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Surgical Robotics presentation 4

The document discusses the role of robotics in precision surgery, highlighting its advantages over conventional surgical methods, such as enhanced precision and reduced invasiveness. It covers the history, development, and various applications of robotic surgical systems, including case studies demonstrating their effectiveness in procedures like nephrectomy and knee arthroplasty. Additionally, it addresses kinematic design considerations essential for the development of minimally invasive surgical robots.

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0% found this document useful (0 votes)
21 views46 pages

Surgical Robotics presentation 4

The document discusses the role of robotics in precision surgery, highlighting its advantages over conventional surgical methods, such as enhanced precision and reduced invasiveness. It covers the history, development, and various applications of robotic surgical systems, including case studies demonstrating their effectiveness in procedures like nephrectomy and knee arthroplasty. Additionally, it addresses kinematic design considerations essential for the development of minimally invasive surgical robots.

Uploaded by

Ashish Yadav
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Robotics and Its role in precision surgery

1
Table of Content
Introduction
Section 1
Section 2
Section 3
Conclusion

2
Introduction

3
Comparison

Precision surgery Precision


Conventional
surgery,
Conventional
surgery,
characterized
rooted
surgery
in by
centuries-old
meticulous
practices,
attentionhas
to detail
long been
and minimally
the cornerstone
invasive of
medical
techniques,
intervention
represents
for various
a significant
conditions.
advancement
However, despite
in modern
its historical
medicine.significance,
One of the
keyconventional
contributors surgery
to the evolution
is not without
of precision
its
surgerylimitations
is the integration
and challenges.
of robotics into
surgical
Below section procedures.
highlights the problems
Thisassociated
introduction
with
explores
conventional
the pivotal
surgery,
role of
underscoring
robotics inthe
enhancing
need forprecision
advancements
surgery,such
focusing
as robotics
on itsto
technological
address thesecapabilities,
issues.
advantages, and impact on patient outcomes

4
Limitations of Conventional Surgery

• 1. Lack of Precision

• 2. Invasive Nature

• 3. Restricted Access

• 4. Surgeon Fatigue and Ergonomics

• 5. Learning Curve

5
History of Robotic Surgery

Early Development: Pioneering Systems: FDA Approval: Expansion of Clinical Adoption:


Applications:
1980s 1990s In 2000 Robotic surgery has
Over the years, become increasingly
The aim was to assist Intuitive Surgical, Inc. for use in general robotic surgery has prevalent in hospitals
surgeons created the da Vinci laparoscopic surgery. expanded beyond its worldwide
Surgical System, the initial applications in
first robotic surgical urology and
system gynaecology

6
Sections for Literature Review

Section 1- Section 2- Section 3-


Observation Case studies Kinematic design
consideration in surgical
robot development

7
Section 1
Observation
CHAPTER 5- SURGICAL ROBOTICS
JACOB ROSEN
Department of Computer Engineering, Baskin School of Engineering, SOE-3 University
of California, Santa Cruz , 1156 High Street, Santa Cruz, CA 95064-1099, USA

8
Abstract -
• he abstract highlights the transformative impact of surgical
robotics on the field of surgery, emphasizing the integration of
technological and clinical advancements
• Key topics covered include soft tissue biomechanics,
teleoperation, haptics, time delay, indexing, motion
compensation, scaling, image-guided surgery.
• The chapter concludes by the reduction of system size to
minimize tissue impact and enhancing human-machine
interaction for semi-autonomous operations.

9
Scope and Background

1-surgeon interacts with the tissue directly


Reality Tissue
Robot-Patient (R-P)
Interface

Tool
Hand
Surgeon–Robot (S-R) Interface

Robot
(Master-Slave)
Surgeon

2-cameras and imaging modalities Simulators


Reality Tissue

assist with visual information Tool


Hand

Virtual Reality

3-operational medium may be Haptic


Device3
Tool Tissue
simulated tissue

10
Schematic representation of the surgeon-robot-patient domains

level of invasiveness in the Robot-


Patient (R-P) interface and their
impact on various operational
parameters from the patient and
surgeon perspectives

level of automation in the


Surgeon-Robot (S-R) interface,
and their impact on various
operational parameters from
surgeon perspectives

11
Teleoperation

Haptics, Time Delay,


12
Indexing, Motion Compensation and Scaling
Image-Guided Surgery ( computer assisted surgery (CAS)
• Different steps
• 1) image acquisition, which can be accomplished by a variety of imaging modalities, including X-ray,
PET, CT, MRI, ultrasound and tomography
• 2) image analysis
• 3) diagnostics
• 4) preoperative planning with or without surgical simulation
• 5) the surgical procedure, which includes registration and navigation and
• 6) post-operative verification

13
Commercial Systems:-
Da Vinci (Intuitive Surgical)
System Architecture of da Vinci:
• Follows the classical master/slave teleoperation architecture
with a surgical console (master) and a patient-side subsystem (slave)
• Patient-side subsystem has four arms – three with MIS surgical tool
(5-8 mm) and one with two endoscopic cameras (12 mm) for a 3D view.
• Approximately 50 different tools can be mounted on robotic arms
through a sterile barrier

Operational Mode:
• While the system is based on a teleoperation architecture, the approved mode of operation is limited to co-located scenarios
where the patient-side and surgeon-side are in the same room.

14
da Vinci® Robotic Surgical System

15
Section 2
Case Studies
16
1- Robotic Partial Nephrectomy with the Da Vinci
Xi George J. S. Kallingal, Sanjaya Swain, Fadi Darwiche, Sanoj Punnen,
MurugesanManoharan,Mark L. Gonzalgo, and Dipen J. Parekh
Department of Urology, University of Miami Miller School of Medicine, Miami, FL 33136, USA

Partial nephrectomy
During a partial nephrectomy, only the cancerous tumor or diseased tissue
is removed (center), leaving in place as much healthy kidney tissue as
possible.

Da Vinci Xi Surgical Robot by Intuitive Surgical

17
Operative Technique
• Patients with clinical stage 1 renal masses
were offered RPN with the Da Vinci Xi
system.

• Preoperative evaluations, including CT


scans and MRI, were performed on all
patients.
Patient positioning for left robotic partia
nephrectomy.
• During a robotic partial nephrectomy, the
surgeon will use a scalpel to make small
incisions in your abdomen. The incisions
are no bigger than about 3/4 of an inch (2
centimeters).

18
Port placement for left robotic partial
nephrectomy

• They’ll insert a laparoscope (a thin rod with a camera) and the


robotic surgical equipment into these small incisions.
• Next, they’ll fill your abdominal cavity with carbon dioxide
gas. The gas expands the area, giving the surgeon enough
space to move the surgical equipment and access your kidney.
• They’ll use the robot to stop blood flow to your kidney,
correct your condition and reconstruct your kidney.

XI robot docked for right robotic partial


nephrectomy

19
• https://youtu.be/31uGJLwUbDo?si=6fatmOgp0BBN15ko

20
Results • Fifteen patients underwent RPN with the Da Vinci Xi system, with no intraoperative
complications or conversions to radical nephrectomy.

• The mean console time was 101.3 minutes, mean ischemia time was 17.5 minutes, and
estimated blood loss was 120 mL.

• Pathological analysis revealed various subtypes of renal masses, with all patients having
negative surgical margins.

• Two postoperative complications were reported, including a pseudoaneurysm and a


readmission for a suspected urinary tract infection.

Overall, the research paper


suggests that the Da Vinci Xi
system is a safe and effective way
to perform robotic partial
nephrectomy 21
2- Catheter Ablation – New Developments
in Robotics
K.R. Julian Chun, Boris Schmidt, Bülent Köktürk, Roland Tilz, Alexander Fürnkranz,
Melanie Konstantinidou, Erik Wissner, Andreas Metzner, Feifan Ouyang, Karl-Heinz Kuck 1
• This paper provides an overview of the
advancements in robotic catheter ablation
systems for treating various arrhythmias,
particularly focusing on atrial fibrillation (AF)
and atrial flutter (AFL). The transition from
simple focal ablation to more complex
procedures like AF ablation has increased the
demand for stable and reproducible catheter
movements during the procedures. To address
these challenges, remote-controlled robotic
systems have been developed.
• The paper discusses two main robotic systems:
the Sensei™ Robotic Navigation System (RNS)
and the Niobe™ Remote-Controlled Magnetic
Navigation System (MNS).
• We discuss only Sensei™ Robotic
Navigation System (RNS)

22
Atrial fibrillation (AFib) is an irregular and often very rapid
heart rhythm. An irregular heart rhythm is called an arrhythmia. AFib can lead
to blood clots in the heart. The condition also increases the risk of stroke,
heart failure and other heart-related complications.

Atrial flutter is a type of abnormal heart rhythm, or arrhythmia. It occurs when a


short circuit in the heart causes the upper chambers (atria) to pump very rapidly. Atrial
flutter is important not only because of its symptoms but because it can cause a stroke
that may result in permanent disability or death.

Catheter ablation is a minimally invasive


treatment for fast heartbeats. A
catheter is a thin tube inserted through
a blood vessel to your heart. Ablation is
a technique used to strategically
23
destroy abnormal tissue and restore
Sensei™ Robotic Navigation
System (RNS)

The RNS utilizes electromechanical


systems to navigate catheters via
steerable sheaths controlled by a robotic
arm. The investigator operates the system
from a control room using a joystick for
catheter manipulation robotic arm 3-D joystick

The system has been used in clinical applications,


primarily for right atrial flutter (AFL) ablation . The
acute procedural success rates are promising, but
fluoroscopy times are longer compared to manual
procedures.

24
ablation catheter central workstation
25
Results
• In a recent series involving 40 patients undergoing AF ablation with
additional AFL ablation in 23 cases, acute procedural success, defined as PVI
plus additional isolation of the superior vena cava, was achieved in all
patients.
• Acute PVI (Peripheral Vascular Intervention) success rates and procedure
times were in line with manual AF ablation data, but total fluoroscopy
times were longer.
• Overall system has demonstrated feasibility of remote-controlled
catheter ablation but still require technological refinements to
improve their applicability and to demonstrate noninferiority to
manual procedures.

26
3- Robotic-arm assisted total knee
arthroplasty is associated with improved B. Kayani,
early functional recovery and reduced time S. Konan,
J. Tahmassebi,
to hospital discharge compared with
J. R. T. Pietrzak,
conventional jig-based total knee F. S. Haddad
arthroplasty

• The objective of this study was to compare


early postoperative functional outcomes and
time to hospital discharge between
conventional jig-based total knee arthroplasty
(TKA) and robotic-arm assisted TKA

• Total knee arthroplasty –


Knee replacement, also called knee arthroplasty or
total knee replacement, is a surgical procedure to
resurface a knee damaged by arthritis. Metal and
plastic parts are used to cap the ends of the bones
that form the knee joint, along with the kneecap.
damaged replaced
27
.
CUVIS Joint robot (previously Robodoc) system for artificial joint
surgery is the most advanced surgical
equipment capable of 3D pre-planning, virtual surgery and precise cutting to provide
accurate and precise surgery results.

28
29
Results
• Overall, robotic-arm assisted TKA demonstrated
several benefits over conventional jig-based TKA,
including reduced postoperative pain, decreased
analgesia requirements, improved postoperative
hemoglobin levels, shorter time to straight leg raise,
decreased need for physiotherapy sessions,
improved knee flexion at discharge, and shorter
hospital stay

30
Section 3

Surgical Robot Development


Kinematic design
considerations

31
Kinematic design considerations for
minimally invasive surgical robots:
an overview

•Chin-Hsing Kuo1* (University of Science and Technology,Taiwan)


••Jian S. Dai2 (King’s College London, UK)
••Prokar Dasgupta3 3(Guy’s and StThomas’ Hospitals NHS Foundation
UK )

32
Introduction
•Kinematic Design: Kinematic design is crucial in
developing robotic manipulators for MIS. Key considerations
include safety, accuracy, ergonomics, and dexterity. These
considerations are translated into design
tasks such as mechanism configuration, workspace
optimisation and isotropy to meet surgical requirement
•Kinematic Design Goals: The paper aims to identify
common kinematic design goals, requirements, and
preferences for MIS robots. It discusses fundamental design
issues and tasks, including the use of the remote center -of-
motion (RCM) mechanism to overcome challenges in MIS
robots.
33
Materials and Methods

Motion constraints for MIS robots


Manipulation mobility-Small incision and limited volume
acts as a "fulcrum
effect," restricting instrument motion to four degrees of
freedom (DOFs):

pan–tilt–spin rotation and axial translation for depth 34


Extracorporeal workspace volume-Each movable
mechanical link of the robot outside should move freely in
the operating room without touching the patient.

General surgical issues for MIS robot


• Safety

• Accuracy

• Ergonomics

• Dexterity

35
Kinematic design considerations

• Tool Motion Representation: The motion of an MIS instrument is conventionally


represented by four displacements: Pθx, Pθy, Eθw, and Edw. These displacements
correspond to geometric parameters that describe the location of the surgical tool.

• Pivoting Motion: Design requirements include ensuring the end-effector has 36four
DOFs and that the translational DOF points along the direction of insertion or
.

• Decoupled Motion: Decoupled motion of the end-effector is preferred


for surgical safety.
Design preferences include having decoupled motion for various
displacement variables.

• Workspace: Determining the workspace of the end-effector is crucial for


surgical robots. Design requirements include confining the workspace to
a single point or a small volume at the entry point, ensuring reachability
inside the patient's body, and preventing collision with the patient or
surgical staff. Optimization techniques are often used to balance
reachable and orientation workspaces.

• Isotropy: Isotropy, or manipulability, measures the motion and force


transmission abilities of a robotic manipulator. A design preference is for
robotic manipulators to have good isotropy over the entire workspace.

• Back-drivability: The choice between back-drivable and non-back-


drivable transmissions is essential. Back-drivability allows manual 37
repositioning in case of power failure

Remote center-of-motion
•mechanisms
Motivation for RCM Mechanisms:
MIS robots need to manipulate
surgical instruments with precision
and safety. RCM mechanisms allow
for manipulation with a fixed
rotational center located outside the
robot's structure, reducing the risk of
collisions with the patient .

38
• Decoupled RCM Mechanisms: These mechanisms reduce
control complexity and enhance manipulation convenience. They
separate rotational and translational degrees of freedom (DOFs),
allowing for more rapid manual positioning.
• Non-mechanical and Passive RCMs: Non-mechanical
RCMs use coordinated control of multiple joints, while
passive RCMs utilize the incision itself as a mechanical
fixture to constrain tool motion. Mechanical RCMs are
considered safer

39
Results and
Discussion
• 4-DOF 3R1T RCM Mechanisms: These mechanisms are discussed in
the context of providing pivoting rotations for surgical instruments. The
integration of translational DOFs into RCM mechanisms can lead to
increased payload and static problems. Different approaches, including
serial and parallel robots, are considered for providing additional DOFs
while minimizing payload issues.

• Motion De-couplability: The ideal RCM mechanism would have fully


decoupled task oriented DOFs, but most current mechanisms are only
partially decoupled. Challenges arise from the coupling of rotational
DOFs in serial-type structures. Fully-decoupled in- parallel actuated
mechanisms have not yet been reported.

40
• Task-Oriented Fully-Isotropic Design: A fully-isotropic RCM
mechanism, which would provide confidence in safety, simplified joint
coordination, and sensing of reaction forces, is considered desirable
but has not yet been achieved for MIS applications.

41
Conclusion

and Future
Perspective
Conclusion
• In conclusion, robotics plays a pivotal role in advancing precision surgery, offering transformative
benefits to both surgeons and patients.
As 3 Case Studies shown that it provide below advantages
• improved patient outcomes,
• shorter hospital stays,
• reduced postoperative complications
• faster recovery times
Disadvantages
• Cost
• Training
• Safety
Furthermore ,The integration of advanced imaging and navigation technologies further augments
surgical precision, allowing surgeons to navigate complex anatomical structures with greater ease and 43
confidence
Future perspective
• As discussed in development chapter, , RCM mechanism, motion decoupling and isotropic
design are future design goals for improved performance.
• Additionally, the integration of artificial intelligence (AI) and machine learning algorithms into
robotic systems promises to enhance surgical precision, optimize decision-making processes
and personalize treatment approaches based on individual patient characteristics.
• Furthermore, the convergence of robotics with other cutting-edge technologies such as
augmented reality, 3D printing, and telemedicine holds the potential to redefine the surgical
landscape, enabling remote guidance, collaborative interventions, and personalized surgical
planning on a global scale.

44
Thank You
Questions?

46

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