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

Wednesday, July 28, 2010

UTwente cyber-OR program

Developing the Operating Room of the future has been a major focus of CIS research in many countries. Engineers at University of Twente are developing futuristic OR concepts along with a new generation of surgical robots. “It has three components: a “cockpit” (controller), which is where the surgeon sits, the instruments that manipulate tissue, and the electro-mechanical connector between the two. UTwente focuses on the platform: the cockpit and the connector, named TeleFLEX. The tools---specifically designed for NOTES procedures---are provided by Storz. The University of Twente is one of the first ten institutions to receive these instrument.” A sweet video animation shows the idea of having an exo-skeleton-like human-machine interface to control the multiple degrees of freedom of the continuum robot. They are also investigating methods to endoscope control by head movements applied to MIS.

Wednesday, July 14, 2010

Surgical Robotics at DLR

I have long wanted to write about the Robotics Center at DLR, the "Deutsches Zentrum für Luft- und Raumfahrt Forschungseinrichtung", as I've always admired their work related to space and robotics. The DLR was founded in 1907 in Cologne, and the Institute of Robotics and Mechatronics directed by Prof. Gerd Hirzinger is located in Oberpfaffenhofen. They have been involved with medical robotic research since the '90s, collecting numerous awards and prizes with their robots every year. Currently, a couple of eye-catching projects are listed in their annual brochure:
  • KineMedic and Miro arms - precise, light-weight manipulators for various surgical applications. KineMedic should appear in KUKA/BrainLab's portfolio soon.
  • MiroSurge - Telemanipulation in minimally invasive surgery
    Minimally invasive surgery (MIS) challenges the surgeon’s skills due to his separation from the operation area which can be reached by long instruments only. To overcome the drawbacks of conventional MIS the DLR works on a research system for telrobotic endoscpic surgery.
  • MICA - Actuated and sensorized instruments
    The DLR MICA is the second generation of DLR versatile instruments for minimally invasive surgery. MICA is a 3 degrees of freedom robot, which–in the MiroSurge system–represents additional joints of the lightweight telemanipulator MIRO. In the present configuration MICA is comprised of a drive unit, wrist, gripper and force/torque sensor, providing dexterity and force feedback for delicate surgical procedures.
  • Preoperative Planning and Registration
    One key aspect necessary for a successful minimally invasive intervention is preoperative planning, done by the surgeon in order to prepare the intervention and to decide about the best access to the surgical site. In case of robotically assisted interventions the results of these decisions must be transferred also to the robotic equipment.
  • Motion Compensation in Heart Surgery
    Motion compensation is a highly desired functionality in minimally invasive beating heart surgery. Before motion compensation in beating heart surgery can be performed, organ motion arising from the patient's respiration or heart beat has to be coped with. Therefore, the reliable measurement of this motion is an essential part of an advanced minimally invasive robotic surgery system.
  • Robot-assisted endoscope guidance
    During manual laparoscopic interventions, the surgeon does not have direct visual control of the operating field as in open surgery, but orientates himself by the laparoscopic image displayed on a monitor. It is the task of an assistant to guide the laparoscope such that the field of view is optimal for the surgeon.
  • DLR-Heart
  • Vision and purpose of the implantable heart-DLR is the long-term support of people with severe heart failure for which there is only limited treatment options available.
  • Brain Spatula
    Based on the technology of DLR Hand II, the project will be to develop a new type of full force controlled mechatronical brain spatula to replace the current passive mechanical support arm without any sensory information. By using the force-controlled brain spatula, the mechanical interaction on the brain tissue can be measured qualitatively and quantitatively. The whole system will be first carried out on the pig’s brain at the lab of Technical University of Aachen (RWTH Aachen).
Source: DLR - RM

Wednesday, July 7, 2010

da Vinci usage numbers: success and failure

As the da Vinci conquers much of the US, even smaller hospitals are investing into the technology, being pushed by market forces often lacking the rational arguments.
A study published in the Journal of Urology found that a hospital needs to do at least 520 surgeries a year with the robot to bring its costs in line with traditional surgery. Smaller hospitals can barely meet that.
"Also, some surgeons with extensive robotic experience say it takes at least 200 surgeries to become proficient at the da Vinci and reduce the risks of surgical complications. That's difficult for surgeons at smaller hospitals to achieve."
More recently, in a 170-bed hospital (Wentworth-Douglass Hospital in Dover, NE) investigations began to clarify on the responsibility of many surgical complication during robotic procedures.
"One patient operated was so badly injured that she required four more procedures to repair the damage. In earlier robotic surgeries, two patients suffered lacerated bladders. In another case, an inexperienced surgeon cut both ureters, supervised by another novice at the procedure. There's no evidence to suggest the injuries at Wentworth-Douglass were caused by technical malfunctions. Noreen Biehl, a spokeswoman for Wentworth, says the hospital's da Vinci complication rates are below the rates published in two recent gynecological studies. As a small regional hospital, Wentworth-Douglass has used the da Vinci about 300 times in four years." This number may give an answer to the emerging issues. At Wentworth-Douglass, surgeons began doing da Vinci procedures unsupervised after four cases, while others simply refused to use the robot with such low number of training sessions. The two day training offered by Intuitive is definitely not enough to make someone a master of the robot, but Aleks Cukic, Intuitive Surgical's vice president of strategy says the robot's learning curve "varies from procedure to procedure and from surgeon to surgeon." He adds: "There's no number of surgeries required to master the device."
Now a woman whose ureters were accidentally cut with the da Vinci robot last year filed a lawsuit against Wentworth-Douglass Hospital, and a law firm is seeking more patients harmed.

A retired Air Force colonel from the Dayton, Ohio area has filed a lawsuit against the Cleveland Clinic, alleging that a botched prostate surgery at the hospital has left him impotent and incontinent.

In 2009, a 42-year-old man died following robotic surgery at Boca Raton, Fla., hospital. An attorney for the man's family said the urologist who operated on him had never before performed the procedure he was attempting with the robot, according to the report.

Some surgeons have also been complaining about the increased price and modest technical innovation that arrived with the newer da Vinci-Si model. Other centers founded wide training programs to overcome the difficulties:

"With surgeons highly experienced in robotic surgery, the Hartford Hospital in Connecticut is showing surgeons across the country the precise, minimally-invasive procedures that often spell less trauma, blood loss and hospital time for the patients through innovative use of new technology.

The hospital’s TANDBERG video teleconferencing (VTC) solutions are being used to provide high-definition (HD) video of ongoing robotic surgical procedures that doctors at the hospital, and across the country, can watch and learn from.

In a recent report from the local NBC affiliate in Connecticut, Dr. Steven Shichman from Hartford Hospital discusses the benefits of the procedure, and how this learning vehicle would not be possible without the recent VTC technology advancements like HD."

"Doctors at Orlando Health's Winnie Palmer Hospital and Florida Hospital's Celebration Health, say measures have been taken at their hospitals to ensure patient safety and successful . "We're developing strict guidelines for these types of surgeries," said Dr. Jessica Vaught, a gynecologic surgeon who leads Winnie Palmer's robotic surgical training program."

In the meantime, Intuitive Surgical is celebrating steady growth, its last quarter (2010Q1) total revenue was $329 million, up 58% over the last year. Gary Guthart, CEO said in July: "...We continue to be and we have made some investments going forward that we think take advantage of some of the unique attributes of robotic surgery. Dual Council [ph] is one of them. Dual Council is being adopted well for use in training. And we’ve talked about surgical simulation as being another one."

Source: The Wall Street Journal, MIT Technology Review, TANDBERG blog, Physorg.com, MEDCITYnews, Fosters, photo: AP