Medical Robotics. Classification of surgical systems

Transcription

1 Università di Roma La Sapienza A.A. 2012/13 Medical Robotics Classification of surgical systems Marilena Vendittelli Dipartimento di Ingegneria Informatica, Automatica e Gestionale

2 potential benefits coupling information to action accuracy access to hostile (e.g., X-rays) or space-constrained areas (inside of a patient or imaging system) smaller targets not replacement but extension/augmentation of the medical staff capabilities human-robot cooperation is one of the the central topics in medical robotics w.r.t. industrial robots, medical robots require specific safety measures, kinematics, hardware and software since they have to cooperate with the medical staff and accomplish tasks in contact with the patient posses application-specific functionalities be easily movable, not bulky, manually controllable accomplish non-repetitive tasks in unstructured environments be sterilizable and MRI-compatible technological challenges in sensing, manipulation, interfaces, system design technical paradigms different by degree of autonomy, type of provided support, type of access M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 2

3 Classification 1 (J. Troccaz, 2001) passive systems provide information to the surgeon active systems: perform the procedure under human supervision interactive systems: mechanical guides semi-active devices synergistic devices teleoperated systems M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 3

4 passive system example articulated arm with manually guided probe Viewing Wand (ISG Technologies) the probe position w.r.t. to the skull is used for registration navigation characteristics tracking of the object of interest stability of positioning if the arm is equipped with brakes drawbacks tracking of only one object cumbersome constraints the surgeon motion limited to navigation M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 4

5 active systems tasks with a complex geometry ROBODOC, CASPAR carry/hold heavy tools Cyberknife force controlled actions Hippocrate, SCALPP intra-body tasks EMIL moving targets Cyberknife + real-time patient tracking M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 5

6 ROBODOC SCARA maniplator with a 2dof wrist 6D force/torque sensor Orthodoc: planning system example: hip surgery 1. planning with Orthodoc 2. pre-op to intra-op registration using implanted titanium pins 3. intra-operative bone milling procedure using ROBODOC M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 6

7 radiosurgery traditional linear accelerator set-up complex trajectories for improved tumor destruction 6 dof required very heavy tools M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 7

8 Cyberknife 6MeV accelerator (1 ev= amount of kinetic energy gained by a single unbound electron when it accelerates through an electrostatic potential difference of one volt) frameless neurosurgery small patient motion compensation large workspace M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 8

9 interactive systems principle: the robot constrains the surgeon s action possible approaches semi-active: a mechanical constraint synergistic: a programmable mechanical constraint advantages man/machine cooperation (safety, psychological acceptance) rather direct interpretation of haptic data M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 9

10 semi-active systems NeuroMate pre-positioning: robot surgical action: surgeon simple tasks linear motions (e.g., needle insertion) planar motions (e.g., osteotomy) conical motions (e.g., laparoscopy) specific architecture M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 10

11 synergistic systems generalization of semi-active systems programmable mechanical guides different technologies programmable brakes (Taylor, P-TER, IMCAS) nonholonomic coupling of dofs (Cobot) windows of admissible velocities (PADyC) active Constraint ROBOT (Acrobot) M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 11

12 PADyC (Passive Arm with Dynamic Constraints) M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 12

13 freewheels F1: ωi = 0 ω + i 0 only ω user + F2: ωi 0 ω + i = 0 only ωuser F3: ωi 0 ω + i 0 both directions F4: ωi = 0 ω + i = 0 none one joint: two freewheels mounted in the opposite direction and actuated by two independent motors ωi and ω + i controlled by the computer, ω user controlled by the user motion authorized for ω i ω i ω + i M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 13

14 task constraints free mode: no constraint, the system computes and memorizes the position of the surgical tool position mode: PADyC helps the user to move the tool towards a predefined position and orientation (e.g., bone fragment or a prosthesis component) region mode: the tool is free to move in a given region of space, but cannot escape from that region (e.g., tumor resection or cavity preparation for prosthesis placement, avoidance of critical areas) keep inside keep outside trajectory mode: constrains the motion to follow a predefined trajectory with a given accuracy (e.g., biopsy trajectory) specialized modes linear motions planar motions conical motions M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 14

15 window of admissible configurations authorized region q 2 (t)+! 2+ "t q 2 (t) Q(t) q 2 (t)-! 2- "t WAC(t) q 1 (t)-! 1- "t q 1 (t) q 1 (t)+! 1+ "t example: 2R manipulator, region mode given the robot configuration Q(t), the velocity constraints must be such that the configuration Q(t + t) is contained in the admissible region M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 15

16 problem: mapping the task constraints to configuration constraints in real time computation of W AC j (t) for k control points on the surgical tool W AC(t) = k j=1 W AC j(t) M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 16

17 teleoperated systems davinci Zeus M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 17

18 Classification 2 (Russel H. Taylor, 2003) Computer Integrated Surgery (CIS) surgical robotic systems are first part of CIS and then medical robots they can be classified according to their role in CIS systems M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 18

19 - patient modeling - planning - registration - execution - follow-up advantages - optimal planning - consistent and accurate execution - safety - validation - information management M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 19

20 examples robot assisted execution orthopedic prosthesis implant (ROBODOC) percutaneous therapy (NeuroMate) execution assisted by navigation systems therapy delivery with the aid of multi-modal images (Cyberknife) augmented reality (images overlay) M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 20

21 surgical extenders improve or extend surgeon s abilities in manipulating surgical tools (e.g., tremor cancellation) auxiliary surgical supports work side-by-side with the surgeon (e.g., endoscope holding or retraction) advantages - perform otherwise not possible procedures (e.g., beating heart surgery) - mortality and errors reduction - reduction of operating time - increased efficiency M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 21

22 examples surgical extenders teleoperated systems (Zeus, davinci) microsurgical systems (teleoperated or not, possibly without manipulators ) cooperative systems auxiliary surgical supports endoscopes, ecographic probes,..., controlled by the surgeon through various interfaces (AESOP) systems for intraluminal appilcations (active catheters, capsules) M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 22

23 Classification 3 (L. Joskowicz, 2005) computer assisted surgery support systems passive mechanisms adjustable frame/arm/support individual templates intraoperative imaging navigation robotics floor/bed mounted patient mounted M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 23

24 floor or bed-mounted advantages integrated planning/execution intraoperative modifications rigid and accurate drawbacks immobilization or tracking bulk, cost (EU K) safety risk due to the large workspace and inertia M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 24

25 patient-mounted robot advantages small size/footprint minimal obstruction close proximity to surgical site no patient/anatomy immobilization, no tracking/real-time repositioning small workspace fine positioning device potentially higher accuracy intrinsic safety due to small size/low power drawbacks patient mount require manual coarse positioning M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 25

26 examples spine surgery: pedicle screw insertion recommended use vertebra fracture degenerative diseas spine tumor scoliosis M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 26

27 individual template advantages inexpensive rigid mechanical support customized drawbacks requires manufacturing no intraoperative changes limited use: anatomy-dependent patient-mounted robots MARS Mazor Surgical Technologies, Israel M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 27

28 Classification 4 (P. Dario, 2004) M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification 28

29 Bibliography O. Snider, J. Troccaz, A six-degree-of-freedom Passive Arm with Dynamic Constraints (PADyC) for cardiac surgery application: Preliminary experiments, Computer Aided Surgery, vol. 6, pp , P. Kazanzides, G. Fichtinger, G.D. Hager, A.M. Okamura, L.L. Whitcomb, R.H. Taylor, Surgical and Interventional Robotics - Core Concepts, Technology, and Design, IEEE Robotics & Automation Magazine, vol. 15, no. 2, pp , R.H.Taylor, D. Stoianovici, Medical robotics in computer-integrated surgery, IEEE Transactions on Robotics and Automation, vol. 19, no. 5, pp , M. Shoham, M. Burman, E. Zehavi, L. Joskowicz, E. Batkilin, Y. Kunicher Bone- Mounted Miniature Robot for Surgical Procedures: Concept and Clinical Applicationsy, IEEE Transactions on Robotics and Automation, vol. 19, no. 5, pp , M. Vendittelli Medical Robotics (Università di Roma La Sapienza ) Classification: Bibliography 29