balancing safety and cost in robotically assisted surgery...louai adhami, phd [email protected]...
TRANSCRIPT
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IROS 2011
LOUAI ADHAMI, PHD
Balancing Safety and Cost in Robotically Assisted Surgery
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Thank yous
ChIR & XirTek
INRIA
Intuitive Surgical France & USA
HEGP & A. Carpentier
The RNTS, RNRT
SimQuest
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Outline
Motivation
Quick Outline of XirTek
Safety vs. Cost: XirTek step-by-step
Safety vs. Cost: Further examples from Immersion
Medical and SimQuest
Conclusion
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Motivation
Example 1: Who knows CPR?
$90 - 5 hrs
Available everywhere
Example 2: The dilemma:
“Humans as absolute value”
vs.
“What it takes to save/help someone”
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Chir/XirTek – What is was
Perception
Analysis
Monitoring
Transfer
Simulation
Validation
Robot Positionning
Port Placement
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Xirtek: How does it increase safety?6
Prepare through PlanningPlanning
Port placement
Pose planning
Prevent through V & VV & V
Formal verification
Result validation
Practice through SimulationSimulation
Pre-empt during MonitoringMonitoring
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Xirtek – What it became7
Project Chir went in a one year evaluation to assess Xirtek’s feasibility
The conclusion was that is was “too soon” for Xirtek
Why too soon?
All the technology was available
Enough customers were identified
Why; really?
Final bottom line after the whole chain was negativenegative (at least at the time)
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Chir: Port Placement8
Problem Statement:
Compute optimal incision sites based on surgeon requirements and robot specs
All ports must be admissibleadmissible
No internal collisions
Triplet optimization based on:
Surgeon’s requirements
Robot limit (max dexterity)
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Chir: Port Placement Cost9
CT scans
Complete torso
Injected and synchronized heart image
Coronarography (optional)
Segmentation
Automatic
Manual
UI
Selecting the targets
Choosing solution
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Chir: Pose Planning10
Problem statement
Position a robot in a way to achieve a collision free path g(t) such that:
Incision points @ remote centers
Maximize a clearanceclearance measure F
3 x-y-4 active6 passive
64
3
412 9 9
12 9
DOFs
Contraints
Active Passive
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Chir: Transfer11
Incision sites
Robot pose
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Chir: Transfer & Monitoring Cost12
Registration of pre / intra operative models
3d reconstruction
Port placement
Robot as pointing device
Robot pose matching
GUI
Required setup
Robot API
1-2 laptops
Stereo system
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Chir: Verification Cost13
Algorithmic Verification
Took 1 post-doc 3 months to formally verify 1 collision detection function (using Coq)
Formal Verification
Intra-operative steps were validated using XEVE
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Further Examples: IMMR LapVR Handles
Handle electrocuted a client
Redesigned the wiring
Cost = Law suit
Handles were burning the clients
Changed the enclosing to plastic
Cost = Loosing clients
Handles were burning out
Removed the haptics despite their recognized benefits
Cost = COGS + less repairs
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Further Examples: SimQuest’s BurrHole15
Requirements
Deliver very high forces (20N)
Low cost without compromising Reliability or Safety
Solution
Used custom made version of commercially available Novint devices (2 Falcons)
Close coordination with Novint was needed
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Conclusion16
Should not idealize safety – yet should not lower our standards
Work with a given or reasonable cost mind to achieve an explicit level of safety
Neglecting the cost could kill your project/product – this doesn’t mean it’s an excuse to neglect safety
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Publications17
References
L. Adhami and È. Coste-Manière. A versatile system for computer integrated mini-invasive robotic surgery. In Medical Image Computing and Computer Assisted Intervention (MICCAI'02), Tokyo, Japan, Oct. 2002.
L. Adhami and È. Coste-Manière. Optimal planning for minimally invasive surgical robots. IEEE Transactions on Robotics and Automation: Special Issue on Medical Robotics, 19(5): 854- 863, 2003.
È. Coste-Manière, L. Adhami, F. Mourgues, and A. Carpentier. Planning, simulation, and augmented reality for robotic cardiac procedures: The stars system of the chir team. Seminars in Thoracic and Cardiovascular Surgery, 15(2), April 2003.
Coste-maniere, E. Adhami , L. Boissonnat, J.-D. Carpentier, A. Guthart, G. Methods and Apparatus for Surgical Planning. US Patent 20070293734. Intuitive Surgical Inc & INRIA Roquencourt
Adhami, L. Falk, R. Ullrich, C. Bi-Directional Communication of Simulation Information. US Patent 20090202972. Immersion Cooporation.
Sites
www.simquest.com/simulation.html
www.cae.com/en/healthcare/home.asp
www-sop.inria.fr/chir (frozen)