Robotics in surgeryPatrick A Finlay PhD CEng

Director and Chief Technical Officer, Prosurgics Ltd

History of Robotics800BC Homer describes walking tripods

1921 The term "robot" invented by Karel Capek

1938 Mechanical arm for spray-painting.

1942 Isaac Asimov: Three Laws of Robotics.

1961 First commercial robot

1965 CMU creates Robotics Institute

1973 Wabot built at Waseda University Tokyo

1982 Int’l Advanced Robotics Programme

1986 First surgical robot

Surgical Robotics: current status

~ 1200 surgical robots in regular clinical use worldwide.

Surgical robotics globally worth ~ $2B

Annual growth ~ 50% per annum

Small number of specialist companies

R&D in progress at over 100 universities world wide,

Commercial surgical robotics

Telemanipulators Image guided surgery

Surgical Robotics

MEDICAL ROBOTICS

Non surgical

The two branches of robotic surgery

Telemanipulator

(master-slave)Image guided

(true robot)

TelemanipulatorsMaster Slave systems

Single arm telemanipulators

endoscopic camera control

Single arm camera holder

EndoAssist, Prosurgics Ltd

Position anywhere around the table

Does not obstruct operation

Entry port can be in any position

Clinical benefits

Single arm camera holder

EndoAssist, Prosurgics Ltd

Head movement control

Pan,zoom or tilt the camera with a head gesture

Miniaturised camera holder

FreeHand, Prosurgics Ltd

Miniaturised camera holder in use

No obstruction of surgical access or screen sightline

Multi arm telemanipulator

Da Vinci

Intuitive Surgical Inc

Multi-arm telemanipulator

Da Vinci, Intuitive Surgical Inc

Motion scaling to micro-wrist

Multi-arm telemanipulator

Surgeon operates robot from a remote console

Telesurgery

                                  

    

Surgeon in New York Patient in Strasbourg

Pictures from Computer Motion Inc

Telesurgery applications

Image Guided RobotsExample: Neurosurgery

Robotic neurosurgery

1927 arteriography 2007 MR image

Image-guided surgery

Fusion of image modalities

MRI AngiographyCT

Fused images and Brain Atlas

The neurosurgeon’s quest

how to reach the target I’ve pinpointed on the scan

with the same accuracy that I can see it . . .

. . . but with minimal collateral damage . . .

. . .and simply, with a short procedure time . . .

. . .and without costing a fortune

Registration: key to accuracy

Stereotactic frame

Stereotactic frame targeting arc

Fiducial markers

Testing prior to surgery

Skin Markers used as artificial targets for confirming accuracy

Neurosurgery robot registration

Camera and light ring

camera in the robot’s wrist scans the patient

computer matches camera and CT scans

Sterile environment control

Deep Brain stimulation

Brain tumour biopsy

Robot guided biopsy needle insertion. Multiple biopsies are possible along a single trajectory

Epilepsy

Robotic 3-D positioning of depth electrodes to determine focus of epileptic seizure

Grid pattern tumour treatment

Magnetic nanoparticles

Modified virus

Stem cells

Interstitial radiotherapy

Convection enhanced delivery

New pharmaceuticals

Image Guided SurgeryApplications outside Neurosurgery

Early beginnings

RoboDoc Femoral reaming

ISS Inc

IGS trajectory control

Orthrobot

Dynamic hip screw placementArmstrong Healthcare (now Prosurgics Ltd)

IGS path control

Machining of femur and tibia for total knee replacement

CASPAR orthopaedic robot

URS GmbH

robot allows the surgeon to operate freely in the safe zone, but prevents entry elsewhere

Picture from Imperial College London

Active-constraint IGS

Total knee replacement

Photographs: Imperial College London

Active constraint IGS

Total knee replacement

Surgical Robots:The next generation

New generation surgical robotics

Telemanipulators Image guided surgery

Tactical Surgical Robotics

MEDICAL ROBOTICS

Strategic Surgical robots

(Dual guidance)

Micro mobile robots with autonomy

Non surgical

Miniaturisation

Praxiteles

Praxim SA

SpineAssist

Mazor Surgical Technologies Ltd

powered and passive DoFs Pedicle screw guidance

Parallel structure

Probe tip tracking

Ascension Technologies Inc

Electromagnetic tracking

Motion compensation

Kinemedic

DLR

Low inertia, high payload, force control robot

Real time imaging and modelling

University of Verona

New types of surgery

“NOTES”:

Natural orifice transgastric endoscopic surgery

New types of surgery

SCP NorwayVancouver Institute for Advanced Ceramics

CAD CAM dental implant

Custom hip implants

Free-roaming camera (pre-robotic)

Given Imaging, Israel

swallowable camera 2 frames/s for 6 hours

Crawling microrobots

swallowable camera with 6-legged propulsion

Roaming robot with camera and biopsy needle NOTES surgery of the abdomen

University of NebraskaCMU/ Korean Intelligent μsystems centre

Swimming microrobots

Swimming robot

Eyeball cavity, CSF, urinary system

Autonomous Swimmer.

Subarachnoid space of spine.

Pushmepullyou swimmer

Technion UniversityCarnegie Mellon University

Multi-segment snake arms

23 DoF holonomic snake arm

Nuclear maintenance

Tube crawling concertina snake

Disaster rescueExperimental flexible endoscopic manipulator

OC RoboticsLtd Johns Hopkins University Carnegie Mellon University

Biomimetics

Biomimetic lobster

goal–achieving behaviour

Artificial muscle actuators

Wood wasp ovipositor

Robot carp:

serpentine motion

Northeastern University MA Essex University

Intelligence

Evolutionary learning bipedal locomotion

I-SWARM

Co-operating robots

21 DoF fault tolerant snake arm for Space vehicles

Kahlsruhe University (leader) NASA JSC Chalmers University

A new safety paradigm

New approach: “intrinsically safe design; control for performance”

Old approach:

“rigid design for accuracy; active control for safety”

LE3 robotDLR

“Dependability”

Safety

reliability

maintainability

Availability

legibility – “the psychological ability of a user to understand what the robot is intending”

Architecture

Classical: “sense > plan > act”

Deliberative (eg NASA): “reason > model > react”

Subsumption (Brooks): behaviour based

Hybrid: high level deliberator <> mediator <> low level reactive executive

Intrinsically safe robot inertia

Stanford University

DM2 robot structureDuplicated actuators

Future surgical robots: in summary

Miniature

Physiologically registered

Sensuate

Dependable

Autonomous

. . . and UbiquitousNASA NEEMO

New surgical robots will be

SMALL, including intra-body.

Intelligent and sensuate

Semi- autonomous

Ubiquitous in surgical procedures

Today’s surgical robots are already

Clinically beneficial

Cost effective

Improving patient outcomes

Improving Safety

Lowering Costs

Enabling New procedures

Robotics in surgeryPatrick A Finlay PhD CEng

Director and Chief Technical Officer, Prosurgics Ltd