Transcript Technological Sciences for the Operating Room

Technological Sciences for the
Operating Room
Robotics for the Surgical
Technologist
That was then
Introduction
• Karel Capek
– Term traced to play written in 1923
– Czech word “robota” means “heavy labor”
• 1961: First industrial robot in U.S.
• Robot: Has mobility; operates
automatically; perform variety of tasks
Introduction
• First Generation Robots
– Mechanical arms without artificial
intelligence (AI)
– Precise repetitive motions at high speeds
– Constant monitoring by humans
• Second Generation Robots
– Some AI
– Tactile sensors
– Some vision and hearing
– Do not require constant monitoring
Introduction
• Third Generation Robots
– Autonomous robots: work independently
w/o human supervision
– Insect robots: controlled by central AI
computer; collective intelligence
• Fourth Generation
– Not yet developed
– But will display abilities to learn and evolve
THIS IS NOW!
Surgical Robots
• Vastly improve surgical patient care by
overcoming human limitations
• Still require surgeon control
– Remote control
– Voice activation
• Future
– Diagnose
– Surgically correct a disease without human
control
Surgical Robots
• Examples of Advantages
– Replace expensive health care personnel
– Telesurgery
– Shorter patient convalescence with
minimally invasive procedures
• Da Vinci and ZEUS allow for smaller
incisions.
– Eliminate hand tremors
• EndoWrist instrumentation
Surgical Robots
• AESOP 3000
– Developed by Computer Motion
– Position endoscope
– Foot pedals or voice-activated
software to position camera
– Leaves surgeon’s hands free
Surgical Robots
• Da Vinci and ZEUS
– Similar set-ups: computer workstation; video
screen; robot next to patient; three manipulators
– Gallbladder surgery
• 3 sm. incisions for 3 rods held by 3
manipulators
• 1 rod holds camera; 2 rods hold surgical
instruments for dissecting and suturing
• Surgeon sits at workstation with joystick
control
Surgical Robots
• Telesurgery
– Perform a procedure in real time at a
distance
– Surgeon remotely controls robotic
arms
– Obstacle: time delay between
surgeon and robotic response
Design
• Robotic Components
– Manipulators
– Surgical instrumentation
– Remote console
– Computers
– Voice activation system
AESOP Design
• Manipulator
– Transported on special cart
– Special O.R. table not necessary
– Move cart next to O.R. table
– Attach manipulator after patient
positioned
AESOP Design
• Manipulator con’t.
– Placement depends on surgery
• Lower abdominal procedures:
manipulator placed at top of O.R.
table
• Upper abdominal procedures:
manipulator placed at bottom of table
– Freedom of movement: markings on
manipulator
AESOP Design
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Draping: sterile plastic cover
Optics: attached by sterile magnetic device
10/12 mm size trocar used
Manipulator controlled by voice commands
– Individual computer chip for each surgeon
created and inserted.
– Programmed to ignore casual conversation
– Orders confirmed by computer
– Corrections to optics by hand
Manipulator
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Perform simple to complex functions
Automated device
Attached to rail of O.R. table
Distal end of arm attaches to
instrumentation or endoscope
• Connected by cables to computer
Manipulator
• Extension of surgeon’s hand
– Conserves time, effort, and motion
– Less chance for error
– Eliminates unnecessary motion
– Safe, secure movement of scope
• Voice Activation System
– Activated by hand or voice of surgeon
– Master unit programmed to ignore outside
conversation
Manipulator
• Other Master Unit Controls
– Unit controls
• Manipulator
• Shaver (Arthroscopic surgery)
• Fluid pump (Arthroscopic surgery)
• Lights in O.R.
• Printer and computer for intraoperative
photos
Remote Manipulation
• Single Manipulator
– Hold endoscope
– Surgeon uses surgical instruments
• Multiple Manipulators
– Hold endoscope and manipulate
instrument
– Instruments similar to other scope
instruments
Remote Manipulation
• Sequence of Events
– Computer receives message from
micromanipulators on remote console
– Computer translates messages
– Micromanipulators translate surgeon’s
hand movements to manipulator(s)
– Surgeon views activity on 3-dimensional
console screen
Remote Manipulation
• Advantages
– Eliminates hand tremor
– Reduces errors
– Performs complex techniques in small
space
– Improves visualization
– Enables telesurgery in rural hospitals and
other countries
Geometrical Design
• Cartesian Coordinate Geometry
(rectangular coordinate geometry)
– Manipulator design based on Cartesian
system
– Joints referred to as shoulders, elbow, and
wrist
– Arm moves along x, y, z axes
Geometrical Design
• Cartesian Design con’t.
– Degrees of Freedom: Number of
dimensions of manipulator movement as
compared to human arm
– Most manipulators have 3 dimensions
• Pitch: Up & down movements
• Yaw: Right & left movements
• Roll: Rotating movement
– Degrees of Rotation: Clockwise and
counterclockwise movements
Geometrical Design
• Cylindrical Coordinate Geometry
– Incorporates plane polar coordinate system
with elevation
• Revolute Geometry
– Allows manipulator to move in 3
dimensions
• Shoulder: 360° rotation; 90° elevation
• Elbow joint: 180°
• Wrist joint: revolve and flex
Hearing
• Machine hearing analogous to human
hearing
– Direction sound originated
– Type of sound
• Binaural Hearing
– Same type as human hearing
Hearing
• Process of Sound
– Varying levels of intensity
– Brain processes sound waves
– Person locates source of sound
– Person interprets source of sound
– Head can be turned
Hearing
• Robotic Hearing
– Two sound transducers
– Microprocessors connected to
manipulator; discern voice patterns
and sound waves
• Determine source of sound
• Identify direction sound came from
Vision
• Sensitivity
– Ability to see in dim light
– High level of sensitivity often required in
O.R.
• Resolution
– Ability to differentiate between two objects
– Can vary
– Better the resolution, better the vision
Vision
• Sensitivity vs. Resolution: Negative
Effect
– Resolution increased, vision
decreases in dim light
– Improved sensitivity – decreased
resolution
Vision
• Binocular Machine Vision
– Analogous to binocular human vision
(stereo vision)
– Allows perception of depth
– Robotic vision in surgery will require
• Development of high resolution camera
• Very powerful robot controller
• Advanced AI system
Decontamination and
Sterilization
• Instruments and Endoscope
– Routine cleaning, decontaminating &
sterilizing
• Magnetic Device that Holds Robotic
Optics
– Steam sterilized
• Manipulators
– Draped with special sterile sleeves
Clinical Applications
• Evolution of Endoscopic Surgery
• Primary Robotic Systems
– AESOP
– Da Vinci
• Surgical Specialties
– Cardiovascular
– Neurosurgery
– General
– Orthopedic
– Maxillofacial
Future Operating Room
• Robots increasingly used for minimally
invasive surgery
• Virtual-reality simulations for training
purposes
• Realistic anatomical models
• Biomechanics-based simulations for training
• Surface-based registration
• Surgical robotics
• Advanced human-computer interaction
Planning and Rehearsal
• Current Method Preoperative Planning
– Study two-dimensional image of pathology
• Future of Preoperative Planning
– Image-based planning and rehearsal;
consists of 3 segments
• Patient imaging
• Create 3-dimensional model
(modeling)
• Planning and rehearsing procedure
Planning and Rehearsal
• Current imaging: MRI or CAT scan
• Advanced: Deformable Modeling
– Provides realistic mechanical simulations
of tissue
– Aid surgeons in predicting potential
complications during rehearsal
– Images obtained are transformed into 3dimensional models manipulated with
virtual instruments
Planning and Rehearsal
• Deformable Modeling con’t.
– Goal: Achieve realistic 3-dimensional
simulation of soft tissue
– Surgeon uses computer-generated model
of patient
• Diagnose condition
• Treatment options
• Practice surgical procedure
Planning and Rehearsal
• Deformable Modeling con’t.
– Key Point: Surgeon is not practicing on
general model
– Images are obtained from patient –
patient’s virtual tissue images
– Advantages
• Anticipate and avoid errors
• Resolve unforeseen complications
preoperatively
Next Step: Surface-based
Registration
• Biomechanical Control System
– Registers (determines orientation of)
tissues in the O.R.
– Surgical Navigation System
• Laser scanners
• Video cameras
• Produce images of MRI and patient
preoperatively and intraoperatively
Surface-based Registration
• How It Works
– Tissue, such as brain, is scanned – MRI or
CAT scan
– Normal and abnormal tissue differentiated
by computer analysis by color
– 3-dimensional images of structures
produced by computer
Surface-based Registration
• How It Works con’t.
– O.R. images superimposed on head of
patient
• Laser scans patient’s head
• Obtains 3-dimensional coordinates
• MRI combined with laser scan
• Patient’s virtual head superimposed on
real head
• Surgeon can “see” inside patient’s head
before incision is made
Surgical Technologists of the
Future
• Surgical Technologists Will Understand:
– Physics
– Biomechanics
– Computer Science and Advanced Software
– Electronics
– Robotics
– Maintain, troubleshoot, operate robotic
equipment
Robotics for the Surgical
Technologist
• SUMMARY
• Intro
• Development
• Types
• Uses
• Designs
• Applications
• Specialties
• THE END