computer aided medical intervention for urology...
TRANSCRIPT
Computer aided medical intervention for Urology,Colonoscopy and orthopaedic
surgery
France – Singapore Workshop on Medical Imaging and Robotics
Speakers: A/P Ng Wan Sing, Dr Louis PheeVenue: The Oriental Hotel, SingaporeDate: 02 Dec 2002
Robotics in Gastroenterology
Gastroenterology:The branch of medicine concerned with the study and treatment of diseases of the digestive system
OesophagusStomach
Small intestineColon
Rectum
Current Medical PracticesDiagnosis only:•Blood test•Stool test•Imaging (Barium enema, virtual colonoscopy) Flexible
endoscopesDiagnosis & intervention:•Flexible endoscopy(gastroscopy, sigmoidoscopy, colononoscopy)
Endoscopic imagesIntervention procedure
Drawbacks of Flexible Endoscopy
•Pain & discomfort for the patient
•Technical complexity for the surgeon
•Expensive; deters patient from examination
ObjectivesLong-term ObjectiveTo develop a wireless intelligent microcapsule small enough to be swallowed. It would be capable of propelling itself along the entire GI tract inspecting and diagnosing the tissue for abnormalities and performing therapeutic intervention when the need arises.
Givenimaging’s M2A capsule
Today’s Technology
Proposed intelligent microcapsule
Tomorrow’s Technology
ObjectivesShort-term ObjectiveTo develop effective locomotion devices to enable a wired device to propel itself, autonomously or semi-autonomously, into the colon. In parallel, a vision system, sensors and actuators would be integrated into the device to increase its functionality.
Colon – 1st Target Organ
State-of-the-art – In-pipe Robots
Hirose & Yoneda Robotics Lab, Japan
Fukuda Lab, Japan
North Carolina State University
State-of-the-art – In-body Semi Autonomous Devices
J.Burdick et al.
(Caltech)
The EndoCrawler
Phee et al.
Robotics in Urology
Urology:The branch of medicine concerned with the study and treatment of diseases of the urinary tract
BladderKidneyUrethralProstate
Male reproductive organ
The Prostate
The prostate is a gland of the male reproductive system. It is located in front of the rectum and just below the bladder.
The main purpose of the prostate is to produce fluid for semen, which transports sperm during the male orgasm.
State-of-the-art
A six axis PUMA robot modified to perform Transurethral Resection of the Prostate (TURP)
B. Davies et al., Imperial College London
State-of-the-art
PRobot – A robot for prostatectomy and Transurethral Resection of the Prostate (TURP)
B. Davies et al., Imperial College London
State-of-the-art
URobot – A robot to treat BHP using Interstitial Laser Coagulation (ILC), laser resection and hot loop TURP.
W.S. Ng et al., Nanyang Technological University
State-of-the-art
System Cart
Visual Display Unit
Supporting Manipulator
Laser Probe Manipulator
Mobile base unit
or Diode laser
Touch screen
Patient
Motion controller
Graphics card
Frame grabber
Host computer
ISA
PCI
Kretz Ultrasound
scanner
Ultrasound display
Foot pedal Foot pedal
Surgeon
Base
Payload – laser applicator manipulator
Endoscope, Albaran bridge and laser applicator
Transurethral ultrasound probe
Supporting manipulator
Ultrasound signal and data
Video signal
Control signal and data
ILC Robot – A robot to treat BHP using interstitial laser
W.S. Ng et al., Nanyang Technological University
Nd:YAG coagulation (ILC)
State-of-the-art
SPUD (Surgeon Programmable Urological Devce)– Latest version of the URobot
W.S. Ng et al., Nanyang Technological University
State-of-the-art
HIFU Robot – A robot to treat prostate cancer using High Intensity Focused Ultrasound (HIFU)
W.S. Ng et al., Nanyang Technological University
Biopsy Robot for Prostate
Present Situation•Gross spatial inaccuracies as surgeon tries to locate a point in space based on 2-D images•High false-negative results•Multiple punctual holes on perineal wall
Objectives•To reduce false-negative results with accurate biopsy of the prostate•To perform multiple biopsies with a single puncture hole
Penis
Scrotum
Anus
Perineal wall
Biopsy Robot for Prostate
Ultrasound Machine Biopsy Robot Computer Module
Biopsy Robot for Prostate
Transrectal UltrasoundProbe
Biopsy Gun
Biopsy Needle
Surgical PlannerPositioning of robot w.r.t. patient
Acquisition of U/S images
Delineation of prostate boundary
3D Modeling of prostate
Definition of points of interest
Adjustment of trajectory of needle
Insertion of needle & firing of biopsy gun
Surgical PlannerPositioning of robot w.r.t. patient
Acquisition of U/S images
Delineation of prostate boundary
3D Modeling of prostate
Definition of points of interest
Adjustment of trajectory of needle
Insertion of needle & firing of biopsy gun
Acquisition of U/S Images
Surgical Planner
Acquisition of U/S images
Positioning of robot w.r.t. patient
Delineation of prostate boundary
3D Modeling of prostate
Definition of points of interest
Adjustment of trajectory of needle
Insertion of needle & firing of biopsy gun
Surgical Planner
Acquisition of U/S images
Positioning of robot w.r.t. patient
Delineation of prostate boundary
3D Modeling of prostate
Definition of points of interest
Adjustment of trajectory of needle
Insertion of needle & firing of biopsy gun
Delineation of Prostate Boundary
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Surgical Planner
Acquisition of U/S images
Positioning of robot w.r.t. patient
Delineation of prostate boundary
3D Modeling of prostate
Definition of points of interest
Adjustment of trajectory of needle
Insertion of needle & firing of biopsy gun
3D Modeling of Prostate
Surgical Planner
Acquisition of U/S images
Positioning of robot w.r.t. patient
Delineation of prostate boundary
3D Modeling of prostate
Definition of points of interest
Adjustment of trajectory of needle
Insertion of needle & firing of biopsy gun
Definition of Points of Interest
Manually defined
point of interest
Needling simulation
Surgical Planner
Acquisition of U/S images
Positioning of robot w.r.t. patient
Delineation of prostate boundary
3D Modeling of prostate
Definition of points of interest
Adjustment of trajectory of needle
Insertion of needle & firing of biopsy gun
Surgical Planner
Acquisition of U/S images
Positioning of robot w.r.t. patient
Delineation of prostate boundary
3D Modeling of prostate
Definition of points of interest
Adjustment of trajectory of needle
Insertion of needle & firing of biopsy gun
Experiments
In VitroPhantoms
Animal Trials
CadaversClinical Trials
Future Works
•Incorporation of Magnetic Resonance Spectroscopy (MRS) images to pinpoint sites for biopsy
•Modification of robot for Brachytherapy; strategic implantation of radio-active pellets in the prostate for the treatment of prostate cancer
Predetermined
Cancer sites