Happy Easter

Happy Easter to all our kind readers!

Play Bunny Surgery here.

Quiz #3

Not many solutions arrived to our previous Quiz, but for the curious, that image was a design drawing of a da Vinci master console's arm. (Taken from the 2003 patent.) Here is our next Quiz: what system is depicted below? 

You can submit your answers to surgrob.blog at gmail.com until April 15. No cheating this time!

Formulation of an IEEE RAS Standards Study Group on Surgical Robotics

The Standing Committee for Standards Activities (SCSA) of the IEEE Robotics and Automation

Society authorized the lauch of an Information Session for the Formation of an IEEE RAS Standards Study Group on Surgical Robotics.

Proposed schedule: Tuesday, May 7th 8:00 am - 12, along the IEEE ICRA conference in Karlsruhe. 

Organizers: Venkat Krovi, Associate Professor, SUNY Buffalo and Gian-Luca Mariottini, Assistant Professor, UT Arlington .

Text of the call:

"The enormous growth of robotic surgical systems (and more generally computer-assisted surgical systems technology) in the past decade builds off from the significant practical utility, enormous economic value, and diversity of applications.  Surgical robotics has also greatly benefitted from the triple convergence of computing, communication and miniaturization. Other growth has come from the synergistic merger of novel component hardware technologies, innovative computational/algorithmic advances, and the system-level integration of diverse technological options. At the same time, several challenges arise not only from the complexities engendered within the human body but the diverse sets of multi-disciplinary knowledge that need to be merged to create these system-level solutions.

Despite the engendered challenges, several surgical robotic systems (and procedures) have now gone beyond the research-lab stage, to receiving  regulatory agency (FDA) approval, and are now routinely used in clinical applications (ranging from minimally-invasive general surgery, pediatric surgery, gynecology, urology, cardiothoracic surgery and otolaryngology). Various professional-societies (including surgical societies such as SAGES and MIRA) are beginning to grapple with a range of issues: 

• appropriateness of  technologies; 
• emergent clinical applications; 
• training and accreditation; 
• economics and viability; 
• safety and risk-assessment; 
• many others in this rapidly growing arena.

In this context, we believe that this is an appropriate time for the robotics and automation community as a whole to initiate a discussion of topics/sub-topics that may be ripe for standardization (based on level-of-interest and experiences of the community). Hence we would like to propose an information-gathering meeting at this ICRA’13 (on Tuesday May 7th, 8am -12pm) to solicit the participation and gauge the level of interest of the community-at-large towards the formation of an IEEE RAS Standards Study Group in the arena of Surgical Robotics. 

The proposed mandate of this Study Group would be to:

1. initiate a dialogue between the scientific, engineering and medical professionals;
2. bring together experts from academia and industry to form expert-groups;
3. leverage this expertise in developing metrics and standards framework
4. identify the most prominent areas needing standardization in surgical robotics;
5. identify standards and validation benchmarks to promote the transition of research-lab technologies to the operating room.

A white paper will be developed based on the discussion at this information meeting - so please come and share your thoughts, suggestions and opinions with us. Attendance is free and refreshments

will be provided."

For more information:

Website: https://sites.google.com/site/ieeerassurgrobstandards/

Mailing-list: ieee-ras-surgrob-standards@googlegroups.com

CIS news

• The Wall Street Journal also picked up the recent findings regarding the economics of hysterectomy.
• Further reports also popped up.  
• MedPage Today is also discussing the hysterectomy case 
• The safety features of the da Vinci are under inspection (again), leading to a roller-coaster effect on stock prices. Learn more about the interior of the robot! 
• Doctors can still can't agree on when to use the robot
• In the mean while, Intuitive's 2012Q4 results sounds as good as always
• Nevertheless, law companies are trying to take a bite of Intuitive's cake
• Catherine Mohr: The Da Vinci Surgical Robot and Beyond
• Cool da Vinci tool for vibration sensing from UPenn.
• Not too recent article on the market status of Intuitive

• US-driven robotics development at Vivonics
• TUM's new RCM structure for eye surgery 
• 98.9 pct implant accuracy reported for the MAKO robot
• Blue Belt announced its first sale of the Navio PFS system for unicondylar knee replacements
• Surgical robotics on Pinterest 
• Seminar on the iSnake robot at IRCAD
• Haptics coming to surgical robots

• Augmented reality for neurosurgeons--with Kinect
• More Kinect in the OR
• IBM Watson's future role in medicine
• Concept of 'Medirobot' medical robotic assistant
• Robotic devices help stroke survivors regain movement
• A personal view on elderly care robots
• Medical device tax would push 146,000 jobs overseas

• Come and join us for the ICCC conference in Hungary!
• The great IRCAD student program for MIS innovation education is continuing!
• Join the ICRA workshop: "Evaluating effectiveness and acceptance of robots in surgery: user centered design and economic factors"
• Also happening at ICRA: the 1st Intl. Workshop on Surgical Vision
• Hamlyn Robotics Symposium will take place again this year
• Apply for the Telluride 2013 Neuromorphic Workhop 
• First European Design of Medical Device Conference  

• Postdoc position openings in the Biorobotics Lab at CMU
• Post-doctoral Fellowship Medical Image Processing – Computer-Aided Diagnosis at NIH

 

Photo credit: Wall Street Journal

US updates its Robotics Roadmap

Yesterday, the updated version of the US Robotics Roadmap was released, prepared by the  Congressional Robotics Caucus Advisory Committee. Compared to the 2009 version, the sections on medical and health care robots have been extended. Robots are listed as therapy devices for mental diseases as well, and as promoters for wellness and healthy living. Too bad there are no references in the text at all, despite the fact that it contains some questionable pieces of information. Here is what the group of experts expect in the future: 

• In 5 years: "New devices and algorithms will enable more effective two-way exchange of information and energy between the human and the robot. In surgical robotics, systems will be able to provide the full suite of physical feedback to the surgeon as they control the robotic instruments. The interface will provide rich haptic feedback including forces as well as complementary information such as surface texture and environmental compliance of the remote patient’s tissue, with similar information available during simulated training sessions. Robotic devices for rehabilitation will be able to output a wide range of impedances, from completely un-encumbering (zero mass/stiffness/friction) to very high impedance with the ability to entirely support the patient’s weight. Orthotic and prosthetic devices will restore lost functionality, such that the human user is able to conduct basic daily tasks without assistance. Understanding of desired human motion based on external sensors and brain-machine interfaces is essential for prosthesis design, requiring an appropriate mapping between human thoughts and the actions of a robotic prosthetic limb.
• In 10 years: Human-robot interaction will be made intuitive and transparent, such that the human’s intent is seamlessly embodied by the robotic system. Interfaces should be automatically customized to the specific user to maximize intuitiveness of the interface. Interfaces will estimate the user’s intent, rather than simply executing the user’s commands that may be subject to human imperfections. Surgical robots will enable outcomes better than what can be expected in open surgery by eliminating non-useful information from the interface and from the motion command. In rehabilitation applications, robots will interface with patients to provide assistance and/or resistance along appropriate degrees of freedom, and should provide backdrivable or compliant behavior that transmits appropriate physical feedback regarding patient behaviors. Patients will feel feedback that makes them aware of movement errors and spasticity, encourages smooth repetitive movements, and is engaging and challenging as needed. Orthotic and prosthetic devices will enable functionality that begins to match that of the original biological capabilities.
• In 15 years: Assistance from robotic systems will enable the human user to become better than human. By sensing a human’s movement and inferring intent, robots will be able to provide con-text-appropriate forces to a human operator, such as a rehabilitation patient using a robot to re-gain limb function and strength after a stroke. The robot will limit applied force or motion to levels that are useful and intuitive for the user. It will provide virtual constraints and other physically meaningful elements to help execute tasks accurately, or to provide feedback helpful for training, motor learning, and musculoskeletal adaptation. Surgical teleoperators will enable a human or multiple humans to control non-anthropomorphic manipulation systems with velocity limits, degrees of freedom, and kinematics that deviate significantly from that of a human, with the limitations of the robotic system intuitively conveyed to the human user(s). Both surgical teleoperation systems and rehabilitation robots will provide training to the human user through-out the physical interaction such that the human learns how to be a better user of the robotic system while simultaneously learning how to rely less on the robotic system. Orthotic and prosthetic devices will enable functionality that surpasses the original biological capabilities."

Read more about it in the document!

Flickstop

The smiley team of the Raven 2 at UWashington, led by Prof. Hannaford.

da Vinci copycats from Asia

No successful innovation can avoid the rise of pretenders, sometimes lousy copies, sometimes  superior designs. Many of the da Vinci copies come from Asia. Here are a couple of examples, you can also learn more about these from the IEC/ISO Workshop materials, presented by Drs Kiyoyuki Chinzei and Kai Xu. And more from Dr. Zhijiang Du.

• The Japanese are well known for their robotic skills, and combined with their protective policies, many da Vinci-like manipulators emerged as a lab prototype, and despite the fact that Intuitive only acquired approval pretty late in 2009, no competitors entered the market. Notable examples include the "Tele-operative Laparoscopic Surgical System" developed at the University of Tokyo, with which even a telesurgical operation between Japan and Thailand was demonstrated. 
• Robotics and Automation Laboratory (RAL) at the Nagoya Institute of Technology has also been a partner with UTokyo and CAMIT in Kyushu University.
• Just next door, the Waseda University has also developed "surgical robot systems that perform advanced, minimally invasive surgery and rehabilitation support systems."  
• The NEDO system was announced last autumn.
• As an alternative approach, Hitachi Medical made a try with the commercialization of an MR compatible setup.
• In China, the Beijing Institute of  Technology built a robot  for facial orthotics, with a very similar look. (NB! The first da Vinci procedure was only performed in 2009 in China, however, surgical robot development projects began a lot earlier.)
• We have already covered the Micro-Hand A.
• The laparoscopic surgical robotic system from the Harbin Institute of Technology could not defy its ancestor.

Workshop on Technology Transfer and Innovation in Robotic Surgery

All are cordially invited to join our workshop on Technology Transfer and Innovation in Robotic Surgery at the 2013 European Robotic Forum in Lyon next week.

"This workshop aims at examining the current situation of robotic surgery and at attempting to identify why European research and industrial companies have such a little impact on the surgical applications of robotics. In particular, this workshop will discuss whether there is a clear business opportunity in robotic surgery and, if so, why new players are slow to enter the market. In fact, the numbers seem to indicate that the business case is very strong. The most successful manufacturer of commercial surgical robots for abdominal surgery is Intuitive Surgical (Sunnyvale, CA-USA), whose robot “da Vinci” has now 2,462 installation worldwide, of which 1,789 in the United States, 400 in Europe, and 273 in the Rest of World. The number of robotic procedures is up 25% with respect of 2011, and Intuitive Surgical operating profits are also up 27% with respect to last year. Other companies have shown more modest results (Accuray, ROBODOC, MAKO, Mazor, Hansen, FreeHand Surgical), and only few of them have used in their products technologies developed by European laboratories. Furthermore, the customer base (i.e. the surgical community) is expanding and asking for new devices. This is generating some uneasiness in the community, whose main complaints are:

• Lack of specific robotic instruments and intervention set-up,     
• Excessive costs of equipment and maintenance,     
• Lack of realistic set-up for experiments and research,     
• Lack of accessible and cost-effective training,     
• Excessive economic burden of National Health Systems.

To discuss this situation and assess whether the slow market acceptance of new companies is physiological or specific to robotic surgery, we are inviting representatives of the Surgical, Research and Industrial communities of Europe to the workshop, and we will ask to illustrate their opinion and suggestions in a 10 minute presentation. A round table summarizing the main points raised will conclude the workshop. Furthermore, we will summarize the workshop findings in a white paper to be distributed to the community and to EU Officers. The workshop is organized within the EuroSurge project, whose goals include examining the non-technical issues affecting the development of robotic surgery."

Check out the provisional program here (March 19, 14:15-18:30). 

Quiz #2

Time for our next quiz! 

What is on the picture? Send your answer to surgrob.blog at gmail.com before March 31 to compete for great prizes!

Titan's Amadeus updates

Finally, a new concept drawing has appeared at Titan Medical's most recent company brochure. 

Features include: 

• "Deployment of system into body cavity through a ~25 mm skin incision 
• Dual snake-like robotic arms with multiple degrees of freedom 
• Stereoscopic 3D HD controllable camera 
• Full array of surgical tools (capable of delivering electrocautery for hemostasis) 
• Small refined workstation"

Patent Portfolio: 7 U.S . Patents, 10 applications:

• Robotic hand controller: 8,332,072 
• Multi articulating robotic instrument: 8,347,754 
• Method and system for performing medical procedure  8,306,656 
• Snaking robotic arm with movable shapers 8,224,485 
• Magnetic retraction system for laparoscopic surgery 6,358,196 
• Magnetic operating table 5,593,379; 5,529,568

Licensed technologies: 

• Surgical Stapler from the Mayo Foundation 
• Insertable Robotic Effector Platform ("IREP") for single-site robotic surgery from Columbia University

Image credit: Titan Medical

Disclaimer: Images for illustration purposes only and are subject to change

Read our previous articles [1, 2] on the Amadeus system! 

ISO/IEC Workshop on Medical Robotics

Early February, we had a workshop at Stanford University, focusing on the state of the art of medical robotics, and current challenges our workgroup is facing dealing with a new medical robotics safety standard. 

Now the presentations are available at the CLAWAR website. 

Presentations:

• GSVirk - Robot standardization
• SColburn - FDA-CDRH and medical robots
• KXu - SoA in China
• Haidegger - Ethics in medical robotics
• SZahedi - SoA in Prosthesis
• KChinzei - SoA in Japan
• ACohen - Robots in Radiotherapy
• J-IMoon - SoA in Korea
• JVeneman - SoA in Rehabilitation
• MCuret - Driving clinical applications
• CMohr - Future medical robots
• PFiorini - SoA in Europe

Special thanks to the CLAWAR group for the support, Intuitive Surgical and Accuray for sponsorship and Prof. Ken Waldron, for hosting us!