Robotics in Gastroenterology. Dr Louis Phee Associate Professor Head, Division of Mechatronics & Design School of Mechanical & Aerospace Engineering

Transcription

1 Robotics in Gastroenterology Dr Louis Phee Associate Professor Head, Division of Mechatronics & Design School of Mechanical & Aerospace Engineering

2 Why Medical Robotics? The use of robotic and mechatronics technologies to aid the clinician in performing difficult and technically demanding surgical procedures. Strengths of the Clinician: Good judgement. Strong hand eye co-ordination. Integrate extensive and diverse information. Very flexible and adaptable. Very dextrous at human level. Highly evolved. Easy to instruct. Easy to get verbal feedback. Strengths of the Robot: Excellent geometric accuracy and repeatability. Untiring and stable. Immune to infection and radiation. Potentially high variety in size, shape and configuration to suit need. Can incorporate many sensors for information feedback and precise application (eg. of force). Creates better accessibility

3 Why Medical Robotics? Surgeon + Robot = Enhances non invasive or minimally invasive surgical procedures Eliminates or decreases technical difficulties faced by clinicians Less pain and discomfort for patients Lower surgical and hospitalization costs

4 The Evolution of Surgery TRADITIONAL SURGERY MINIMALLY INVASIVE SURGERY ENDOLUMINAL SURGERY Microendoscope for spinal cord Da Vinci CAS system Endoscopic capsule Reconfigurable surgical system FETAL SURGERY CELL SURGERY Force-feedback scissor for fetal surgery Artificial virus for cell therapy

5 The Da Vinci system

6 Robotic Surgery Vs Traditional Laparoscopy Same hospitalization time Similar blood loss Same cauterization time Patient reported mean pain scores were almost identical Robotic surgery is expensive Robotic surgery has higher operative duration time

7 The new challenge for surgeons and engineers The real challenge for the future of robotics in surgery (and perhaps for surgery in general) is to go beyond the mere imitation and substitution by a robot of conventional procedures and surgical gestures, and rather to explore completely novel procedures that are possible only by means of robotic/mechatronic tools together with human surgeons.

8 Previous Projects: Colonoscopy Robot Motivations Colon cancers are one of the deadliest but most preventable malignancies Kills people worldwide each year Curable 90% of the time, if detected and treated in the earlier stages Death toll could drop by 50 to 75% with mass screening of the population 1 million colonoscopies performed in France each year, resulting in 52% of colorectal cancers cured Colonoscopy tops the list of recommendations because the entire colon can be inspected and therapeutically treated as soon as ailments are discovered Colon cancer is the one of the most common form of cancer in Singapore Endoscopic View of fungating colon cancer Mass screening of population for colon ailments would be desirable

9 Previous Projects: Colonoscopy Robot Pain & discomfort for the patient Technical complexity for the surgeon Expensive; deters patient from examination Objective: To develop a robot which can propel itself autonomously into the colon (anus to caecum) for inspection purposes

10 Previous Projects: Colonoscopy Robot Understanding the Environment σ = γε 2 γ 5.0 MPa Clamp Active surface Tissue Controlled weight Thermostatic support T DC Motor Load cell T Known Weight Tissue Controlled Temperature Plate Thermocouple Controlled Speed Motor

11 Analysis of the Solutions The Inchworm The INCHWORM locomotion mechanism never let go of what you are holding until you are holding something else

12 Previous Projects: Colonoscopy Robot Understanding the Environment σ = stress ε = strain η e = l 0 l1 + l 1 = l l 1 t σ = 2 γε l m ε = l l 0 0 η e = l F 1 0 c lt πγφt

13 Previous Projects: Colonoscopy Robot Prototyping

14 Previous Projects: Colonoscopy Robot Disposable The future of colonoscopy?

15 Master And Slave Transluminal Endoscopic Robot (MASTER) Current Gastroscopy

16 Master And Slave Transluminal Endoscopic Robot (MASTER) Objectives Nintendo Wii for Surgery

17 Design: Overview Perform treatment Patient Attend to Inside GI tract Attach together Slave Robotic System Actuate Distal end Parameters changes Endoscopist Stabilised position Conventional endoscopy system Actuators housing Assist Control Changes proximal load cell readings Surgeon Provide vision feedback Microprocessor/ Motion Controller Control Send signals Master Console System Control actuator torque 17

18 Master And Slave Transluminal Endoscopic Robot (MASTER) Benefits for Clinicians Enable endoscopist to perform intricate procedures otherwise normal performed by surgeons Intuitive, easy to use, very short learning curve

19 Master And Slave Transluminal Endoscopic Robot (MASTER) Benefits for Patients Minimally invasive No holes = no scars Shorter hospitalization stays, if any Lower costs

20 Surgical Navigation System for NOTES

21 Force Feedback 22

22 Envisaged NOTES Platform 23

23 State-of-the-Art of Wireless Capsule Endoscopy

24 PillCam Colon 2 Inventors: Given Imaging Capability: Bi-directional communication, adaptive frame rate adjustment Specifications: 1.1cm in diameter and 3.1cm long; 4-35 frames per second

25 MiRo capsule Inventors: Intelligent Microsystems Centre Capability: uses the human body as a conductive medium for data transmission Specifications: 10.8 mm in diameter and 24mm long; 2 frames per second

26 Magnetic Maneuverable Capsule Inventors: University of Hamburg Capability: Controlled locomotion by using a handheld external magnet (magnetic disks are inserted inside one of the capsule's domes) Specifications: 1.1cm in diameter and 3.1cm long; 4 frames per second

27 Maneuverable Pill (Research) Inventors: CRIM Lab at Scuola Superiore Sant Anna and Katholieke Universiteit Leuven Capability: Controlled swimming using BLDC motors, Wireless power supply Specifications: 1cm in diameter and 4.5cm long; 2 frames per second

28 Magnetic Internal Mechanism capsule (Research) Inventors: CRIM Lab, Scuola Superiore Sant Anna Capability: gross positioning and precise control of the capsule orientation, tethered Specifications: 1.5cm in diameter and 4.8cm long

29 Hybrid locomotion (Research) Inventors: CRIM Lab, Scuola Superiore Sant Anna Capability: Hybrid locomotion (external magnetic dragging and internal actuating legged mechanism) Specifications: 1.4cm in diameter and 4.4cm long

30 Mermaid Pill Inventors: Ryukoku University and Osaka Medical College Capability: Controlled swimming using fins in GI tract Specifications: 1cm in diameter and 4.5cm long; 2 frames per second

31 Innovative Imaging System -Clearer images -Steerable vision -Longer operation duration Rotatable camera (by using a micro-motor) Self-focusing lenses with variable view angle

32 Tagging Device Principle: - The capsule will inject a pre-determined volume of a solution into a desired location of the small intestine/stomach sub-mucosal layer using a fine needle - The tagged location could be recognized by X-Ray or by the physician during an open-surgery operation

33 Monitoring of Gastric Bleeding Enabling Technologies: - Blood Sensor - Stop Mechanism (inflating balloon)

34 Weight Management Strong market for the clinical treatment of overweight and obesity Market forecast $6.4 billion globally by 2015

35 (e) Removal (natural discharge) (d) Balloon deflates (a) Capsule enters the stomach (b) Resides in stomach (c) Balloon inflates

36 The Future Robots in your Body

37 Self Configurable Robot A customizable self assembled and self reconfigurable robot able to adapt its configuration to the specific site of intervention and to the task that must be executed

38 Learning from nature Studying social insect colonies, e.g. ants and bees, to inspire solutions for collective behavior, mechanics and sensing systems of microrobots I-SWARM project: 1000 cooperating bio-inspired microrobots Technological challenges (*): size (3 3 3 mm 3 ) extremely low power limits onboard (< 1mW) mass-fabrication and assembly through microtechnologies swarm behavior algorithms on the base of the developed HW (*) P. Valdastri, P. Corradi, A. Menciassi, T. Schmickl, K. Crailsheim, J. Seyfried, P. Dario, Micromanipulation, Communication, Swarm Intelligence Issues in a Swarm Microrobotic Platform J. of Robotic and Autonomous Systems, Elsevier 2005)

39 Micro/Nano Self Configurable Robots Screening Biopsy, surgery and other therapies

40 Louis Phee Tel: Thank You