computer aided surgery
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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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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