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

Thursday, October 29, 2009

Tactile robot for tumor detection

Late summer a Canadian group reported on the first prototype of a palpation robot setup for tumor identification.

"Malignant tissue is usually stiffer than the surrounding tissue. Oncologists use scanning techniques such as MRI and CT scanning pre-operatively to identify lesions. But tissues may shift during surgery, making it hard to rely on the position identified by the scan. So instead surgeons use gentle pressure (palpation) to confirm where the tumor is, or to locate further tumors not picked up through scanning. But in MIS this can be very tricky due to access difficulties - as the surgeon must attempt to feel for harder tissue using long, slim instruments via a very small incision. Using tactile MIS sensing instruments under robotic control reduces the maximum force applied to the tissue by over 35% compared to a human controlling the same instrument. Accuracy in detecting the tumors was also far greater with the robot - between 59 and 90% depending on the robot control method used for palpation." /Source: surgicalproductsmag.com/

"The 10 mm incisions used in minimally invasive cancer surgery prevent the direct palpation of internal organs, making intraoperative tumor localization difficult. A tactile sensing instrument (TSI), which uses a commercially available sensor to measure distributed pressure profiles along the contacting surface, has been developed to facilitate remote tissue palpation. The objective of this research is to assess the feasibility of using the TSI under robotic control to reliably locate underlying tumors while reducing collateral tissue trauma. The performance of humans and a robot using the TSI to locate tumor phantoms embedded into ex vivo bovine livers is compared. An augmented hybrid impedance control scheme has been implemented on a Mitsubishi PA10-7C to perform the force/position control used in the trials. The results show that using the TSI under robotic control realizes an average 35% decrease in the maximum forces applied and
a 50% increase in tumor detection accuracy when compared to manual manipulation of the same instrument. This demonstrates that the detection of tumors using tactile sensing is highly dependent on how consistently the forces on the tactile sensing area are applied, and that robotic assistance can be of great benefit when trying to localize tumors in minimally invasive surgery. /Source: The International Journal of Robotic Reseearch/"

Wednesday, October 21, 2009

CIS news from around the world

A bouquet of surgical technology news I came across recently:

Monday, October 12, 2009

SMIT meeting in Sinaia

This year, the 21st Conference of the Society for Medical Innovation and Technology took place in Sinaia, Transylvania. The picturesque town up in the Carpathian hills used to be home of the Romanian king, and kept its wonderful charm for the 300 attendees. Most participants came from the EU, but a great number of professionals came from overseas as well, including Rick Satava. The general audience was a healthy mixture of engineers and physicians, therefore the talks were various. Many case studies were presented with the use of the 3 Romanian da Vincis, and Greg Weinstein from UPenn showed extensive results with Intuitive's 5 mm throat instruments. A group from the University of Eindhoven showed many of their CIS research. An entire section was dedicated to the latest achievements of two big EU FP7 projects, the ARAKNES, led by Paolo Dario's CRIM Lab in Pisa, and the Vector, headed by the Norwegian SINTEF R&D company. Both projects aim for the creation of effective micro-robots for the GI tract.
Posters represented a wide spectrum as well from the introduction of the healthcare system in Armenia to our prelimirany results with the Apollo surgical trainer. The abstract book is available here.
The exhibition area was in the splendid atrium of the former Casino, with OR lights and HD endoscopes everywehre. A shift was observable from the hype around NOTES towards SILS and LESS (Laparo-Endoscopic Single-Site surgery). Many of the exhibitors presented new tools for these appraches, including Storz and Olympus. The Tuebingen Group's Radius system made a very good impression on me: it redefines the way laparoscopic tools are used, allowing for the control of a remote wrist at the tip.

Monday, October 5, 2009

Exhibition at MICCAI

MICCAI2009 featured an impressive exhibition with many CIS related products and projects.
- The first public appearance of the RoboCast system was here. It is an EU funded IG neurosurgical robot system, currently consisting of a PathFinder and a SpineAssist.
- Intuitive Surgical brought over a da Vinci S system, unfortunately not the HD version. The da Vinci was open to play with, and also served to demonstrate the cool stuff of the SAW architecture developed by the Hopkins people. Through video overlay many functions are available in the virtual environment of the surgeon's viewer, such as landmark positioning, distance measurement pre-op image overlay and so on.
- Hopkins also brought a mock surgical system consisting of 4 teleoperatable Omnis and a simple 3D viewer.
- Hansen Medical demonstrated its new heart ablation robot that got a very impressive haptic master console. A previous article about the system.
- Qatar recently announced its aim to become an international leader in robot assisted technologies. They offer fellowship for renown professionals to join there new Qatar Robotic Surgery Centre that was created with a mere 65M USD investment. It will begin operations in 2010 with 3 da Vincis immediately.
- Major IGS technology provider NDI was also present with some experimental generator and probe design for EM tracking.
- The small brother, Claron, also brought its more affordable solutions.
- Tobii was built on innovative eye tracking technology, also showing some surgical demos.
- There were many companies advertising haptic systems along with high performance 3D visualization for education and demonstration. It's worth mentioning SenseGraphics open source haptic system development toolkit.