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

Wednesday, September 30, 2009

Da Vinci surgery in Hungary

Today, the first urulogic robotic procedure will take place in Hungary at the Telki Hospital. The da Vinci S robot came from Prague (together with the surgeon and his team) just for this prostatectomy. You can follow the surgery live at Videoklinika (Hungarian site) from 2 p.m. CET. (The Hungarian press release can be found here.) The event is organized by Duthcmed Hungary Ltd., the local distributor of Intuitive's sytem.
The very first da Vinci procedure also took place at Telki in 2007.

After a brief press conference, the surgery went on fine. The 62-year-old patient did not care about the swarm of press people in the OR. The technical staff brought the equipment for the real time streaming, and people were also following the surgery at the Hopsital and in Keszthely, where the National Urulogist Congress takes place these days. Another S robot had been brought there for a hands-on experience for the surgeons. Learn more about da Vinci prostatectomy here. The whole event was very well organized, and got wide media coverage. Hope this will help to move towards the first permanent da Vinci in Hungary.
Pictures of the procedure and short videos from the OR.

Stay tuned with the latest news from Intuitive: Third quarter earnings report coming on October 20.

Sunday, September 27, 2009

MICCAI 2009 Workshops

This year's MICCAI was popular again, as Imperial College homed it in the heart of London. For two days before and after the congress, several workshops and tutorials were held. Some of them were extremely exciting and relevant to this blog:
- The Workshop on Geometric Accuracy in Image Guided Interventions brought up a heated discussion over the general use of TRE and FRE in Image Guided Surgery to measure accuracy. Hard to believe, but Dr. Fitzpatrick prooved that FRE is independent from TRE!
- The Medical Robotics and Computer Assisted Intervention full day tutorial was organized by Dr. Taylor based on the positive feedback of the similar tutorial on the first day of the MRCIIS winter school back in January.
- A separate tutorial was dedicated to Tutorial on Image-Guided Interventions.
- The Augmented Environments for Medical Imaging including Augmented Reality in Computer-Aided Surgery (AMI ARCS) dealt with all the imaging aspects of CIS.
- The Modeling and Monitoring of Computer Assisted Interventions Workshop was more about explicit representation, formal understanding and statistical modeling of the interventions.
- Dr. Kazanzides organized the next WS focusing on Systems and Architectures for Computer Assisted Interventions. The goal of this workshop was to establish a forum for discussing open interfaces, interoperability, and standards for the development of computer assisted intervention systems.
Many of the MICCAI workshop materials are available free online in the form of the Midas Journals.

Sunday, September 20, 2009

Mock OR at Hopkins

In March 2008, along with the inauguration of the new CSEB building, the full-window room next to the breezeway got the name Richard A. Swirnow Mock Operating Room remembering the generous donation (400K for 5 years) he made to create a unique demo room where surgical robotic systems can be tested and demonstrated in an OR like setup. The room got pretty full since the opening, now accommodation several projects and many hardworking people. The major systems taking place in the Mock OR:
- da Vinci S: got on loan from Intuitive, the original demo device of the second generation robot takes up a good amount of the room. There are various projects associated with it. Most importantly, the development of the SAW (Surgical Assistance Workstation) architecture that can significantly extend the surgeon’s capabilities using data fusion (video overlay), advanced visualization and extended access to patient conditions through the 3D environment of the master consol’s viewer.
- The neuroMate robot used for our skullbase drilling project seems small compared to the da Vinci. Resent improvements of the system have been published at the EMBC09 conference.
- The MR compatible brachytherapy robot built by Axel Krieger sits in the back of the room, right next to the transrectal ultrasound guided robot.
- A mobile C arm in the other corner is used for needle steering experiment, and previously was involved with X-ray based anatomical atlas creation and registration.
- Minor setups are also around: optical tracking, surgical navigation environment enhancement, EM and optical tracking fusion and many others.
If you happen to walk around the Homewood campus, do not miss to take a look!

Friday, September 11, 2009


The 31st Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC'09) took place in Minneapolis (September 2-6). There have been almost 1900 papers published with the conference, and around 2200 participants.
The first plenary speaker was Andrew Zachary Fire from Stanford, giving a talk under the title: Use of new nanotechnology-based DNA sequencing technologies to illuminate cellular regulation and defense. Further plenary speakers included Earl Bakken, founder of Medtronic Inc.
There were several sessions dedicated to surgical robotics and computer.integrated surgical systems. The oral sessions covered the following topics:
  • Design of an Ultrasound-Guided Robotic Brachytherapy Needle-Insertion System
  • Soft Tissue Deformation Tracking for Robotic Assisted Minimally Invasive Surgery
  • Testing of Neurosurgical Needle Steering Via Duty-Cycled Spinning in Brain Tissue in Vitro
  • Observations of Needle-Tissue Interactions
  • Semi-Autonomous Surgical Tasks Using a Miniature in Vivo Surgical Robot
  • Simulation for Optimal Design of Hand-Held Surgical Robots
  • Robotic Patch-Stabilizer Using Wire Driven Mechanism for Minimally Invasive Fetal Surgery
  • Autonomous Avoidance Based on Motion Delay of Master Slave Surgical Robot
  • Model Based Stabilization of Soft Tissue Targets in Needle Insertion Procedures
  • The Study of Fiducial Localization Error of Image in Point-Based Registration
  • A High Performance Graphic and Haptic Curvilinear Capsulorrhexis Simulation System
  • Minimally Invasive Localization of Light Source in Tissue with an Equidistant Measurement
  • Modeling the Temperature Dependence of Thermophysical Properties: Study on the Effect of Temperature Dependence for RFA
  • Operability Evaluation Using an Simulation System for Gripping Motion in Robotic Tele-Surgery
  • Ultrasound Guided Robotic Biopsy Using Augmented Reality and Human-Robot Cooperative Control
  • A Novel Non-model-based 6-DOF Electromagnetic Tracking Method Using Non-iterative Algorithm
  • MRI-Compatible Micromanipulator, Positioning Repeatability Tests and Kinematic Calibration
  • Soft-Tissue Modeling and Image-Guided Control of Steerable Needles
  • Development of a robotic endoscope that locomotes in the colon with flexible helical fins
  • Patient Motion Tracking in the Presence of Measurement Errors
  • Catheter Localization in the Left Atrium Using an Outdated Anatomic Reference for Guidance
  • Comparison of Visual Tracking Algorithms on in Vivo Sequences for Robot-Assisted Flexible Endoscopic Surgery
  • Design of a Telemanipulated System for Transluminal Surgery
  • Hybrid Attitude Estimation for Laparoscopic Surgical Tools: A Preliminary Study
  • Active Guidance for Laser Retinal Surgery with a Handheld Instrument
  • Dynamic View Expansion for Minimally Invasive Surgery Using Simultaneous Localization and Mapping
  • Influence of Visual Feedback and Speed on Micromanipulation Accuracy
  • Master and Slave Transluminal Endoscopic Robot (MASTER) for Natural Orifice Transluminal Endoscopic Surgery (NOTES)
  • Real-Time, Haptics-Enabled Simulator for Probing Ex Vivo Liver Tissue
  • Characterization of Pre-Curved Needles for Steering in Tissue
  • Wireless Steering Mechanism with Magnetic Actuation for an Endoscopic Capsule
These papers are available through IEEE Xplore.

Tuesday, September 8, 2009

Medtronic headquarters

Within the frames of the IEEE EMBC’09 conference, we were given a chance to visit the headquarters of Medtronic Inc. Medtronic is the world’s 2nd biggest medical device company, with a mere 14 B USD sales last year, providing jobs for 38,000 people in 120 countries. More importantly, they invested 10% of that to R&D. Earl Bakken, the founder of the company was the special invited speaker at the Gala dinner, and he spoke about the history of the company. He was greatly inspired by the 1931 Frankenstein movie to create electrical systems for medical purposes. They started in 1949 in a small garage with huge dreams. Their motto is "To contribute to human welfare by application of biomedical engineering in the research, design, manufacture, and sale of instruments or appliances that alleviate pain, restore health, and extend life.". Earl Bakken’s personal dreams that he has already made come true include measuring the ECG signal of a humpbackwhale, sailing around Hawaii, building a kiss-o-meter, inventing a better radar for the airforce, creating a medical technology history museum and many other things.
In 1957 they tested their first external pacemaker, and heart beat regulation quickly became their major profile. Nowadays their treatment profile includes heart and vascular diseases, neurological and spinal disorders, chronic pain, diabetes, urological and digestive system disorders, ENT problems.
The company’s main center for both research and business is still in Minneapolis, just 15 min drive from downtown. The core facility usually does not accept visitors, but they were kind to show us around. To support their major product lines (pacemakers, implants, neurostimulators) they have their own research and manufacturing capabilities for material sciences, batteries, plastic caging and so on. Medtronic has several internal awards, honor societies and merits to promote and reward in-house innovation and leadership.
Medtronic Navigation, the surgical guidance business is located in Louisville, CO. They build and commercialize surgical navigation and intra-operative imaging systems, such as the StealthStation product line, equipped with either optical or electromagnetic tracking capability.

Friday, September 4, 2009

More of the da Vinci

Recently I came across the most complete historical review of the da Vinci: „The da vinci telerobotical system the virtual operating field” from Dr. Ballantyne. Worth reading it.
Despite the world economy’s temporal weakness, the da Vinci is getting selling well. By the end of the first half of 2009 there have been a total of 1,242 unit shipments worldwide (916 in the United States of America, 221 in Europe, and 105 in the rest of the world).
The popularization of the system can be well followed on the plots used by Intuitive. The claimed possible penetration of the da Vinci at different segments: 30% for GI lap chole, 60% gynencology, 80% for urology and eventually 90% for cardiac procedures. They assume, there is a need for at least two da Vincis at every major hospitals (within the US).
MIS and Intuitive’s principle equation is Value = Effectiveness / Invasiveness2, therefore they are moving towards SILS and NOTES procedures. The first tools should appear soon.
Some interesting facts: the smallest da Vinci patient was a 6 pound 5-day-old baby, and the biggest was a 576 pound patient for lap band. While radical prostateectomy, pyeloplasty and Nissen fundoplicaton are the most common procedures conducted with the da Vinci, the most complex have been intravesical ureteral reimplantation, mitrofanoff, colectomy and mitral valve repair.
As they put it, the formula for success is to acquire:
• Surgeon champions
• Administration support
• Identify your “beachhead”
• Patient volume/strong referral network
• Dedicated, well-trained team
• Well-communicated goals
• Strong marketing campaign
• Document and publish clinical outcomes
• Commitment to “weather the storm”
• Commitment to continuing education

The predicted total support and added value of the system in the future:
• da Vinci Networks cooperating with each other
• Telecollaboration of surgeons
• Digital Video Capturing for evaluation and training
• On Demand Support
• On Demand Training
• Inventory Management
• Voice Feedback

Credit: Intuitive Surgical Inc.