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

Sunday, January 25, 2009

Da Vinci Surgical System I.

The following posts will be about the famous da Vinci system, the only complete teleoperation surgical robot currently available. It is also remarkable that the developer and producer Intuitive Surgical Inc. is the only profitable company in the field. They went to NASDAQ in 2004 at 15USD price (ISRG), and went up to 310 in summer 2008. They made 144 M USD net income in 2007 (out of 600M sales), doubling their 2006 results, but they are still on the way to pay back the total 500 M USD investment needed to develop the da Vinci robot.
The history of the development goes back to the late ‘70s when the idea of surgical robotics was born. Inspired by the great possibilities of telesurgery, NASA made some plans, but never financed a real development project. Later, around 1994, they built a pilot system, the Robot Assisted MicroSurgery (RAMS). The robot showed great capabilities, but unfortunately in the late’90s the project was stopped due to the lack of funding (and is still sitting untouched in a lab at JPL).
The DARPA decided to invest into the area, and in the early ‘90s promising technologies emerged. Primarily, SRI was investigating the feasibility of telesurgery with master-slave manipulators with stereo vision feedback. In the mid ‘90s, they licensed the master manipulator design of Madhani along with many other patents (e.g. the RCM robot concept developed by Taylor et al. at IBM) and founded Intuitive Surgical Inc. Akhil Madhani had the idea in 1993 watching an episode of the M*A*S*H to develop a surgical robot. He created the Black Falcon as his thesis work working under Prof. Salisbury in the Artificial Intelligence Laboratory of the MIT. This tendon driven robot became the prototype of the da Vinci arms.
By 1997 the first prototype Lenny was ready for animal trials, at Intuitive, and next, Mona was madefor the very first human trials tooking place in the Saint-BlasiusHospital, Dendermonde, Belgium in March 1997 (Vascular & Gynecologic surgeries). As the system was intended primarily for cardio-vascular surgeries, specific clinical trials were performed in Paris and Leipzig in May 1998. Based on the initial experiences, the market ready version of the robot (da Vinci) got advanced control and ergonomic features compared to the Mona, and final tests began in 1999.
Eventually, the FDA approved the system for general laparoscopic surgery (gallbladder, gastroesophageal reflux and gynecologic surgery) in July 2000, and Thoracoscopic Surgery and Laparoscopic Radical Prostatectomy in 2002, followed by many other 510K approvals.
As soon as the da Vinci was out, Intuitive continued with perfection the system, and the new generation, the da Vinci-S got ready in 2005. The next post will tell more about the new features.
Source of pictures: Simon DiMaio, Practicalities: Tele-Robotic Surgery and the daVinci System

Sunday, January 18, 2009

CISST ERC Graduation

The National Science Foundation is running approximately 30 Engineering Research Centers (ERC) around the US. (Providing seed funds for 10 years.) The CISST ERC at Hopkins has run since 1998 under the directory of Prof. Russ Taylor. The CISST ERC has been really successful and they managed to double the original 30M USD NSF fund in the past 11 years. On January 12, an official Graduation Celebration event was held that brought together all the members, partners and associatives of the past decade. The full day program began with the greetings from the Dean and the Provost of Hopkins, then Dr. Taylor went through the bright history of the past years, showing e.g. how many research projects they managed to run. (The slides will be available soon.)
The professors of the CISST introduced their field in more details one after the orther (Greg Hager, Allison Okamura, Gabor Fichtinger, Peter Kazanzides and Ralph Etienne-Cummings), and also the key partners got a chance to talk (CMU, Morgan State University, Brigham and Women’s Hospital, etc).
More presentations followed in the afternoon; the Dean of the medical school talked about his vision on the future of CIS. He showed his wish list for the next few years. Richard Satava talked about the integration of information and energy. He believes the future stands for the devices that are both suitable for diagnosis and treatment, and also mentioned the self-sterilizing surfaces and organ printers as most promising applications. His quotable closing comment was: "My goal as a surgeon is to put myself out of business". The best presentation was probably from Gary Guthard, president of Intuitive Surgical (a separate post will cover his talk). A round-table discussion was next, featuring many famous and respected professional of the field.
The guests could get an insight view to the research in the CISST lab, presented by the students and faculty on 42 posters and through 11 demos. (The complete list of the materials can be found here, and the most of the works is accessable here.) The celebration ended with a Gala dinner, and thanking Dr. Taylor his leadership.
The Graduation day was also the first official day of the MRCIIS winter school. My next post will tell about that in details.

Saturday, January 10, 2009

Lindbergh operation - intercontinental surgery

Today it is well acknowledged that telesurgery has great potential, and robotic technology offers remarquable solutions for remote access and teleoperation scenarios. The most important breakthrough in this field was a special experiment more than 7 years ago.
The first trans-Atlantic surgical procedure—the Lindbergh operation—was performed by Dr. Marescaux with a Zeus in September 2001. (Video coverage can be found here and also here).
The Zeus surgical system got ready at the same time with the da Vinci in 2000, offering similar advanced functions to the surgeon. It had two effector manipulator and the third camera holder arm, controlled in master-slave setup. The Zeus had only 2D vision system and a precision movement control inherited from the AESOP camera-holder. Other features, such as motion scaling and tremor filtering have also been introduced later. The advantage of the Zeus was the open UDP protocoll used to transfer the control signals between the surgeon and the patient, making it an ideal choice for telemanipulation experiments. (The company was purchased and the system discontinued after a complicated lawsuit case on patents.)
Dr. Marescaux was controlling the robot from New York (from the office building of the France Télécom due to regulatory issues and as they were worried about further network latencies), while the patient laid 6200 km away in Strasbourg, France. The cholecistectomy was performed without any complicatons. Based on previous research, it was estimated that the time delay between the master console and the linked robot mirroring should be less than 330 ms to perform the operation safely, while above 700 ms, the operator may have real difficulties with controlling Zeus. A dedicated trans-Atlantic 10 Mbps fiber optic link was used, transmitting not just the control signals and video-endoscope feedback, but also servicing the video conferencing facilities. (This required a 150M USD investment from the France Télécom.) An average below 150 ms communication lag time was experienced, that is barely noticeable for human users.
Further materials are available on the IRCAD website.