"The future of surgery is not about blood and guts; the future of surgery is about bits and bytes.”
/Dr. Richard Satava/

Monday, February 20, 2017

Standardization for safe surgical robotics



A recent article in the Int J Med Robotics Comput Assist Surg analyzed the current status of surgical robotics, and the future ways of development from safety and standardization point of view.
The paper "A research review on clinical needs, technical requirements, and normativity in the design of surgical robots" from Diaz et al. "explores the clinical needs and the technical requirements that will trace the roadmap for the next scientific and technological advances in the field of robotic surgery, the metrics that should be defined for safe technology development and the standards that are being elaborated for boosting the industry and facilitating systems integration."
Their key findings include: 
"Cost reduction, shorter time of intervention, reduced time and complexity for the setup, reduced OR footprint, enhanced data integration and improved decisionmaking have been identified as the main clinical needs that have to be met in order to achieve greater acceptance and market penetration of surgical robots. Taking into account these clinical needs, the main technical requirements that should be addressed in the near future, and that consequently, will trace the roadmap for the next scientific and technological advances in the field of robotic surgery are: reduced size, shape and weight of the equipment, increased number of DOFs, increased resolution, improved platform stability, force feedback feeling, suitable visualization and spatial orientation of the surgical field, enhanced wireless modules, triangulation capabilities, reduction of repetitive instrument exchange, flexibility of rigid instruments, enhanced manoeuvrability, suction and irrigation capabilities, improved ergonomics and unified training and credentialing requirements."

Areas of improvement for surgical robots in different clinical applications:
Source: Wiley's Int J Med Rob

Friday, February 17, 2017

High-end surgical robotics research with the DVRK


"The da Vinci Research Kit (DVRK) is an “open-source mechatronics” system – consisting of electronics, firmware, and software that are used to control systems based on the first-generation da Vinci system. Research institutions can access the open-source software and electronics through GitHub. To date, researchers at 25 institutions –from Canada and Italy, to Hungary, Israel and Hong Kong – are using the dVRK.
What’s more, the dVRK is making retired and outdated da Vinci systems useful again.
“Until now, research into more sophisticated control strategies using the da Vinci system was hampered by a lack of a robust common platform, leaving [researchers] to choose between building an expensive, one-of-a-kind system, or using an overly simplistic platform that reduced research impact,” explained Peter Kazanzides from JHU LCSR.
Many institutions had obtained their da Vinci robots from manufacturer Intuitive Surgical, Inc., which retired its first-generation systems as they became outdated. The company donated the system’s mechanical components to research institutions interested in pursuing tele-robotic medical research. (Others got their retired systems from hospitals or online.)
However, an issue arose: universities had only received the mechanical parts, and not the electronics or software that made the systems work. This is where Hopkins came in.
When Hopkins acquired its first da Vinci back in 2004, a team of researchers led by Kazanzides and Allison Okamura (now at Stanford University) decided to build electronics and write custom software for the system tailored to their research objectives. Colleagues at other institutions took notice.
In 2012, the Kazanzides team joined with Worcester Polytechnic Institute, Stanford, and University of British Columbia to better manage their da Vinci related work. The result, according to Kazanzides, is that many research universities around the world now have access to a robotic surgical system that would be extremely expensive to buy and to customize.
Researchers at the University of Washington developed a similar system, complete with mechanics, electronics, and software, called Raven. Raven is similar to the parts of the dVRK that operate on the patient, but does not include master controllers. Seattle-based company Applied Dexterity has sold about 18 of these systems to other research universities and institutions. Between those using the dVRK and those using Raven, there are about 40 institutions around the world using these systems for minimally invasive medical robotics applications, and that community continues to grow.
With the support of the $969,800 National Science Foundation grant, which is administered through the NSF’s National Robotics Initiative, the Kazanzides team plans to expand the consortium each year. (According to Kazanzides, at least eight more institutions have expressed interest in obtaining a dVRK.) The team also plans to improve the technical details of the da Vinci and is devising a way to consolidate and merge the technology in various surgical tele-robotic units, including the Raven and the dVRK."

Read more at Hopkins


 
Source: LCSR, JHU

Wednesday, February 15, 2017

Monday, February 13, 2017

The Galen Surgical System

Galen robotics is a new surgical robotics company formed for the purpose of commercializing the latest surgical robotics technology from Johns Hopkins University.
"The Galen Surgical System was created as an answer to the challenges faced by surgeons during minimally-invasive head-neck operations: long instruments causing amplified arm tremor and reduced precision, tight spaces near sensitive anatomy and limited work areas. The system is based on the technology developed for the Eye Surgical Assistant Workstation at JHU, holding surgical instruments together with the surgeon and sensing the surgeon’s intent through a force sensor. Because the robot has control over the instrument, it can filter out undesired motions like hand tremor, or constrain motions with virtual fixtures. The system’s typical applications are in laryngeal / vocal cord surgeries, open microsurgeries and in Image-guided sinus surgeries with virtual fixtures. It can also be used in otology, craniotomy, spine and hand surgeries. A clinically deployable version of the system is undergoing validation experiments."
"Russell Taylor, the John C. Malone Professor of Computer Science and director of the Laboratory for Computational Sensing and Robotics, is working to refine research and surgical applications of the Galen Surgical System, a robot used to reduce surgeon hand tremors and increase precision during head and neck microsurgery. Taylor also recently received a TEDCO Maryland Innovation Initiative grant to turn the robot into a more useable prototype for clinical practice use.
The Galen robot was created by a Hopkins PhD student, Kevin Olds, who worked with Taylor and is now a senior staff engineer at the Johns Hopkins School of Medicine.
Olds and Taylor based the Galen on technology developed for the Eye Surgical Assistant Workstation at JHU. The system is typically used in laryngeal/vocal cord surgeries, open microsurgeries, and in image-guided sinus surgeries, but it can also be used in otology and craniotomy, as well as spine and hand surgeries.
Taylor’s team created the Galen as an answer to the challenges faced by surgeons during minimally-invasive head and neck operations: hand tremor, visualization, and safety. Holding and manipulating long medical instruments (25cm) increases surgeons’ hand tremors and reduces precision. In addition, tight spaces near sensitive anatomy, delicate structures that might tear, and limited surgical work areas do not allow surgeons much flexibility. Surgeons also visualize the operating field through microscopes and endoscopes, limiting their view.
The beauty of the Galen is that it allows a surgeon to work with the robot. The surgeon guides the procedure, but the robot steadies the motion."
"
What’s more, the Galen’s different control modes—free hand, remote center of motion, teleoperation, and virtual fixture avoidance—allow the surgeon to choose how much the robot guides the surgeon’s hand through a ‘safe path’ during surgery, Taylor says.
If contact with a certain area of the surgical site could cause harm – that location can be programmed as a ‘virtual fixture’ into the interface. As a result, the robot will ensure that the surgeon avoids that sensitive area.
Now that the pre-clinical system of the Galen surgical robot is complete, Taylor is working on a clinical version that will eventually be used by surgeons in medical center settings."


Source: Johns Hopkins University, LCSR

Sunday, February 12, 2017

Friday, February 10, 2017

SDS - Surgical Data Science

A great article appeared from a group of renowned expert about a new field: Surgical Data Science. (SDS: Enabling next-generation surgery 2016
"Future advances in surgical care increasingly require a close partnership between caregivers, patients, technology, and information systems. As part of the move towards personalized medicine, interventional care will more and more transform from an artisanal craft based on physicians’ individual experiences, preferences and traditions to a discipline that relies on objective decision-making based on large-scale data from heterogeneous sources." 
SDS has the promise to solve many of our urging issues in CIS. We will keep following this thread.