robot-assisted vitreoretinal surgery & retinovascular surgery · da vinci robot in...
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Confidential, Patents Pending, Copyright Columbia University 2008
Robot-Assisted Vitreoretinal Surgery
& Retinovascular Surgery
12/19/2008
ARMA – Advanced Robotics and Mechanism ApplicationsColumbia University
Nabil Simaan PhD – ARMA, NYHoward Fine, MD MHSc – Harkness Eye Instititue, Columbia, NY
Hari Sundram, MD – Medical Capital Advisors, Boston
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Confidential, Patents Pending, Copyright Columbia University 2008
CONFIDENTIALITY
• This presentation covered by signed NDA• All the material presented in this document is protected
by one or more provisional patents • The material is provided for an overview of our recent
work at ARMA. • Please do not share this document with anyone else
without a written permission of Dr. Simaan (email [email protected])
• Copy [email protected] on all correspondence related to this material
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Confidential, Patents Pending, Copyright Columbia University 2008
Y. Chen Ph.D.
A. Salerno, Ph.D.
1/05 9/05 9/079/06 1/071/06 3/08 6/08 9/08J Ding Ph.D.
A. Bajo Saleem Hamid
Roger Goldman
Jian ZhangWei2Kai
Xu
Res
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MIS of Throat & Smart Surgical Devices
Robotic Center for High-Throughput Biodosimetry
Cochlear Implant SurgeryDesign and optimal Path planning for under actuated robots
Less Invasive (Single Port)With sensory assistance
MicrosurgeryDesign of Flexible Parallel Robots
ARMA’s Research Activity
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Confidential, Patents Pending, Copyright Columbia University 2008
ROBOTS IN OPHTHALMOLOGY
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Confidential, Patents Pending, Copyright Columbia University 2008
Robot-assisted surgery
• Has numerous potential advantages / applications Improved precision over human hands Tremor reduction / elimination Increased dexterity Reduced complication rates Potential to make good surgeons great Potential to expand the capabilities surgeons
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Confidential, Patents Pending, Copyright Columbia University 2008
Robot-assisted surgery
• Examples: Urology – cut rate of impotence / incontinence by 30% in
nerve-sparing radical prostatectomy NOTES – natural orifice transluminal endoscopic surgery
– allows laparoscopic surgery without visible incisions Sansei robot allows remote-controlled cardiac catheter
ablation, EP cardiologist no longer exposed to radiation
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Confidential, Patents Pending, Copyright Columbia University 2008
Robotic-Assisted Ophthalmic Surgery
No intra-ocular dexterity. No manipulation/stabilization of eye under microscope
Grace et. al. 1995. Bilateral manipulation, parallel robot, cannulation.
Wei-Tech, Cam Riviere Hand-held device, tremor cancellation, force sensing
Taylor et. al 1999Cooperative manipulation. Tremor filtering, virtual fixtures
Das et. al 1996/NASA JPLMicro-Dexterity Systems
Mitsuishi 1996 hand-held device with wrist
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Confidential, Patents Pending, Copyright Columbia University 2008
Da Vinci Robot in Ophthalmology
BJO 2007 Jan;91(1):18-21
Retina Today May/June 2008
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Confidential, Patents Pending, Copyright Columbia University 2008
Expand surgical armamentarium
• Retinal vascular surgery Apply techniques / technology of interventional cardiology
toward retinal vascular diseaseCannulationStentingAngioplasty
• Drug delivery• Membrane peeling (PVR, etc…)• Sub-retinal surgery (RPE cell transplantation, etc…)• Others…
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Confidential, Patents Pending, Copyright Columbia University 2008
ROBOT DESIGN
Dual-Arm Robotic System for Ocular manipulation and Intraocular Dexterity
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Confidential, Patents Pending, Copyright Columbia University 2008
Two Armed Slave Robot for μ-surgery of the eye
Microscope view cone
Adjustable arm w. fast lock
6-DoF parallel robot with a stage and a intraocular dexterity device
Stereo-tactic frame with dental lock
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Confidential, Patents Pending, Copyright Columbia University 2008
VIDEO 1: see movie 2 in web page
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Confidential, Patents Pending, Copyright Columbia University 2008
Dual-arm micro surgery
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Confidential, Patents Pending, Copyright Columbia University 2008
Dual-arm micro surgery
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Confidential, Patents Pending, Copyright Columbia University 2008
Preliminary Experiments
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Confidential, Patents Pending, Copyright Columbia University 2008
Retinal vascular stenting
• Apply techniques / technology of interventional cardiology to retinovascular disease
• Retinal vascular stenting (i.e. to treat BRVO)
Ophthalmology. 2001 Dec;108(12):2249-57
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Confidential, Patents Pending, Copyright Columbia University 2008
Venous stenting in humans
• Venous stenting in humans has been performed extensively Portal vein stenting
TIPS procedure: transjugularintrahepatic portosystemicshunt relieves cirrhotic
Following deep vein thrombosis Chronic deep venous obstruction:
definition, prevalence, diagnosis, management. Phlebology. 2008;23(4):149-57
Peripheral vascular disease Venous stenting across the inguinal
ligament. J Vasc Surg. 2008 Nov;48(5):1255-61.
• Obstacles in retinal venous stenting Bleeding
Control with IOP on tamponade Thrombosis
Many retinal veins recanalizeWR Green, Histopathologic
study of nine branch retinal vein occlusions, Archives 1982
Stent “re-stenosis” Low flow system less likely
Stent displacement
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Confidential, Patents Pending, Copyright Columbia University 2008
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Confidential, Patents Pending, Copyright Columbia University 2008
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Confidential, Patents Pending, Copyright Columbia University 2008
Placing a 200m Stent in a CAM blood vessel
Dual-arm placement of a micro stent (4/2/08)
Single-arm placement of a micro stent (4/18/08)
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Confidential, Patents Pending, Copyright Columbia University 2008
Movie 3: stenting apparatusMovie 5: Stent experiment 2
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Confidential, Patents Pending, Copyright Columbia University 2008
Points of Contact
• For questions about the technology please contact:Nabil Simaan (Assistant Professor, Mechanical Engineering)Columbia University234 S.W. Mudd Building, Mail code 4703500 West 120th street, New York, NY 10027email: [email protected] phone: +1-212-854-2957
• Note: please copy [email protected] on ALL inquiries