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

Thursday, July 28, 2011

Origins of surgical robotics

I was always wondering who had first the idea to use robots for surgery. Many of the famous people started their work towards their robotic surgery system in the late '80s, early '90s, inspired by some physicians. But apparently, the idea dates back a lot earlier. 
Arthur D. Alexander III, from NASA Ames Research Centerpublished a few articles in 1972-73 around the topic "Impacts of Telemation on Modern Society". What is really impressive that he had already had a clear concept how a master-slave teleoperational robot system should look like, and also envisioned dedicated medical-purpose comm stellites. (See the figure on the right.) Below, excerpts from the 1973 publication. Should you have any furher information, please, let us know!

"A 90-day study was made of teleoperators, robotics, and remote systems technology in the United States. The purpose of the study was to survey state-of-the-art technology in this field, determine major user needs in medicine, mining, and oceanography, and suggest initiatives where federal research and development funding would most significantly impact the application of this technology to the alleviation of explicit national social problems. Following a review of the findings of this study commencing with user needs, speculation is made on impending developments in the application of telemation to remote emergency medical care and remote mining systems. " Source: CSA

"Use of Manipulators for Remote Medical Emergency Care Recent advances in the technology of human extension by remote manipulation, concepts derived largely from the U.S. space program, make possible professional medical care, including surgery, in situ at the emergency site and remote from an environmenrspecializing in acute care (such hs a hospital emergency facility or Clinic). Figure 2 illustrates such a remote surgical system. A proposal, currently under consideration, suggests the use of human extension through remote manipulation to upgrade the quality of medical care at both remote and accessible areas and to make the most effective use of scarce skilled medical practitioners
throughout this nation and the world for the relief of human suffering. This proposal is directed specifically to a pilot study of the use of human extension by remote manipulation for extended medical care at the emergency site. It includes a survey of on-site remote medical care capability, the
design of an emergency care package, and a pilot research demonstration of remote surgery for one or
more procedures.
Initially assuming a modular concept, a proven minimum requirement for remote patient treatment is
a two-way color TV/voice communication system (Massachusetts General Hospital's Logan Airport Emergency Room) that enables skilled doctor/patient interfacing. Next, in order of importance, basic diagnostic equipment is required at the emergency site: 
  • respirometer, 
  • sphygmomanometer, 
  • remote stethoscoper,
  • fluoroscope, 
  • image intensifier radiography, 
  • EKG machine,
  • possibly EEG capability. 
All such equipment must be remotely operable through reliable telemetry, which state-of-the-art technology presently permits. The ultimate modular design would provide remote treatment capability, thus eliminating the need for trained paramedical personnel to be in attendance at the remote emergency site. Envisioned for this purpose would be a pair of master/slave manipulator arms remotely extending the doctor's manipulative, tactile (touch), visual (stereo TV or fiberoptic telemetry at terminal "hands"), and listening (stereosonic) capability. Adjunct treatment equipment would provide for remote maintenance of life-support functions and might include respirator, heart stimulator, blood flow control apparatus,anaesthesia equipment, and skeletal support systems.
In summary, an idealized modular remote care system must provide the attending physician with reliable two-way communication, diagnostic and treatment capability in that order. Each of the preceding concepts represents a distinct and measurable improvement over existing emergency care procedures.
As remote emergency care is demonstrated to be feasible, and as the concept becomes accepted domestic medical practice, a number of international implications will become evident. As emerging
nations place greater emphasis on developing technology (greater use of machinery, cars, etc.), they
will encounter an increasing accident frequency--a frequency they may be unable to deal with effectively unless they are able to educate and develop concurrently a medical staff adequate for their needs. A practical interim solution would be to draw upon medical staffs in the developed nations to provide that care using remotely operable facilities linked by dedicated medical communication satellites.
Further, these remotely operable emergency care facilities, when not in direct use, could be used for
medical education purposes, linking the outstanding medical centers of the world to the most remote
regions, providing access to the most advanced medical techniques and procedures available."

So thus surgical robotics was born...

A couple of the early patents citing this: SRI1, SRI2, SRI3, SRI4, SRI5, SRI6, Intuitive, Intuitive1 , Intuitive2, Intuitive3.

Learn more about in-space surgery capabilities from this old but very detailed NASA report.

Source: Alexander AD, "Impacts of telemation on modern society," Proc. of the 1st CISM-ITOMM Symposium. New York: Springer, Wein, 1972; pp.121–36.
~ in Proc. of the Annual Meeting of Human Factors and Ergonomics Society, vol. 17, no. 2, Santa Monica, CA, 1973, pp. 299–304.
~  Human Factors Society, 17th Annual Meeting, Washington D.C.; 16-18 Oct. 1973. pp.299-304. 1973

Sunday, July 24, 2011

SmartMove: a TMS robot

Although it has been around for a while (3+ years), the SmartMove got some publicity recently. "Robotized TMS is a novel approach in the application for image guided transcranial magnetic stimulation (TMS).
SmartMove allows planning of a complete stimulation session ahead by defining stimulation sites based on anatomical MRI information and functional information like fMRI, PET or EEG/MEG. During the execution of the TMS stimulation sequence, the system places the coil at the predefined target positions and keeps the coil in place even if the head of the patient/subject moves."

The system includes an NDI Spectra camera for tracking, and relies on point-based registration to the pre-op MR. Learn more about it from their leaflet, or watch some videos

Key features include:
  • Accurate&automatic positioning of TMS coil
  • Easy target and grid definition
    Placement of the coil tangentially to the head
  • Head movement compensation
  • Defining of entire stimulation protocols
    Repetition of previous stimulation target positions
    Online mapping of evoked responses 
  • Compatible with all TMS stimulation.
According to their disclaimer, it is only iontended for research use (as of now): "This products is not sold as Medical Device as defi ned in EU directive 93/42/EEC. The product is not designed or intended to be used for diagnosis or treatment of disease."

Tuesday, July 19, 2011

The new ALF-X robot

The first news about the Telelap ALF-X system “Advanced Laparoscopy through Force-. RefleCT(X)ion” leaked out some three years ago, indicating that SOFAR S.p.A., (a pharma company in Milan) started to use retrofited industrial manipulators to create a da Vinci competition. They art supported by an EU joint effort, and operating under the academic assistance of the New European Surgical Academy (NESA). Next, they teamed up with Immersion Corp.  to ensure a good haptic interface (TouchSense) for their robot, and they tried to patent it (US prov. pat. 20100204713, 20090024142). 
Features include:
  • Preoperative simulation 
  • Force controlled tools (US prov. pat. 20100094312)
  • Automated fulcrum point identification
  • Real-time patient monitoring to enable VR overlay
  • Laser scanners for safe robot positioning
  • The main application would by gyneacology 
  • Target: 1.5 mm clinical accuracy, <60 ms latency
  • Severel trials on porcine models have been done
  • Preclinical trials with the robot included: hysterectomy, salpingo oophorectomy, myomectomy, partial and radical nephrectomy, total pelvic exenteration and cholecystectomy. Current trails focus on:
    • 1. The use of the newly designed handles, surgical arms and instruments
      2. Haptic force transmission
      3. Ergonomic aspects
      4. Safety and reliability
      5. The 3D Stereo Vision system
      6. Docking time
      7. Durability of the re-usable instruments
      8. Capability of complex surgical steps
      9. Economic aspects (all elements are reusable)
This year, they have already had a presentation of the system at the MIRA congress, the Italian SICT, and will be featured in Leueven, as the SERGS as well.

FYI! "The system is called Telelap rather than a robot in order to avoid any misunderstanding, as it is manipulated by the surgeon rather than through artificial intelligence." /Tinelli et al./

Updates on the robot are here.

Thursday, July 14, 2011

SCATh Workshop in Graz

SCATh (Smart CATheterization) is an EU FP7 project, led by KU Leuven, spanning across the whole continent, and focusing on the development of advanced navigation techniques for intravascular procedures.
The project is half way down the road, and they held an international joint workshop on on New technologies for Computer/Robot Assisted Surgery in Graz, this week. There were many great people attending, great keynotes, and a lot of old and new friends. The proceedings is open access, with topics reaching a long beyond catheters (excerpts): 

Saturday, July 2, 2011

CIS Workshop presentations and videos

Our first International CIS Workshop ended with great success, everyone was enthusiastic about the lecturers presenting. They were kind enough to share their materials, so now you have a wonderful set of powerpoint presentations and videos. Enjoy, and comment, if you like it!
The abstract booklet is still under editing, and the presentations are gradually uploaded. You can check the original program here.

CIS Workshop presentations and videos
0 Haidegger: Origins of CIS
1 Bejczy: The dawn of robototic surgery at NASA--a personal experience
 2 Kazanzides: Evolution of surgical robotics
 3 Cleary: Computer-Aided Interventions and Medical Robotics in Interventional Radiology
 4 Kronreif: Robot Systems for Percutaneous Needle Placement
 5 Fichtinger: Pre-operative to intra-operative image guidance for prostate brachytherapy
 6 Maier-Hein: Intra-operative registration for computer-assisted medical interventions
 7 Pernus: Image registration: 2D/3D problems (article at Srpinger)
 8 Fichtinger: Radiation Oncology
 9 Pongrácz: Video Tracking in Clinical Environment
10 Benyó: High-speed, high-performance multi-modal imaging
11  Lassó: MR-guided prostate brachytherapy
12 Kovács: Telesurgery: a control theory approach
13 Meskó: The future patient
14 Takács: Anatomical ultrasound
15 Emirdağ: Collecting Environment Data during Surgery
16 Coban: Four channel double hand coil for MRI
17 Mironov: An estimation of inaccuracy in dosimetric data smoothing
18 Hanganu: System-on-Chip Solutions for Portable Medical Applications
19  Groch: In-vitro Evaluation of 3D Surface Reconstruction Techniques
20 Wéber: The modern tools and education of surgery
21 Haidegger: New trends in surgical robotics
22 Szaniszlo: In vivo mass spectroscopy for tissue analysis
23 Sirokai: Electromagnetic tracking in the medical environment
24 Pajkanovic: Proposed algorithm for wireless control of electric wheelchair by head movement
25 Nonnis: Blood cells extraction, recognition and counting using Matlab
26 Zukic: Haptic paddle in virtual reality applications
27 Verhagen: The advantages of new, computer based techniques of surgery
28 Albrecht: Carbon Nanotube Sensors
29 Nagy: Technical solution to support sterilization in the medical environment