robotic joint replacement surgery - department of computer …cis/cista/445/lectures/robodoc.pdf ·...
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Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Robotic Joint Replacement Surgery
Russell H. TaylorDept. of Computer Science/Radiology/Mechanical EngineeringDirector, Center for Computer-Integrated Surgical Systems and
TechnologyThe Johns Hopkins University3400 N. Charles Street; Baltimore, Md. [email protected]
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Computer-assisted planning
Patient-specific Model
Update Model
Computer-Assisted
Execution
Update Plan
Computer-Assisted
Assessment
Preoperative Intraoperative
Atlas
Postoperative
Patient
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Computer-assisted planning
Patient-specific Model
Update Model
Computer-Assisted
Execution
Update Plan
Computer-Assisted
Assessment
Preoperative Intraoperative
Atlas
PostoperativePatient
Surgical “CAD”
Surgical “TQM”
Surgical “CAM”
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Computer-assisted planning
Patient-specific Model
Update Model
Computer-Assisted
Execution
Update Plan
Computer-Assisted
Assessment
Preoperative Intraoperative
Atlas
Postoperative
Patient
Surgical
Assistants
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Robotic Joint Replacement Surgery
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Disclosures• Russell Taylor is a member of the
Scientific Advisory Board of Integrated Surgical Systems and has a (very modest) financial interest in ISS
• ISS is an Industrial Affiliate of the CISST ERC, of which Dr. Taylor is the Director, and sponsors research within the Center.
• Dr. Taylor also enjoys salt water fly fishing
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Demographics
• US– Total Hip Replacement ≈ 300,000/year– Total Knee Replacement ≈ 250,000/year
• Worldwide
• NOTE: Numbers need updating
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Total hip replacement
Fit?
Placement?
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Robotic total hip replacement
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Total hip replacement
Fit?
Placement?
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Total hip replacement
Fit?
Placement?
≈≈
2 shape error25% bone-to-implant
contact
mm
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Robotic Total Hip Replacement Planning
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Robotic total hip replacement
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Robotic total hip replacement
≈≥≈
0.1 shape error95% implant-bone contact1 placement accuracy
mm
mm
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Leverage from Surgical CAD/CAM in Robotic THR
• Better planning
• Ability to carry out the plan– Accurate shape– Accurate placement– Limited forces– Reduced complications– Shape flexibility – Consistent execution
• Process learning
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Leverage from Surgical CAD/CAM in Robotic THR
• Better planning
• Ability to carry out the plan– Accurate shape– Accurate placement– Limited forces– Reduced complications– Shape flexibility – Consistent execution
• Process learning
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Leverage from Surgical CAD/CAM in Robotic THR
• Better planning
• Ability to carry out the plan– Accurate shape– Accurate placement– Limited forces– Reduced complications– Shape flexibility – Consistent execution
• Process learning
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
ROBODOC® (Integrated Surgical Systems)• History
– Veterinary use (IBM prototype, ’90)– Clinical use (US ’92 Europe, ’94)– Marketed in Europe, Asia– 30 systems in Europe & Japan (9/’00)– FDA approval pending
• Total Hip Replacement (THR)– First clinical case 1992– ~ 8000 primary, ~300 revisions (9/’00)– No fractures or other complications
due to robot• Total Knee Replacement (TKR)
– First clinical case March 2000– ~ 30 cases as of September 2000 – No fractures or other complications
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
CASPARTM System (URS)
• History– Introduced 1997– About 50 installed in Europe
• Experience– ~ 300-500? THR cases– TKR demo 4/2000– ACL tunnel drilling ?/2000– Few complications
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Robodoc® Total Knee Replacement
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Dr.Sugano& Prof.Borner Dr.Kakimoto performed the firstSuccessful ROBODOC TKA in Japan
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Robodoc® Total Knee Replacement
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Robotic THR & TKR Systems in Research Phases (Partial List)
• Parallel link approaches– Aachen (GRIGOS)– KAIST – Technion
• “Conventional” arms– Northwestern– U. Washington– Rizzoli Institute
• Cooperative Control– Imperial College (ACROBOT)– Grenoble (PaDyc)
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Robotic THR & TKR Systems in Research Phases (Partial List)
• Parallel link approaches– Aachen (GRIGOS)– KAIST – Technion
• “Conventional” arms– Northwestern– U. Washington– Rizzoli Institute
• Cooperative Control– Imperial College (ACROBOT)– Grenoble (PaDyc)
Movie: Brian Davies
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
CAOS 2002
The AcrobotFirst Clinical Trial of a ‘hands on’ Active Constraint Robot
J. Cobb, J. Henckel, S.J. Harris, M. Jakopec, F. M. Rodriguez y Baena, M.P.S.F. Gomes, B. L. Davies
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Navigation Based THR
• Emphasis on component placement
• Planning is similar to Robodoc
• Execution uses more conventional instruments
• Instruments are registered to the patient’s bone and tracked intraoperatively
• E.g., HIPNAV system (DiGioia, Jaramaz, et al.)
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Related work at JHU: x-ray registration
2D-3D registration
Iterative robotic cutting
Postop CT or X-Ray
Plan• shape• place
X-ray
Follow-up
Preop CT or X-ray
Update plan
R. Taylor
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
X-ray based localization
R. Taylor
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Iterative Cutting to Improve Accuracy
R. Taylor, R. Kumar, R. Goldberg & J. Yao
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Statistical Atlases
Training Data Sets
Segmentation
Multiple resolution density models
Statistical Analysis
Average model + variation modes
Anatomical Labels
Biomechanics
General Surgical Plans
Outcome data
Electronic Anatomical
Atlas
R. Taylor & J. Yao
Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology
Statistical Atlas
“Virtual CT”
Deformable 2D-3D
Planning Updated Plans
Registered Model
Visualization & Guidance
X-raysX-rays
Rigid 2D-3D
R. Taylor & J. Yao