1. Technological Sciences for the Operating Room Robotics for the Surgical Technologist

2. That was then

3. Introduction Karel Capek –Term traced to play written in 1923 –Czech word “robota” means “heavy labor” 1961: First industrial robot in U.S. Robot: Has mobility; operates automatically; perform variety of tasks

4. Introduction First Generation Robots –Mechanical arms without artificial intelligence (AI) –Precise repetitive motions at high speeds –Constant monitoring by humans Second Generation Robots –Some AI –Tactile sensors –Some vision and hearing –Do not require constant monitoring

5. Introduction Third Generation Robots –Autonomous robots: work independently w/o human supervision –Insect robots: controlled by central AI computer; collective intelligence Fourth Generation –Not yet developed –But will display abilities to learn and evolve

6. THIS IS NOW!

7. Surgical Robots Vastly improve surgical patient care by overcoming human limitations Still require surgeon control –Remote control –Voice activation Future –Diagnose –Surgically correct a disease without human control

8. Surgical Robots Examples of Advantages –Replace expensive health care personnel –Telesurgery –Shorter patient convalescence with minimally invasive procedures Da Vinci and ZEUS allow for smaller incisions. –Eliminate hand tremors EndoWrist instrumentation

9. Surgical Robots AESOP 3000 –Developed by Computer Motion –Position endoscope –Foot pedals or voice-activated software to position camera –Leaves surgeon’s hands free

10. Surgical Robots Da Vinci and ZEUS –Similar set-ups: computer workstation; video screen; robot next to patient; three manipulators –Gallbladder surgery 3 sm. incisions for 3 rods held by 3 manipulators 1 rod holds camera; 2 rods hold surgical instruments for dissecting and suturing Surgeon sits at workstation with joystick control

11. Surgical Robots Telesurgery –Perform a procedure in real time at a distance –Surgeon remotely controls robotic arms –Obstacle: time delay between surgeon and robotic response

12. Design Robotic Components –Manipulators –Surgical instrumentation –Remote console –Computers –Voice activation system

13. AESOP Design Manipulator –Transported on special cart –Special O.R. table not necessary –Move cart next to O.R. table –Attach manipulator after patient positioned

14. AESOP Design Manipulator con’t. –Placement depends on surgery Lower abdominal procedures: manipulator placed at top of O.R. table Upper abdominal procedures: manipulator placed at bottom of table –Freedom of movement: markings on manipulator

15. AESOP Design Draping: sterile plastic cover Optics: attached by sterile magnetic device 10/12 mm size trocar used Manipulator controlled by voice commands –Individual computer chip for each surgeon created and inserted. –Programmed to ignore casual conversation –Orders confirmed by computer –Corrections to optics by hand

16. Manipulator Perform simple to complex functions Automated device Attached to rail of O.R. table Distal end of arm attaches to instrumentation or endoscope Connected by cables to computer

17. Manipulator Extension of surgeon’s hand –Conserves time, effort, and motion –Less chance for error –Eliminates unnecessary motion –Safe, secure movement of scope Voice Activation System –Activated by hand or voice of surgeon –Master unit programmed to ignore outside conversation

18. Manipulator Other Master Unit Controls –Unit controls Manipulator Shaver (Arthroscopic surgery) Fluid pump (Arthroscopic surgery) Lights in O.R. Printer and computer for intraoperative photos

19. Remote Manipulation Single Manipulator –Hold endoscope –Surgeon uses surgical instruments Multiple Manipulators –Hold endoscope and manipulate instrument –Instruments similar to other scope instruments

20. Remote Manipulation Sequence of Events –Computer receives message from micromanipulators on remote console –Computer translates messages –Micromanipulators translate surgeon’s hand movements to manipulator(s) –Surgeon views activity on 3-dimensional console screen

21. Remote Manipulation Advantages –Eliminates hand tremor –Reduces errors –Performs complex techniques in small space –Improves visualization –Enables telesurgery in rural hospitals and other countries

22. Geometrical Design Cartesian Coordinate Geometry (rectangular coordinate geometry) –Manipulator design based on Cartesian system –Joints referred to as shoulders, elbow, and wrist –Arm moves along x, y, z axes

23. Geometrical Design Cartesian Design con’t. –Degrees of Freedom: Number of dimensions of manipulator movement as compared to human arm –Most manipulators have 3 dimensions Pitch: Up & down movements Yaw: Right & left movements Roll: Rotating movement –Degrees of Rotation: Clockwise and counterclockwise movements

24. Geometrical Design Cylindrical Coordinate Geometry –Incorporates plane polar coordinate system with elevation Revolute Geometry –Allows manipulator to move in 3 dimensions Shoulder: 360° rotation; 90° elevation Elbow joint: 180° Wrist joint: revolve and flex

25. Hearing Machine hearing analogous to human hearing –Direction sound originated –Type of sound Binaural Hearing –Same type as human hearing

26. Hearing Process of Sound –Varying levels of intensity –Brain processes sound waves –Person locates source of sound –Person interprets source of sound –Head can be turned

27. Hearing Robotic Hearing –Two sound transducers –Microprocessors connected to manipulator; discern voice patterns and sound waves Determine source of sound Identify direction sound came from

28. Vision Sensitivity –Ability to see in dim light –High level of sensitivity often required in O.R. Resolution –Ability to differentiate between two objects –Can vary –Better the resolution, better the vision

29. Vision Sensitivity vs. Resolution: Negative Effect –Resolution increased, vision decreases in dim light –Improved sensitivity – decreased resolution

30. Vision Binocular Machine Vision –Analogous to binocular human vision (stereo vision) –Allows perception of depth –Robotic vision in surgery will require Development of high resolution camera Very powerful robot controller Advanced AI system

31. Decontamination and Sterilization Instruments and Endoscope –Routine cleaning, decontaminating & sterilizing Magnetic Device that Holds Robotic Optics – Steam sterilized Manipulators –Draped with special sterile sleeves

32. Clinical Applications Evolution of Endoscopic Surgery Primary Robotic Systems –AESOP –Da Vinci Surgical Specialties –Cardiovascular –Neurosurgery –General –Orthopedic –Maxillofacial

33. Future Operating Room Robots increasingly used for minimally invasive surgery Virtual-reality simulations for training purposes Realistic anatomical models Biomechanics-based simulations for training Surface-based registration Surgical robotics Advanced human-computer interaction

34. Planning and Rehearsal Current Method Preoperative Planning –Study two-dimensional image of pathology Future of Preoperative Planning –Image-based planning and rehearsal; consists of 3 segments Patient imaging Create 3-dimensional model (modeling) Planning and rehearsing procedure

35. Planning and Rehearsal Current imaging: MRI or CAT scan Advanced: Deformable Modeling –Provides realistic mechanical simulations of tissue –Aid surgeons in predicting potential complications during rehearsal –Images obtained are transformed into 3- dimensional models manipulated with virtual instruments

36. Planning and Rehearsal Deformable Modeling con’t. –Goal: Achieve realistic 3-dimensional simulation of soft tissue –Surgeon uses computer-generated model of patient Diagnose condition Treatment options Practice surgical procedure

37. Planning and Rehearsal Deformable Modeling con’t. –Key Point: Surgeon is not practicing on general model –Images are obtained from patient – patient’s virtual tissue images –Advantages Anticipate and avoid errors Resolve unforeseen complications preoperatively

38. Next Step: Surface-based Registration Biomechanical Control System –Registers (determines orientation of) tissues in the O.R. –Surgical Navigation System Laser scanners Video cameras Produce images of MRI and patient preoperatively and intraoperatively

39. Surface-based Registration How It Works –Tissue, such as brain, is scanned – MRI or CAT scan –Normal and abnormal tissue differentiated by computer analysis by color –3-dimensional images of structures produced by computer

40. Surface-based Registration How It Works con’t. –O.R. images superimposed on head of patient Laser scans patient’s head Obtains 3-dimensional coordinates MRI combined with laser scan Patient’s virtual head superimposed on real head Surgeon can “see” inside patient’s head before incision is made

41. Surgical Technologists of the Future Surgical Technologists Will Understand : –Physics –Biomechanics –Computer Science and Advanced Software –Electronics –Robotics –Maintain, troubleshoot, operate robotic equipment

42. Robotics for the Surgical Technologist SUMMARY Intro Development Types Uses Designs Applications Specialties THE END