how the future of surgery is changing: robotics, telesurgery
TRANSCRIPT
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Fig 1
How the Future of Surgery is Changing:Robotics, telesurgery, surgical simulators and other advanced technologies
Richard M. Satava, MD FACSProfessor of Surgery
University of Washington
Program Manager, Advanced Biomedical TechnologiesDefense Advanced Research Projects Agency (DARPA)
andSpecial Assistant, Advance Medical Technologies
US Army Medical Research and Materiel Command
University of Washington, September, 2006
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Fig 2
Holomer Total body-scan for total diagnosis
Satava March, 2004
From visible human to Virtual Soldier Multi-modal total body scan on every trauma patient in 15 seconds
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Fig 3
Virtual Autopsy
Wound Tract
Less than 2% of hospital deaths have autopsy
Statistics from autopsy drive national policies
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Fig 4
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Fig 5
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Fig 6
Why robotics, imaging and modeling & simulation• Healthcare is the only industry without a computer representation of its “product”
•A robot is not a machine . . .it is an information system with arms . . .
• A CT scanner is not an imaging system it is an information system with eyes . . .
thus
• An operating room is an information system with . . .
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Fig 7
Total Integration of Surgical Care
Joel Jensen, SRI International, Menlo Park, CA
Minimally Invasive Surgery
Pre-operative planning
Intra-operative navigation
Remote Surgery
Simulation & Training
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Fig 8
Prof. Jacques Marescaux, IRCAD
Remote telesurgery
Dr. Mehran Anvari, MDMcMaster Univ, Toronto CANADA
“Operation Lindberg”
First remote and trans-AtlanticTelesurgery procedure
ROUTINE telesurgery from Hamilton to North Bay
300 mile distant
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Fig 9
“TriCorder” Point-of-care noninvasive therapy
High Intensity Focused Ultrasound for Non-invasiveAcoustic hemostasis
HIFU
Courtesy Larry Crum, Univ Washinton Applied Physics Lab
Mechanics to energy
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Fig 10
The LSTAT
Courtesy of Integreated Medical Systems, Signal Hill, CA
“ . . .is aware of everything (patient) . . .”
• Defibrillator• Ventilator• Suction• Monitoring• Blood Chemistry Analysis• 3-Channel Fluid/Drug Infusion•Data Storage and Transmission• On-board Battery• On-board Oxygen• Accepts Off-Board Power and Oxygen
Total Patient Awareness
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Fig 11
212th MASH Deployed with LSTAT - Combat Support Hospital
LSTAT Deployment to Kosovo - March 2000
Courtesy of Integreated Medical Systems, Signal Hill, CA
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Fig 12
LSTAT Lite
LSTAT for far-forward battlefield – less than 50 lbs
LSTAT – Back pack version
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Fig 13Why now?VTOL UAV technology is maturing rapidly enough to minimize risk.
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Fig 14Nightingale UAV Goal Identify “optimum” VTOL UAV design Create a new VTOL UAV tailored to the operational need
LSTAT
Or:
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Fig 15
Classic Education and Examination
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Fig 16
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Fig 17
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Fig 18
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Fig 19
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Fig 20
c. Laparoscopic Simulator with tactile feedback Courtesy Murielle Launay, Xitact, Lausanne Switzerland
b. Laparoscopic hysterectomy Courtesy Michael vanLent, ICT, Los Angeles, CA
a. LapSim simulator tasks - abstract & texture mapped Courtesy Andres Hytland, Sugical Science, Gothenburg, Sweden, 2000
SurgicalSimulators
Simulation and Objective Assessment
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Fig 21
ENT Sinusoscopy Simulator Lockheed Martin 1999
HapticsFull System
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Fig 22
“Red Dragon”“Blue Dragon” passive recording device
Courtesy Blake Hannaford, PhD University of Washington, Seattle
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Fig 23
Hand motion tracking patterns Ara Darzi, MD. Imperial College, London, 2000
Novice
Intermediate
Expert
Objective Assessment
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Fig 24
Modified Endoscope for Transgastric Surgery
Courtesy of N Reddy, Hyperbad India 20005
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Fig 25Trans Oral Intra-peritoneal Surgery - Future
Courtesy of N Reddy, Hyperbad India 20005
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Fig 26
Peroral Transgastric Endoscopic Surgery
Need for development of modified accessories and endoscopes
Courtesy of N Reddy, Hyperbad India 20005
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Fig 27
Suture Devices
Eagle ClawApollo ProjectOlympus, Tokyo.
Courtesy of N Reddy, Hyperbad India 20005
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Fig 28So What Next?
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Fig 29
“Ubiquitous lights” and “Sea of Cameras”Courtesy Eric LaPorte, MD Barcelona, Spain 2005Courtesy Takeo Kanade, PhD Pittsburg, PA 1999
l
Continuous training, assessment and maintenance of certification
“Black Box”
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Fig 30
“Penelope” – robotic scrub nurse
Michael Treat MD, Columbia Univ, NYC. 2003
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Fig 31
The Operating Room of the Future
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Fig 32
SATAVA 7 July, 1999DARPA
Fighter Pilots – until 2002 Fighter Pilots – Beyond 2003Predator 2003
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Fig 33
Robotic Medical Assistant
SATAVA 7 July, 1999DARPA
Nursing shortage crisis
Applicable at all levelsHospitalsClinicsNursing HomeAssisted living
Courtesy Yulun Wang, InTouch Technologies, Inc, Goleta, CA
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Fig 34
Scientific MethodA Paradigm Change?
Hypothesis Study Design Experiment Results Reporting
Hypothesis Study Design Modeling & Results Experiment Results Reporting Simulation (Preliminary)
Modeling & Simulation
Thousands of iterationson a computer
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Fig 35
BIO INTELLIGENCE AGETE
CH
NO
LOG
Y D
EV
ELO
PME
NT
CONSUMER ACCEPTANCE
AGRICULTURAL AGE
INDUSTRIAL AGE
BIOINTELLIGENCE AGE
INFORMATION AGE
TIME (year)
2000 BC 0 2000 AD190018001500
Satava 29 July 99
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Fig 36
BIOLOGIC PHYSICAL
INFORMATION
FUTURE
RoboticsHPCC/WWWMEMS/Nano
GenomicsBioinformaticsBiocomputation
BiosensorsBiomaterialsBiomimetic
Satava 2 Feb 1999
The BioIntelligence Age
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Fig 37
¿And just what are these incredible new technologies?
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Fig 38
University of Montana, 1999
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Fig 39
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Fig 40Biomimetic Micro-robot
a. Courtesy Alan Morimoto,Sandia National Labs
b. Capsule camera for gastrointestinal endoscopy
Courtesy Paul Swain, London, England
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Fig 41
Cold Spring Harbor Laboratory, Long Island, NY
Femtosecond Laser(1 x 10 –15 sec)
c.Time of Flight Spectroscopy
d. Cellular opto-poration
Los Alamos National Labs, Los Alamos NM
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Fig 42
Surgical console for cellular surgery
Courtesy Prof Jaydev Desai, Drexel Univ, Philadelphia, PA 2005
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Fig 43
Surgical console for cellular surgery
Courtesy Prof Jaydev Desai, Drexel Univ, Philadelphia, PA 2005
Motion Commands
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Fig 44
Fig. 2. Top: Fluorescent micrograph of the actin cytoskeleton of an engineered striated muscle cell. Bottom: AFM-acquired topographical map. Wrinkles and lines along the diagonals of the 30 micron square are actin stress fibers under the lipid membrane surface.
Fig. 3. Schematic illustrating the technique for functionalizing AFM tips to identify specific molecules on the cell surface during raster scanning.
Fig. 4. Nanoincision by electroporation. (A) The AFM cantilever is positioned above a region of interest in the cell. (B) Electrical current is injected through the cantilever tip, causing the formation of a nanometer scale pore in the membrane, thru which the AFM tip can be dropped, or other instrumentation attached to the tip, prior to the membrane resealing.
New Surgical Tools
Courtesy Prof Kit Parker, MD, Harvard Univ, Boston, MA 2005
Atomic Force Microscope ManipulatorFemtosecond Lasers
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Fig 45
Greg Kovacs. Stanford University, 1990
“BrainGate” John Donohue, Brown University, 2001
Richard Andersen, CalTech, 2003
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Fig 46
Recorded activity for intended movement to a briefly flashed target.
TARGET MOVEMENT
Time
PLAN
Courtesy Richard Andersen, Cal Tech, Pasadena, CA
Brain Machine Interface – Controlling motion with thoughts
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Fig 47
Thoughts into Action
Miguel Nicholai, Duke University, 2002
Direct brain implant control of robot arm
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Fig 48
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Fig 49
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Fig 50
a) Rheo Bionic knee Ossur, Reyknavik, Iceland b) C-leg Otto Bock, Minneapolis, MN
Intelligent Prostheses
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Fig 51
Artificial Retina
a) Multi-disciplinary team from USC Doheny Retinal Institute, Oak Ridge National Labs, North Carolina State University and Johns Hopkins University
Courtesy Jim Weiland, USC Doheny Retina Institute,Los Angeles, CA
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Fig 52
Tissue Engineering
Liver Scaffolding
Artificial Blood VesselJ. Vacanti, MD MGH March, 2000
Artificial Ear
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Fig 53
Courtesy of J. Vacanti, MD MGH March, 2000
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Fig 54
Spider silk protein as biomaterial -BioSteel
Nexia Biotechnologies, Montreal Canada
Cross section of synthetic fiber
Spinnerette of spider
Orb spider - web
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Fig 55
Brian M. Barnes, Institute of Arctic Biology , University of Alaska Fairbanks 11/02
Institute of Arctic Biology’s
Toolik Field Station,
Alaska's North Slope
SuspendedAnimation
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Fig 56
metabolic rate 0.5 0.01 (2%)
active hibernating
body temp. 37oC -2oC
gene ongoing transcription function and translation suppressed
heart rate 300 3
resp. rate 150 <1 (breaths/min)
(beats/min)
(mlO2/g/h)
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Fig 57
Confidential
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Fig 58
• The rate of new discovery is accelerating exponentially
• The changes raise profound fundamental issues
• Moral and ethical solutions will take decades to resolve
Technologies will change the Future
Differing responses to scientific discovery by various sectorsTIME
Rat
e of
Cha
nge
Society
Business
Sector
Technology
Healthcare
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Fig 59
Technology is Neutral - it is neither good or evil
It is up to us to breathe the moral and ethical lifeinto these technologies
And then apply them with empathy and compassionfor each and every patient
The Moral Dilemma
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Fig 60
Reason there are no penguins at the North Pole
The Scientific Community must engage in their moral and ethical responsibilities . . .
. . . Or abdicate to those with political and selfish agendas.
ALERT !!
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Fig 61
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Fig 62
February 12, 2004
South Korean team demonstrates cloning efficiency for humans similar to pigs, cattle | Thersa Tamkins
After outlandish claims, a few media circuses, and some near misses by legitimate researchers, a team of South Korean researchers reports the production of cloned human embryos. The findings, were released Wednesday (Science, DOI:10.1126 /science.1094515, February 12, 2004).Wook Suk Hwang and Shin Yong Moon of Seoul National University used somatic cell nuclear transfer to produce 30 human blastocysts and a single embryonic stem cell line; SCNT-hES-1. Using 242 oocytes and cumulus cells from 16 unpaid donors, the group achieved a cloning efficiency of 19 to 29%, on par with that seen in cattle (25%) and pigs (26%).
Human embryos cloned
Chinese Cloning Control RequiredTuesday 16 April, 2002, 10:41 GMT 11:41 UK
Strict ethical guidelines are needed in China to calm public fears about new cell technologies such as cloning, the country's leading scientist said. Professor Ching-Li Hu, the former deputy director of the World Health Organization, was speaking at the Seventh Human Genome Meeting in Shanghai. His call follows recent reports that Chinese scientists are making fast progress in these research fields. One group in the Central South University in Changsa is said to be producing human embryo clones, while another team from the Sun Yat-sen University of Medical Sciences in Guangzhou is reported to have fused human and rabbit cells to make tissues for research.
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Fig 63
Genetically “designed” child1997
Jeffery Steinberg, MD Fertility Institutes of Los Angeles (2003)
Five "designer babies" created for stem cell harvest
Five healthy babies have been born to provide stem cells for siblings with serious non-heritable conditions. This is the first time "savoir siblings" have been created to treat children whose condition is not genetic, says the medical team.The five babies were born after a technique called preimplantation genetic diagnosis (PGD) was used to test embryos for a tissue type match to the ailing siblings, reports the team, led by Anver Kuliev at the Reproductive Genetics Institute in Chicago, US.The aim in these cases was to provide stem cells for transplantation to children who are suffering from leukaemia and a rare condition called Diamond-Blackfan anaemia (DBA)."It's a big step, because it gives people another option," says Mohammed Taranissi, at the Assisted Reproduction and Gynaecology Centre, London, UK, one of the team. "Before that the only option was to look in the siblings and immediate family to see if you had a match or alternatively to just keep trying [to have a baby which matches]."He told New Scientist that people trying to conceive a child naturally as a tissue match for a sick sibling had only a one in five chance. This method can also lead to terminations where the foetus is not a tissue match for the sibling."If you do it this way, the chance of finding a match is 98 per cent." 'Unlawful and unethical' However, the use of this technology to provide a "designer baby" to treat an ill sibling is highly controversial.A UK couple involved in this study travelled to the US for treatment after the UK's Human Fertilisation and Embryology Authority (HFEA) ruled that they could not create a tissue-matched sibling as a stem cell donor to their son.In-vitro fertilisation (IVF) and tissue-typing was used in the US to give the Whitakers a perfectly matched baby boy to help their son
1. Verlinsky Y, Rechitsky S, Sharapova T, Morris R, Taranissi M and Kuliev A. Preimplantation HLA Testing. JAMA (2004) 29: 2079
Preimplantation Genetic ScreeningGeneral Science: May 13, 2006
A British woman has become the first in the country to conceive a "designer baby" selected specifically to avoid an inherited cancer,
The woman, who was not identified, used controversial genetic screening technology to ensure she does not pass on to her child the condition retinoblastoma, an hereditary form of eye cancer from which she suffers. Doctors tested embryos created by the woman and her partner using in-vitro fertilisation (IVF) methods for the cancer gene. Only unaffected embryos were implanted in her womb, the newspaper said. It suggested the woman's pregnancy would increase controversy over the procedure -- pre-implantation genetic diagnosis (PGD) -- because critics say it involves destroying otherwise healthy embryos whose conditions are treatable.
Gregory Stock
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Fig 64
Extending Longevity
A strain of mice that have lived . . .
. . . more than three normal lifespans
Should humans live 200 years?
Life extension
Life extension consists of attempts to extend human life beyond the natural lifespan. So far none has been proven successful in humans. Several aging mechanisms are known, and anti-aging therapies aim to correct one or more of these: Dr. Leonard Hayflick discovered that mammalian cells divide only a fixed number of times. This "Hayflick limit" was later proven to be caused by telomeres on the ends of chromosomes that shorten with each cell-division. When the telomeres are gone, the DNA can no longer be copied, and cell division ceases. In 2001, experimenters at Geron Corp. lengthened the telomeres of senescent mammalian cells by introducing telomerase to them. They then became youthful cells. Sex and some stem cells regenerate the telomeres by two mechanisms: Telomerase, and ALT (alternative lengthening of telomeres). At least one form of progeria (atypical accelerated aging) is caused by premature telomeric shortening. In 2001, research showed that naturally occurring stem cells must sometimes extend their telomeres, because some stem cells in middle-aged humans had anomalously long telomeres.
April 14, 2004
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Fig 65Gaak
Courtesy Professor Noel Sharkey, Sheffield Unversity, London
"Thinking" robot in escape bid Scientists running a pioneering experiment with robots which think for themselves have caught one trying to flee the centre where it "lives". The small unit, called Gaak, is one of 12 taking part in a "survival of the fittest" test at the Magna science centre in Rotherham, South Yorkshire, which has been running since March. Gaak made its bid for freedom after it had been taken out of the arena where hundreds of visitors watch the machines learning how to repair themselves after doing daily battle. Professor Noel Sharkey said he turned his back on the drone, but when he returned 15 minutes later he found it had forced its way out of the small make-shift paddock it was being kept in. He later found it had travelled down an access slope, through the front door of the centre and was discovered at the main entrance to the car park when a visitor nearly flattened it with his car.
TECHNOLOGY NEWS
Intelligent “Living Robot”Uses genetic algorithms to “learn”
Kismet
Courtesy Rosalind Picard, MIT Affective Computing Lab, Boston, MA
ESCAPED
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Fig 66
Will Machines become “smarter than humans?
ROBOTHans Moravec
Ray Kurzweil
Humans vs Machine
Humans 4.0X10 19 cpsRed Storm 3.5X10 15 cps
Moore’ s Law “computer power doubles every 18 months”
Do the Math !!
Who is smarter now??
The Age of
Spiritual
Machines
WHEN COMPUTERS EXCEEDHUMAN INTELLIGENCE
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Fig 67CAN I REPLACE MY
B O D Y ?
If I replace 95% of my body . . .
. . . Am I still “human”?
Artificial organs
Smart Prostheses
Genetic engineering
Regeneration
What does it mean to be human ?
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Fig 68
For the first time in history,
there walks upon this planet, a species so powerful, that it can control its own evolution, at its own time of choosing …
… homo sapiens.
Who will be the next “created” species?
The Ultimate Ethical Question?
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Fig 69
Do Robots Dream ?
http://depts.washington.edu/biointel