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Computer Assisted Surgical Intervention

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Information about Computer Assisted Surgical Intervention
Technology

Published on November 15, 2008

Author: anirudh.s

Source: slideshare.net

Description

A presentation on computer-assisted surgical intervention. Includes a case study on needle insertion.
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Shah Hrishi Shivaswamy Anirudh

Introduction “Computer-assisted intervention” is defined as the use of automated systems in surgery Two different approaches : As a tool (assisting the surgeon) An autonomous system (replacing the surgeon) Several assistive systems are available, but the autonomous systems are still in the development stages

“Computer-assisted intervention” is defined as the use of automated systems in surgery

Two different approaches :

As a tool (assisting the surgeon)

An autonomous system (replacing the surgeon)

Several assistive systems are available, but the autonomous systems are still in the development stages

History First robot-assisted surgery performed in 1985, for treating brain lesions First robot-assisted orthopedic surgery was performed in 1991 In 1991, the first patient was treated with Probot, for prostate cancer. Newer version of Probot 

First robot-assisted surgery performed in 1985, for treating brain lesions

First robot-assisted orthopedic surgery was performed in 1991

In 1991, the first patient was treated with Probot, for prostate cancer.

Classification of surgical systems Surgical Robots Service Robots Prostheses Simulators Robots for diagnosis Passive manipulators Assistive Robots

Surgical Robots

Service Robots

Prostheses

Simulators

Robots for diagnosis

Passive manipulators

Assistive Robots

Surgical Robots Surgical robots can be tele-manipulators or preprogrammed robots Tele-manipulators are handled by the surgeon during surgery (intraoperative images used) Preprogrammed robots are guided by a fixed plan (preoperative images used)

Surgical robots can be tele-manipulators or preprogrammed robots

Tele-manipulators are handled by the surgeon during surgery (intraoperative images used)

Preprogrammed robots are guided by a fixed plan (preoperative images used)

Workflow of tele-manipulators

Typical Workflow of surgical robots

Service Robots. These are used for rehabilitation They have some pre-programmed movements which help the patient regain lost functionality A vision system may be present to support interaction

These are used for rehabilitation

They have some pre-programmed movements which help the patient regain lost functionality

A vision system may be present to support interaction

Simulators Simulators help in training/ assessment of surgeons Able to simulate a wide variety of situations Not subject to the constraints of practicing on humans/animals Simulator for Orthopaedic operation 

Simulators help in training/ assessment of surgeons

Able to simulate a wide variety of situations

Not subject to the constraints of practicing on humans/animals

Applications Orthopaedics Urology Radiosurgery Biopsies / interventional radiotherapy Endoscopy/Colonoscopy/Endoscopy Cardiac Surgery Neurosurgery ENT Surgery Oral/Cranio-maxillofacial surgery

Orthopaedics

Urology

Radiosurgery

Biopsies / interventional radiotherapy

Endoscopy/Colonoscopy/Endoscopy

Cardiac Surgery

Neurosurgery

ENT Surgery

Oral/Cranio-maxillofacial surgery

Orthopaedics. The operation procedure consists of four main steps: Image acquisition Planning with Orthodoc Registration in the operating theatre Milling the cavity by the robot Examples are RoboDoc, Acrobot, CRIGOS Parallel Link Robot CRIGOS 

The operation procedure consists of four main steps:

Image acquisition

Planning with Orthodoc

Registration in the operating theatre

Milling the cavity by the robot

Examples are RoboDoc, Acrobot, CRIGOS

Urology. Probot used for transurethral resection of the prostate Both imaging and cutting done in the operating theatre - no pre-operative planning required Main steps: Measuring gland size with ultrasound Imaging and cavity design Cutting

Probot used for transurethral resection of the prostate

Both imaging and cutting done in the operating theatre - no pre-operative planning required

Main steps:

Measuring gland size with ultrasound

Imaging and cavity design

Cutting

Radiosurgery. Main steps: Image acquisition of CT/MR scans Segmentation and modeling of tumor Planning of radiation procedure Execution of intervention Dose distribution and various directions of dose delivery help to protect vital organs from radiation. Examples: Accuray Cyberknife Hitesys NOVAC7 Accuray Cyberknife 

Main steps:

Image acquisition of CT/MR scans

Segmentation and modeling of tumor

Planning of radiation procedure

Execution of intervention

Dose distribution and various directions of dose delivery help to protect vital organs from radiation.

Examples:

Accuray Cyberknife

Hitesys NOVAC7

Endoscopy/Colonoscopy/Laparoscopy Surgeon can’t handle instruments and camera at the same time Other manual control leads to errors so robot control is preferred Robot may be controlled by surgeon’s head movement. Examples: Endoassist Aesop Endoassist in operation 

Surgeon can’t handle instruments and camera at the same time

Other manual control leads to errors so robot control is preferred

Robot may be controlled by surgeon’s head movement.

Examples:

Endoassist

Aesop

Cardiac Surgery. Generally system consists of a master console and a slave manipulator that executes the commands in the thorax. Instruments and endoscope inserted through small incisions. Examples: Zeus, DaVinci. DaVinci robot in operation 

Generally system consists of a master console and a slave manipulator that executes the commands in the thorax.

Instruments and endoscope inserted through small incisions.

Examples: Zeus, DaVinci.

Case study – Needle Insertion… Introduction Main aim is to avoid obstacles and reach target with minimum invasion Flexible needle modeled as beam with virtual springs and approximated as a 7 degree polynomial Initial path planning done Real time correction Experimental verification Overall setup of system 

Main aim is to avoid obstacles and reach target with minimum invasion

Flexible needle modeled as beam with virtual springs and approximated as a 7 degree polynomial

Initial path planning done

Real time correction

Experimental verification

Case study – Needle Insertion… Virtual Spring Model Tissue forces are non-linear with strain – so modeled as combination of tangential friction force and lateral springs. Needle broken up into a number of segments at the spring attachment points Tissue interaction modeled as springs Linear system model

Tissue forces are non-linear with strain – so modeled as combination of tangential friction force and lateral springs.

Needle broken up into a number of segments at the spring attachment points

Case study – Needle Insertion… Forward / Inverse Kinematics Generally, forward kinematics required to ascertain position of needle end-point from known needle base parameters. In this scenario, inverse kinematics is done for each point on the planned path to ascertain needle base parameters for this position.

Generally, forward kinematics required to ascertain position of needle end-point from known needle base parameters.

In this scenario, inverse kinematics is done for each point on the planned path to ascertain needle base parameters for this position.

Case study – Needle Insertion… Path Planning / Optimization Relates to finding a path that connects the target to the needle insertion point while maintaining minimum needle curvature. Orientation of needle tip unimportant- infinite paths possible. Minimize sum of squares of virtual spring displacements and slopes. Multiple solutions for path with same endpoint 

Relates to finding a path that connects the target to the needle insertion point while maintaining minimum needle curvature.

Orientation of needle tip unimportant- infinite paths possible.

Minimize sum of squares of virtual spring displacements and slopes.

Case study – Needle Insertion… Control Loop. Input is desired needle target excluding its orientation (optimized by controller). Controller does inverse kinematics and optimization to minimize needle deflections. Control Loop Diagram

Input is desired needle target excluding its orientation (optimized by controller).

Controller does inverse kinematics and optimization to minimize needle deflections.

Case study – Needle Insertion Needle Detection. Needle end-point detected by comparison with reference image and rest of needle tracked using low-gradient area. Full image comparison done only once Needle length also checked Needle fitted using 7 degree polynomial Actual Needle profile from Fluoroscopy Interpolated needle profile

Needle end-point detected by comparison with reference image and rest of needle tracked using low-gradient area.

Full image comparison done only once

Needle length also checked

Needle fitted using 7 degree polynomial

Current Trends… MRI-compatible materials / mechatronics / actuators Safety studies Incorporating haptic feedback into surgical systems

MRI-compatible materials / mechatronics / actuators

Safety studies

Incorporating haptic feedback into surgical systems

Challenges/Future Scope Robotic systems are not usable for routine treatment Unlike industrial robots, medical robots need to operate in conjunction with the operator Ease of training and assessment Minimally invasive surgery

Robotic systems are not usable for routine treatment

Unlike industrial robots, medical robots need to operate in conjunction with the operator

Ease of training and assessment

Minimally invasive surgery

References Various product websites ( Prosurgic, Intuitive etc.) “ Robots in the operating theatre—chances and challenges” - Korb, Marmulla et. al. , Int. J. Oral Maxillofac. Surg. 2004(33) “ Image-Guided Robotic Flexible Needle Steering” – Shoham, Glozman, IEEE Trans. Robotics Vol.23 No.3 Encyclopedia Britannica

Various product websites ( Prosurgic, Intuitive etc.)

“ Robots in the operating theatre—chances and challenges” - Korb, Marmulla et. al. , Int. J. Oral Maxillofac. Surg. 2004(33)

“ Image-Guided Robotic Flexible Needle Steering” – Shoham, Glozman, IEEE Trans. Robotics Vol.23 No.3

Encyclopedia Britannica

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