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PAST: Cut, then see

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PRESENT: See, then cut

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FUTURE: Combine, see,minimally cut

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How do surgeries proceed? Diagnosis

based on physical exams, images, lab tests Preoperative planning

determine the surgical approach

elaborate intraoperative plan (path, tools,implants)

Surgery

prepare patient and assess condition acquire intraoperative images, adapt and execute

plan

Postoperative follow-up

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How can computers help?(or are already helping)

Image processing single image : enhancement, noise reduction,

segmentation, quantitative measurements

image stacks: 3D reconstruction, segmentation image sets : registration, comparison, data fusion

Planning and simulation

integrate medical images and CAD models planning and simulation programs

Computer vision and graphics

camera modeling, image registration, rendering

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Image processing

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Planning and simulation

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Computer-Assisted

Surgery (CAS)A computer-integrated system to enhance the dexterity,

visual feedback, and information integration of the

surgeon Key points: The goal is NOT to replace the surgeon A new paradigm for surgical tools

Address a real clinical need Prove efficacy and cost-effectiveness

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Trend towards minimally invasive surgery:

laparoscopy, endoscopy, minimal incisions Computer plays a key role in:

3D visualization, model construction quantitative integration of information preoperative planning and intraoperative execution

Medical CAD/CAM -- a paradigm shift!

omputer e urgery(CAS)

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Elements of a CAS system

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Salisbury

Endoscopic, Minimally Invasive Surgery (MIS)

Elimination of large incisions

Dramatic decreasein post-op pain

A revolution insurgical technique

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Salisbury

Why Use Robotically Aided Surgery?

Precision Enhance Dexterity Enables work in confined spaces Enable Remote Participation Eliminates hand tremor

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Salisbury

Medical Robotics - the second wave

Illustration courtesy Dr. Akhil Madhani

Computer-enhanced surgical dexterity through telemanipulation

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Salisbury

Surgeons Console

3D visual immersion

Eye - hand alignment

7 DOF haptic interface

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Salisbury

Eye - Hand Alignment

Image of instrumentsappears in place of hands

Hand motions replicatedinside patient

Scaled and indexed motion

Camera and cautery control

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Da Vinci surgical system 1994 - Intuitive Surgical 1997 First robotic procedure:

cholecystectomy 2000 200 patient trial 2005 - 350 units sold

2006

70,000 operations done

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Robots in Surgery Definition Surgical assisting

devices Surgeon-computer-

instrument interface Minimally invasive

surgery

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Da Vinci surgical system

NASA Amesresearch centre -space surgery

DARPA battlefieldsurgery

1994 first robotic

operation

intestinalanastomosis

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CAS, Spring 2001 L. Joskowicz 21

Examples of CAS systems inuse

Image-guided navigation systems ROBODOC: Total hip replacement surgery

LARS: Laparoscopic assistant Radiosurgery

Brief overview follows; will be covered in detail later

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22

Image-guide navigation Purpose

accurate placement of instruments withrespect to imaged anatomy for severalprocedures

Problem addressed provide 3D vision of unseen structures

replace static 2D fluoroscopy or larger openings

improve precision of biopsies, screwplacements

Scope non-invasive

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CAS, Spring 2001 L. Joskowicz 23

Image-guided navigation

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CAS, Spring 2001 L. Joskowicz 24

Image-guided navigation (2) pedicle screw insertion

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CAS, Spring 2001 L. Joskowicz 25

Status In clinical use Over 7,000 neurosurgeries performed with

commercial systems Gaining popularity in pedicle screw

insertion Decreased the misplacement rate from 10-

40% to 5-18% (clinical study of 700cases)

More clinical applications under develo ment

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CAS, Spring 2001 L. Joskowicz 26

ROBODOC: Total hipreplacement

Purpose precise machining of cementless hip implant

canal

Problem addressed complications in canal preparation and implantfixation

improve positioning accuracy and surface finish Scope

invasive, numerically controled machining plan from preop CT, registered via pins adapted commercial robot

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CAS, Spring 2001 L. Joskowicz 27

Artificial hip joint

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CAS, Spring 2001 L. Joskowicz 28

procedure

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CAS, Spring 2001 L. Joskowicz 29

ROBODOC: Total HipReplacement

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CAS, Spring 2001 L. Joskowicz 30

ROBODOC system diagram

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CAS, Spring 2001 L. Joskowicz 31

ORTHODOC Planning

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CAS Spring 2001 L J k i 32

ROBODOC robot diagram