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

Monday, October 31, 2011

B.E.S.T. Innovation in MIS course from IRCAD


This is your great chance: the IRCAD Student group is  organizing a great event on technology and innovation in Minimally Invasive Surgery. The course will consist of online lectures and then a week-long on-site training at IRCAD for the best students, and all that for free. Apply now, since the program starts very soon.

You can learn more about it on the official website, or check the flyer of the program.

Wednesday, October 26, 2011

Da Vinci for SILS

The community has been long fascinated with the idea how to use robotic manipulators--and especially the da Vinci--to compensate for the ergonomic difficulties in NOTES.
In the early experiments, groups tried to arrane the da Vinci robot in a twisted way to perform NOTES, e.g. "A single 12-mm trocar was placed in the midline, and two 12-mm standard laparoscopic ports were placed into the abdomen via the vagina and the colon. The robotic ports were then telescoped into the 12-mm ports, and the daVinci S robot was docked. Dissection was performed using the Hot Shears and the ProGrasp instruments. The robotic camera was placed via the midline port and held by an assistant. " (Box et al., 2008).
"Haber et al. adopted a different approach toward robotic NOTES in the porcine model, placing the robotic camera lens and one arm through the umbilicus, with the other robotic arm inserted through the vagina.  Desai et al. performed transvesical robotic RP in a cadaver model with the a Kaouk et al reported in 2009 the first successful series of single-port robotic procedures in humans, including RP, dismembered pyeloplasty, and radical nephrectomy [86]."
Since classical tool manufactures started to come out with roticulators, steerable cameras and other pre-bent instruments (Dhumane et al., 2011), it was desired to create the same tools for the da Vinci as well.
The first solutions were published by Joseph et al.: "Cholecystectomy and nephrectomy were performed utilizing the chopstick technique: where the instruments are crossed at the abdominal wall so that the right instrument is on the left side of the target and the left instrument is on the right, preventing collision of the external robotic arms." The control on the consol has been switched as well.
The newer setup is the VeSPA tools from Intuitive for the SI system, and numerous experiments have been conducted on the porcine by Haber et al.: "The configuration of the current IS3000 da Vinci Si was modified with the intent to perform R-LESS surgery. The console and the slave remain the same and only arms 1 and 2 were used in addition to the camera arm. A newly designed prototype multichannel port (Intuitive Surgical) allowed the placement of an 8.5-mm scope, a 12-mm cannula for the assistant, and, more importantly, 2 crossing curved cannulae for the robotic instruments. The VeSPA instruments and accessories are of similar construction to existing da Vinci Si EndoWrist instruments, except for the shaft that is semirigid, allowing them to be inserted through curved cannulae. In addition, the instruments do not have a wrist at the distal end of the instrument. The VeSPA instruments and accessories include needle driver, Cadiere grasper, right-angle Maryland retractor, curved scissors, hook, clip applier, and suction irrigator."

Beyond robotics, some hand-hel devices also pushed the boundaries of SILS/LESS tools, such as SPIDER, USGI's Transport, or Direct Drive from Boston Dynamics. However, they are facing the same issues with the increased complexity and towering costs of the devices.

Sunday, October 16, 2011

8th IFAC Symposium on Biological and Medical Systems

Our lab has the pleasure to organize the upcoming IFAC BMS Symposium. The last edition was in Aalborg, DK in 2009. The conference will take place in downtown Budapest, 29-31 August, 2012. 
"The Symposium provide a forum for the presentation of new developments in the important interdisciplinary field of biomedical systems involving the application of concepts, methods and techniques of modelling, informatics and control of complex biomedical systems. The Symposium address problems in biomedicine, physiology and biology related to:
  • model formulation,
  • experiment design,
  • identification and validation,
  • biosignals analysis and interpretation,
  • developments in measurement, 
  • signal processing,  
  • tracer kinetic modeling using various,
  • imaging systems,
  • biomedical system modeling,
  • simulation and visualization,
  • decision support and control."
You are most welcome to enter a submission before Febr. 3, or propose a special session within the next week. If you are interested in attending, let me know, and we could put together a SS on surgical robotics. 
Looking foward to seeing you here!

Wednesday, October 12, 2011

MICCAI in Toronto

This was my third MICCAI, and absolutely the best one! The chairs (Drs. Fichtinger, Peters and Martel) did a great job, and the program was very relaxed, leaving space for a lot of discussions. There were numerous workshops and sessions dealing with robotics, although, as typical for MICCAI, CAI was underrepresented relative to MIC. There were many CIS relevant sessions and workshops, e.g.,
A couple of the more exciting talks:
  • Distance Measurement in Middle Ear Surgery using a Telemanipulator
  • Unified Detection and Tracking in Retinal Microsurgery
  • MR-based Real Time Path Planning for Cardiac Operations with Transapical Access
  • Interventional Radiology Robot for CT and MRI Guided Percutaneous Interventions
  • and many more...
You can access the entire proceedings here.

Thursday, October 6, 2011

Visiting Intuitive

At the end of September I was privileged to get a semi-private tour to Intuitive Surgical’s headquarter in Sunnyvale California. (Eventually, two of my friends from Hopkins joined the program.) Intuitive is located in Silicon valley, close to the Caltrain on Kifer road. The main facility was acquired from HP, and has been extended significantly. Currently, there are app. 5-600 employees on site, the other 1300 are located at the strategic logistic centers around the world, travelling for sales, or sitting in another Intuitive building along Kifer road. People at the “campus” are divided between the manufacturing, support, sales departments, the engineering research center and the management.
Simon DiMaio, applied research manager, devoted much of his time to guide us around. First, we went to the dry demo room in the main building (beautifully decorated with a lot of tools), where they have a dual consol setup (sometimes touring around the country) equipped with the simulator module. We did some simple tasks with dual-console cooperation, and were able to try some of the MIMIC skill training programs. These were developed in collaboration, and through them we will be able to far better understand human learning in surgical procedures. Intuitive has a couple of “wet” operating room as well to train surgeons (and they were all busy at the time of visit.) The main building also features a huge map with all the da Vinci systems’ location (quite busy in some parts of the world), and a wall with hundreds of granted patent placards—quite impressive.
(I gave a lunch seminar talk—mostly about the emerging da Vinci competitors—which you can access here.)
The next part of the tour was to the new manufacturing facility, the first Intuitive building raised from scratch. (It was opened by Rep. Jackie Speier, Mayor Melinda Hamilton this summer.) All manufacturing (assembly) take place here on the first floor, while supply chain management and support is on the second floor. The rooftop is entirely covered with solar panels, making it the largest array in the area. Intuitive has a separate plant for tool manufacturing in Mexicali, Mexico established in July 2008 with 60 workers, and later enlarged significantly.
The current throughput of the main factory in Sunnyvale is enough to serve the demand (over 350 units/year) in one work-shift. The complete integration of a da Vinci Si takes two days, but they are ready to sell and install a robot anywhere in the world within 24 hours of purchase.
In the plant, first, they test every pre-manufactured part (~30K) incoming from various partners form all around the world:
  • Customized optical stereoscopes from Germany,
  • High-definition video display monitors are from Philips' Femi Division,
  • Image-acquisition tool from Toshiba and Panasonic,
  • Harmonic shears (for US tissue cutting) are from the Ethicon Endo-Surgery division of Johnson&Johnson
  • motors in the da Vinci are from Maxon, Switzerland (read more about them here)
  • etc.
The assembly of the arms is done entirely by hands, cabling, soldering, integration is done by the skilled workers (also trained to replace each other if need be).  There are approximately 80 working cells, and some steps take up to 1-3 hours.
Having seen all of that what’s under the panel increased a lot my appreciation for the designers. It’s also true that the Si version incorporates a lot of upgrades and tweaking unseen to the user, but making e.g., servicing of the robot much easier.
Thorough testing follows every stage for mechanics, electrical functionality and capability. Once the parts of the arms are assembled, they are undergoing a controlled motion cycle (overnight) that moves all arms all around the workspace to identify any malfunctions. It’s like a dance of the robot, and looks very cool, since the arms stretch a lot further than during regular operation. Naturally, all software procedures are also tested on the actual system.
Last comes packaging, which makes the system look really big! There were like a dozen boxes waiting to get loaded into trucks. "Our sales cycle is not smooth. We sell the majority of units in the last month of a quarter," explained Dr. Major, manufacturing director of Intuitive in an interview given to Forbes
The back section of the plant is a “medical grade clean room”, where the manufacturing and test of new tools is happening. Inspection of returned robot and retrofitting of the older models also take place in the building.

Image credit: obviously, I was not allowed to take pictures in the plant, this is all I got (from Forbes.com) I could dig out of the Internet. The Mexicali one is from Maquila Watch, and the opening is through Sunnyvale News. Simon DiMaio.
If you have more info about the manufacturing of the da Vincis, let us know!

Sunday, October 2, 2011

CIS news

A quick survey on what is going on in our beloved field: