass production within the next three years.  The announcement was made April 4, 2014 at a press conference held by the Third Xiangya Hospital of Central South University. Wang Shuxin, project director and Dean of TJU School of Mechanical Engineering, was invited to attend. "
It performed its first clinical trials on March 26, March 31 and April 2 2014, as reported in a recent publication in Surgical Endoscopy
"In march 2014, one patient with gastric perforation and two patients with acute appendicitis who underwent robotic perforation repair and robotic appendectomy respectively. In these procedures, we firstly use ‘‘Micro Hand S’’ robot system. All of the patients were followed for 3 months, Total robotic operation time, Intraoperative blood loss and pre- and postoperative changes in routine blood test, liver function test, renal function test and major complications were recorded. Results ‘‘Micro Hand S’’ succeeded in accomplishing operations. No intraoperative complications or technical problems were encountered. At a three-month follow-up, patients were found to be progressing well, without evidence of adverse reactions."

Source: Tianjin University, Surgical Endoscopy

Saturday, August 22, 2015

News from Titan's SPORT

 "Titan’s Single Port Orifice Robotic Technology (SPORT™) Surgical System, currently under development, comprises a surgeon-controlled single incision robotic platform that includes a 3D vision system and interactive instruments for performing minimally invasive surgery (“MIS”) procedures, and a surgeon workstation provides the surgeon with an interface to the robotic platform and also provides a 3D endoscopic view of inside a patient’s body during MIS procedures.
The SPORT™ Surgical System is being developed with the goal of providing interactive instruments and a 3D vision system capable of being inserted into the patient’s body cavity through a single incision.
The design contemplates a collapsible device that, when collapsed, would be capable of being inserted into the patient’s body cavity through a skin incision of approximately 25mm.
Once inserted, the device is configured to deploy into a working configuration wherein the 3D high definition vision system and interactive multi-articulating instruments would be capable of being controlled by a surgeon at the workstation."

"The SPORT Surgical System delivers:
– Next Generation Surgical Robotic Technology 
• Innovative Robotic Platform to Enable Computer-assisted surgery 
• Automation and Navigation – Automate tasks and subtasks
• Traditional Surgical Robotic Features 
– Teleoperation 
– 3-Dimensional (Stereoscopic) Imaging 
– Restores intuitive control 
• Enhanced or New Functionality 
• Enhanced Ergonomics"

June 9, Titan had its 2015 Annual General meeting. They were named 2015 OTCQX Best 50 performing companies. The system is planned to acquire CE mark in mid-2016 and US product launch in mid-2017.

Read our previous coverage here and here. Further reading: Titan Investor presentation.

Wednesday, August 19, 2015

Monday, August 17, 2015

Virtual Incision's abdominal robots

The spin-off company of the Nebraska University--Virtual Incision--has been developing for a long time a first-of-its-kind, miniaturized robot for general surgery abdominal procedures. Recently they received another investment to boost the marketization

"Virtual Incision Corporation is a privately-held medical device company focused on developing an advanced, miniaturized robot for general surgery abdominal procedures, such as colon resections.Propelled by the knowledge that colorectal and lower gastrointestinal procedures are the fastest growing in the United States, Dr. Dmitry Oleynikov and Dr. Shane Farritor founded Virtual Incision in 2006.The company is a spin-out of the University of Nebraska, where Dr. Dmitry Oleynikov and Dr. Shane Farritor are currently based. John Murphy joined Virtual Incision in 2012 and is based in Pleasanton, California."
"According to the company’s press release, “More than two million patients undergo colon resection procedures globally each year. Approximately two-thirds of these procedures are performed via a completely open surgical procedure involving an 8- to 12- inch incision and up to six weeks of recovery time. Because of the complicated nature of the procedure, existing robotically assisted surgical devices are rarely used for colon resection surgeries, and manual laparoscopic approaches are only used in one-third of cases.1”  What makes this system so interesting and unique is that the surgical robot is essentially self-contained and basically works entirely within the body. A single incision is made for the robot to enter the body, providing access to two arms, a camera, and a light source.  Unlike it’s much larger peers that are being utilized in procedures currently, this miniaturized system does not require a specialized surgical suite. Also, the smaller size of it will bring a much lower price point. It’s possible that this minimally invasive robotic system could be used for other traditionally “open” surgical procedures.  The following video from the company offers a clearer picture of how the system functions and also offers comparisons for size reference to a quarter and cell phone. It certainly represents an exciting leap in robotic surgical technology that will hopefully be indicated for colon resection as well as an array of other procedures in the not-to-distant future."


Friday, August 14, 2015

Surgical robotics archives vol.6

Following a series of successful articles about the early days of surgical robotics (Vol.1, Vol.2, Vol.3, Vol.4, Vol.5), here is another forgotten story.

"Researchers at IBM and NYU Medical Center have recently begun development of a model-based system for optimal planning and augmented execution of precise osteotomies to correct craniofacial malformations. In these procedures, the facial bones are cut into several fragments and relocated to give the patient a more normal facial appearance. There is a significant synergy between better pre-surgical planning methods and the ability to execute the plans precisely and efficiently. The planning component of our system will transform CT images into a 3D geometric model of the patient's skull and assists the surgeon in planning an optimal procedure based on an analysis of the patient's anatomy compared to a database of normal anatomy. The surgical component will use real-time sensing to register the model-based surgical plan with the reality in the operating room. It will employ a variety of man-machine interface modalities (graphics, synthesized speech, etc.) together with passive manipulation aids to assist the surgeon in precise execution of his plan. This paper describes the overall system architecture, the proposed surgical procedure, implementation status, and  some early experiments that we have performed."