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Technological Sciences for the Operating Room Robotics for the Surgical Technologist That was then 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 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 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 THIS IS NOW! 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 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 Surgical Robots • AESOP 3000 – Developed by Computer Motion – Position endoscope – Foot pedals or voice-activated software to position camera – Leaves surgeon’s hands free 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 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 Design • Robotic Components – Manipulators – Surgical instrumentation – Remote console – Computers – Voice activation system 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 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 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 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 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 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 Remote Manipulation • Single Manipulator – Hold endoscope – Surgeon uses surgical instruments • Multiple Manipulators – Hold endoscope and manipulate instrument – Instruments similar to other scope instruments 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 Remote Manipulation • Advantages – Eliminates hand tremor – Reduces errors – Performs complex techniques in small space – Improves visualization – Enables telesurgery in rural hospitals and other countries 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 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 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 Hearing • Machine hearing analogous to human hearing – Direction sound originated – Type of sound • Binaural Hearing – Same type as human hearing 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 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 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 Vision • Sensitivity vs. Resolution: Negative Effect – Resolution increased, vision decreases in dim light – Improved sensitivity – decreased resolution 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 Decontamination and Sterilization • Instruments and Endoscope – Routine cleaning, decontaminating & sterilizing • Magnetic Device that Holds Robotic Optics – Steam sterilized • Manipulators – Draped with special sterile sleeves Clinical Applications • Evolution of Endoscopic Surgery • Primary Robotic Systems – AESOP – Da Vinci • Surgical Specialties – Cardiovascular – Neurosurgery – General – Orthopedic – Maxillofacial 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 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 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 3dimensional models manipulated with virtual instruments 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 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 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 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 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 Surgical Technologists of the Future • Surgical Technologists Will Understand: – Physics – Biomechanics – Computer Science and Advanced Software – Electronics – Robotics – Maintain, troubleshoot, operate robotic equipment Robotics for the Surgical Technologist • SUMMARY • Intro • Development • Types • Uses • Designs • Applications • Specialties • THE END