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

Wednesday, November 28, 2007

Operation da Vinci

It was very exciting to see the da Vinci robot in action at Hopkins. The Johns Hopkins Hospital has been awarded this year "The best Hospital of America" title by US. News for the 17th time. They invest a lot to medical research and innovation , and have been using robotic technology for years.
This time it was a partial nephrectomy, lasting for almost 5 hours. I had a chance to attend the operation, as other people from the lab were there to record the procedure for further research. The surgeon sat in front of the master controller in one corner of the OR, and the assistant surgeon was handling the third trocar, holding tissues, removing waste and providing needles and other equipment. The da Vinci offers high quality 3D visual imaging, but still lacks and haptic feedback. The master surgeon used the robot with an incredible accuracy, though it took two hours to gain access to the patient's left kidney, thoroughly coagulationg all the vessels on the way. They had to remove parts of the kidney, as the tissues died due to the renal stones and sand blocking its circulation. They cut the bottom end of the kidney and cleared the rest of the renal pyramids from the sediments. (Based on the laparoscopic Ultra Sound probe's image.) This part of the procedure is time-critical, as the renal arteries are climped, leaving only 20-25 minutes to finish operation without damaging the healthy tissues. After effectively burning the edge of the new surface, they put biocompatible gauze and regenerating gel around the kidney (video), and cover it with the original fat-husk. The final suturing was performed by the assistant surgeon, to gain additional practice. As soon as the operation was over, the da Vinci was pulled out to another room for the next procedure.
The entire surgery went very smoothly, the surgeon commented the happenings all along, giving a chance to better understand the steps.
Fore more da Vinci operations, visit the official site of Intuitive Surgical Inc. A complete record of a mitral-valve repair operation can be seen here.

Sunday, November 25, 2007

Computational Interaction and Robotics Lab

The Computational Interaction and Robotics Lab (CIRL) is directed by Prof. Greg Hager, and app. 12 students are working on the projects along with the regular stuff members. The current focus of research in CIRL is on robotic applications of computer vision and similar sensing modalities, with a focus on the surgical domain. The goal of these applications varies between computational analysis, tracking and visualization, and providing guidance. Current major ongoing projects include surgical modeling and robotic gesture recognition, human-machine collaborative systems, micro-surgical assistant workstation, computer vision for sinus surgery and ultrasound elastography.

( Source: ERC List)

Thursday, November 15, 2007

Seminars at CISST

Within the frames of the extra-curricular education, there are several seminars organized every week primariy for the students, however a lot of the professors take part as well. On Wednesdays there is a Lab seminar with a prominent invited speaker from the field of surgical robotics. On Fridays, it is the student seminar, where the labs are introducing themselves this semester and in addition there are other CS and CIS related seminars throughout the week. This Wednesday, Prof. Kevin Cleary was invited from the Imaging Science and Infomarion Systems Group at Georgetown University. He has been working a lot with the CISST, and this time he talked about three topics, related to their present research. Firstly, he presented the concept of electromagnetic imaging. Now we are able to manufacture coils that are only about the size of 0.5 mm X 3 mm, so it can be attached even to the tip of a needle or a catheter. (Such as AURORA Tracking system.) After that, with the help of an external EM field generator, we can track the probe. It is not as accurate as the optical localization, however works within the body as well.
Secondly, he talked about the Cyberknife robot, that was built at Stanford University and in clinical use since 1999, having performed over 15.000 operations. The advantage of the robotic system that it can actually turn the radiation source around the patient, to treat tumors anywhere in the body non-invasively and with sub-millimeter accuracy. This system can be considered as a success story, as it is able to significantly reduce the overall dose in chemotherapy, and now sells well.
Later, he presented some robotic systems they developed, such as the C-arm combined robot for spine biopsy and CT fluoroscope-guided lung biopsy. The second was realized with the ERC's Steady-hand robot, and they added respiratory motion compensation based on processing the grabbed frames of the CT. Besides, they also have an impedance controlled, 3D ultrasound based biopsy robot.
Finally, he addressed some of the mayor questions of CIS R&D. Lacking the critical mass of installed surgical platform, the growing of the market will continue slowly. A winner strategy is to look for niche markets. MIS represents the future of surgery, however, robots will only remain powertools for human surgeons for a long time.

Sunday, November 11, 2007

The "Perk Labs"- Laboratories for Percutaneous Surgical Interventions

A large and growing family of medical interventions involves the placement of some linear surgical instruments. Typical examples include needle based aspirations, injections, local ablation therapies, brachytherapy, but "virtual needles" like high energy X-ray and laser beams are also commonly applied. The majority of these interventions today are performed percutaneously (i.e., across the skin). Recently, a rapidly growing variety of these procedures have also deployed through alternative access routes from within body cavities (rectum, sinus, throat), as well as the vascular and gastro-intestinal systems. Typical guidance methods are computed tomography, ultrasound, magnetic resonance imaging, and fluoroscopy. Our lab focuses on development of enabling technology for image guided percutaneous procedures and the translation of these to clinical trials.
Research subjects are of interdisciplinary nature, spanning across computer science, electrical engineering, mechanical engineering and clinical sciences, primarily radiology, radiation oncology and surgery. Students and postdocs are routinely co-advised by multiple affiliated faculty members. Our research program leverages an extensive network of clinical and engineering collaborators worldwide funded by a diverse portfolio of U.S., Canadian grants and sponsored research contracts, as well as by our host institutions.
The Perk Labs are housed in twin facilities located at the Johns Hopkins University (Baltimore) and Queen's University (Kingston, Canada), directed by Prof. Gabor Fichtinger.
(Source: ERC List)

Wednesday, November 7, 2007

CIS Conferences

There are some prominent conferences around the world that professionals dealing with Computer Integrated Surgery (CIS) might be interested in. One of the highest priorities of the CISST lab is the MICCAI (Medical Image Computing and Computer-Assisted Intervention). The 2007 conference just ended in Brisbane, Australia, and the next one will be in New York in September. Check this site regularly for updates! Another annual conference is the MMVR (Medicine Meets Virtual Reality) that is always held in Long Beach, California. ICRA (IEEE International Conference on Robotics and Automation) is well known among engineers, the next one will be in Pasadena, California in May. Another huge IEEE related event is the EMBC's annual meeting (Annual International Conference of the IEEE Engineering in Medicine and Biology Society), stay up to date on the next conference in Vancouver here. The triannual IFAC (International Federation of Automatic Control) Symposium on Modelling and Control in Biomedical Systems should also be considered relevant. The last event took place in Reims, France, 2006. Several other scientific organizations are having conferences in this field. The MIRA (Minimally Invasive Robotic Association) annual conference will be in Rome, late January. The 19th International Conference of SMIT (Society for Medical Innovation & Technology) 2007 will come shortly in Japan. The ATA (American telemedicine Association) Annual Meeting will be in Seattle, April 2008. Last but not least, I would like to raize the attention that beside the biannual Summer University on Surgical Robotics in Montpellier, there will be a similar event organized next September at the ERC CISST in Baltiomore, primarily for higher year PhD students. Details will follow later.
There are several other international conferences that might deal with surgical robotics, please feel free to add any by commenting this post!

Friday, November 2, 2007

Visit to the JHU Computational Sensory-Motor Systems Lab

The Computational Sensory-Motor Systems Lab headed by Dr. Ralph Etienne-Cummings focuses on multiple research areas which include neuromorphic and biomorphic systems, motion control, ultrasonic imaging, VLSI sensors with applications in autonomous robots, surgery, entertainment, medicine, alternative energy technologies among others. Specifically, in the neuromorphic systems, the group develops biologically inspired sensors and sensory computation systems which mimic the structure, plasticity, algorithm, asynchronous event-driven protocol of their biological equivalents. Besides developing novel VLSI systems and architectures, some of the recent works have included experiments to understand neurophysiology of spinal neural circuits, interface with them, decode their sensory-motor relationships and use these relationships to control biomorphic robots.
(Source: ERC List)

Thursday, November 1, 2007

The da Vinci robot

Probably the best known surgical robot is Intuitive Surgical’s da Vinci, debuted in 1992. Its 3D vision system and camera is fully controlled by the surgeon, with the help of simple voice commands. Da Vinci also consists of two 6DOF slave manipulators, but later, an additional 7th decoupled joint–EndoWrist–has been added in order to enhance the robot’s dexterity. The CCD camera—equipped with dual endoscope to enable stereo vision—is mounted on a separate 4DOF manipulator. The built-in tremor filtering system is able to smooth the signals in real time, and scaling can be adjusted up to 1/5th of the real size. Da Vinci was the first teleoperated medical robot to receive the U.S. Food and Drug Administration’s (FDA) approval in 2000 for Laparoscopic Radical Prostatectomy, and since then it has been verified for 6 other procedures as well. (It was approved as a surgical assistance device since 1997.) In the past 6 years, approximately 60 000 operations have been performed with more than 1000 da Vincis only in the U.S. The second generation of the robot–da Vinci S– was completed by 2005 with HD cameras, augmented ergonomic features and a fourth robotic arm for servicing tasks. It has reached the market recently, after having performed several hundred test operations.
There are not many da Vincis serving for research purposes, the CISST only got one because Prof. Kazanzides used to work with Intuitive. Even this way it was really hard to get it, and Intuitive did not provide the robot controller, the lab people had to put together their own. The da Vinci is now ripped off of its cover, and used for several project. They are controlling other robots as well with the master device, use the 3D vision system for the verification of enhanced reality programs (like merged anatomical atlases), test teleoperation methods and trying to add appropriate haptic feedback to the system. Basically every labgroup can use it for its own research. The CISST is planning to buy a new da Vinci - S soon, for further research.