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

Sunday, November 22, 2009

Da Vinci news

Research interface
So far on the CISST ERC at Johns Hopkins had the possibility to get access to all the data of the robot that passes between the console and the patient side. While they are already negotiating an extended option to be able to write the data beyond reading, general read-only API is getting to be available for more labs:
"The da Vinci research interface allows third party developers and research collaborators to retrieve a real-time stream of kinematic and user event data from the da Vinci Surgical System during clinical use. This data includes the motion of all master and slave manipulators, as well as a number of user console events such as button and pedal activations. In order to support research and further development of the da Vinci platform, we offer a research interface—also known as the da Vinci Application Programming Interface (API)—that allows third party developers and research collaborators to retrieve a real-time stream of kinematic and user event data from the da Vinci during clinical use. This data includes the motion of all master and slave manipulators, as well as a number of user events such as button and pedal activations. This data is streamed from a TCP/IP Ethernet server embedded within the robotic system, to an external research workstation. Figure 1 illustrates the main system components, including the Patient-Side Manipulators used to position the EndoWrist instruments and stereo endoscope, and the Surgeon Console that includes a stereo display and master controls used by the surgeon to maneuver the Patient-Side Manipulators.
access to the API interface is available to authorized researcher partners only, pending the execution of an API Agreement—a legal document that outlines terms of use, restrictions of use, confidentiality, limitations of liability, as well as agreed rights to intellectual property developed through the use of the da Vinci research interface, or data captured from this interface.
The API interface is not active by default and must be activated on-site by a trained Intuitive Surgical Field Engineer—subject to approval of the API agreement. Once the interface is installed and enabled, the da Vinci Surgical System may be commanded to serve API data from its Ethernet interface."
Source: MIDAS Journal article

Prostatectomy study
Recently a large-scale study was published in JAMA under the title "Comparative Effectiveness of Minimally Invasive vs Open Radical Prostatectomy" That got very well covered, as it concluded that MIS prostatectomy has had better patient outcome so far. It was even claimed that "human beat robots in RRP", because the paper did not separate hand-made and robotic procedures. "MIRP included procedures performed with and without robotic assistance
because both share a common CPT code. We were therefore unable to distinguish whether the robot was used during laparoscopy; however, the intraoperative strategy is
similar and the prostatic anatomy is by definition identical." This is a misleading conclusion, as we know that the precision of the surgery is increased with the da Vinci (motion scaling, 3D view, tremor filtering, etc.) And in fact their data is from 2001-2006, when the overall share of robotic RRP must have been under 10%. (Compared to current 70%+) Any conclusion for the robotic outcome based on this is questionable therefore.

Da Vinci trainer
MIMIC guys have been working for a while to create a realistic da Vinci simulator. Their product is now on the way to conquer the hearts and minds of the surgeons. Get more information, videos and presentations at their site.
"Based on the growing acceptance of VR technology in laparoscopic simulation training, two companies have created robotic simulators that model da Vinci telemanipulation – MIMIC Technologies, Inc., Seattle Washington and SimSurgery, Oslo, Norway. Mimic Technologies has developed a training simulator, the dV-Trainer, designed to allow efficient, on-demand training for surgeons learning to use the da Vinci Surgical System, a sophisticated robotic platform designed to enable complex surgery using a minimally invasive approach. The MIMIC simulator
relies on a da Vinci-like human-computer interface with telemanipulators similar to the real da Vinci while the SimSurgery simulator utilizes an existing laparoscopic simulator platform with
software upgrades to simulate robotic instrument movements. The benefits of simulation training in robotics have yet to be formally evaluated, yet preliminary validation studies have demonstrated the ability for robotic simulators to discern experienced from nonexperienced
roboticists which is an initial validation criterion for applicability for any simulator.

Mimic’s dV-Trainer is a “flight simulator” for the da Vinci® Surgical System. This simulator is designed to teach basic robotic skills, such as instrument manipulation, camera control, clutching, and suturing. Key components of the dV-Trainer are a compact hardware platform that closely reproduces the look and feel of the da Vinci® surgeon’s console, and simulation software based on Mimic’s proprietary virtual reality modeling technology. Benefits of Mimic’s dV-Trainer include:

  • Virtual robot training does not require a da Vinci robot, vision cart or patient cart
  • Surgeon focused independent training may accelerate learning and increase da Vinci utilization
  • Performance analysis and assessment tools can be used to monitor learning progress
  • Training costs are minimized as the dV-Trainer does not degrade the life of da Vinci instruments or waste materials such as sutures and training aid
Source: MIMIC Inc.

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五月天 said...
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