Robotic for a cardiac surgeon
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1 Robotic for a cardiac surgeon N. Bonnet La Pitié-Salpêtrière Surgery Mini-invasive Video-assisted Videoscopic celioscopy thoracoscopy arthroscopy... Robotic Surgery: kheiros Is mini-inavsive surgery new? Morton, Warren et l'ether Ambroise Paré
2 Mini-Invasive Surgery Two direction No CEC Small wounds Both(TECAB) Trocart for ITA haversting during thoracoscopy Thoracoscopic ITA harvesting Why do we need surgical robots? Better procedures: Direct Enhancement of the quality Mini-invasive surgery Surgical precision Enhancement of the quality via Training of the surgeons Ergonomy New procedures?
3 Aesop 3000 Aesop 3000 robot Arm for the Endoscope Motor 3 ddl Voice Command Stability Ergonomy 3 d hand for the surgeon Placement d Aesop History robota 1921, Karel Capek RUR: Rossum s Universal Robot 1961, 1 st robot is industrial Productivity Dangerous works
4 Industry (fabrication) Robot in the laboratories Surgical Robot... Robots for medecine Robots at hospital Surgical Robots Robots for drugs delivery Robots for transport: patients bags family (Welcome Robots) Robots harvester blood: BloodBot de l Imperial College of London skin (Scallp Sinters) Robot - nurse... Robot-Surgeon Telemanipulation: precision Intracorporeal wrist Stereotaxy: CASurgery Preoperative simulation In the futur the robot should interact with the whole operative theater The begining What is a robot for a surgeon? Essential Concept : retro-action Linked Concepts: mechanism and numeric mesurment computation effect action
5 Surgical robots Robots for all surgery: Aesop (Computer Motion ) Zeus (Computer Motion ) DaVinci (Intituitive) Robots for specific Caspar (Maquet ) Robots for neurosurgery or radiotherapy... Soft Hard 17 Teleoperators, general anatomy Console / Master Electronic Link Bras effecteur / Slave Teleoperator in cardiac OR DaVinci at Broussais
6 DaVinci Zeus, Computer Motion For endoscopic surgery 3 arms 2 Zeus for instrument 1 Aesop for endoscope master slave Zeus Zeus Tête Tête Computer motion
7 multifunction Two different concept teleoperators futur «robot-surgeon» (star war) unifunction stereotaxy futur «component of robot-surgeon» Analysis of the surgical procedure Types: Taking and holding (pince) rotation (screwing, perceuse ) others!!! Precision Haptic Force dof Amplification / Adaptation des gestes force et skill stability precision, filter rapidity reproducibility...
8 Now Precision Dexterity Ergonomy Plug and play 3 d hand Intrathoracic wrist Futur: Complex motion automatisation haptic stereotaxy teleoperations teaching Interests of teleoperator Intrest of teleoperator Frein de vélo, transmission par câble Frein ABS, interposition d électronique Intracorporal wrist Noeuds
9 Découplage des axes Trois bras indépendants fixés sur la table Colonne optique indépendante Bras porte-optique commandé à la voix ddl=4+1 point fixe réel Zeus -vs- DaVinci Trois bras liés sur un portique Colonne optique intégrée avec vision 3D Bras porte-optique commandé manuellement ddl=6+1 point fixe virtuel teleoperator > robot Zeus / DaVinci now Zeus / DaVinci futur Robot > teleoperator Surgeon Surgeon
10 Surgeon Vishnu News in endoscopy 3CCD High Resolution 3D Wide angle point of view angle of view numeric Videoscopy Smaller Automatic control light Contrast focus Enhanced reality Chimène (Thomson/Genzyme) Other Robots Orthopedic precision/simulatiom/stereotaxy Hipnav, Caspar, Robodoc Neurosurgery stereotaxy, neuronavigation Microrobots et endovascular surgery Radiointervention, radiotherapy stereotaxy Enhanced reality radioprtection tele-echography...
11 Neurosurgery et stereotaxy Hippocrate Sinters Reproductibilité Robot spécifique dédié Télédiagnostic Feldtbuch der Wundatzney, Hans Gersdorff Strasbourg 1517 HERMES, voice commad (table, lights, video...) Telesurgery Lindbergh procedure industrial and médical Marketing (G Landrivon Nouvelles technologies et chirurgie du futur, Ed Arnette, 2000) Technological challenge Real time master-slave (logiciels de prévision) Safety of communication Distributed net Telesurgery, where Far away (Mars, Antartic ) Closer (Other OR, same OR: cosurgery)
12 Futur OR TM Current Customers US Hospital Installations As of July, 2004 Europe Hospital Installations As of July 2004 TM Current Customers US Hospital Installations As of June 30, 2004 Far East Hospital Installations As of July, 2004 Canada Hospital Installations As of July, 2004 This Legend applies to the US only
13 TM Current Customers Europe Hospital Installations As of June 30, 2004 Middle East Hospital Installations As of July, 2004 Teleoperators in cardiac surgery Endoscopic surgery «classical» / without suture ITA harvesting (Juillet 99 avec Zeus à la Pitié) «new» / with sutures 1 er TECAB off pump Janvier 2000 Pr Mohr (Allemagne) Mitral surgery Heart Port CABG Grafts harvesting (LITA RITA) Opening the pericardium Coronary idntification Coronary stabilisation Arteriotomy Temporary hemostasis Anastomosis
14 With intracorporeal wrist, coronary anastomosis Mediastinum Ventricular resynchronisation LV epicardial leads With heart-port technology: Femoral ECC Aortic XClamp Small thoracothomy Mitral and tricuspide Totally endoscopic procedure Valvular sugery
15 Heart Port Knots ASD da Vinci TM Procedures Completed Cardiac- Vascular & Thoracic ASD Repair FDA Multicenter Trial Thoracoscopic Cardiotomy procedure claim January 2003 Totally Endoscopic Approach Excellent surgical alternative for active patients seeking minimal disruption in quality of life Endoscopic Single Vessel Beating Heart Bypass, LIMA-LAD Endoscopic Double Vessel Beating Heart Bypass, LIMA-LAD & RIMA-RCA Endoscopic Arrested Heart Single Vessel Bypass, LIMA-LAD or RIMA-RCA Endoscopic Arrested Heart Multi-Vessel Bypass IMA Harvesting Bilateral IMA Harvesting Coronary Anastomosis Atrial Septal Aneurysm Subrenal Aortic Aneurysm Atrial Septal Defect Repair Mitral Valve Repair & Replacement Tricuspid Valve Repair Thrombectomy Pericardial Window Lobectomy Pneumonectomy Abdominal Aortic Aneurysm Aortic Femoral Bypass Pacemaker Lead Implantation Mediastinal Resection Pulmonary Wedge Resection Beating Heart Single Vessel Bypass LIMA-LAD
16 Multi-Specialty Solutions: Cardiac/Thoracic Cardiac Mitral Valve Repair IMA Takedown Mitral Valve Repair Epicardial Lead Placement Beating Heart TECAB (Single Vessel) Arrested Heart TECAB (Single & Multiple Vessel) Mediastinal Mass Removal Pericardial Window Sternotomy LIMA-LAD Enhanced MIDCAB Atrial Septal Defect Esophagectomy Thymectomy Lobectomy Wedge Resection Mediastinal Tumor Heller Myotomy Esophageal Achalasia Esophageal Mass Enucleation Aortic Ring Dissection Sympathectomy Sympathectomy Total Esophageal Myotomy Splenic Artery Aneurism Pulmonary Descending Aorta Ligation Aortic Coarctation Comparison of relevant clinical variables for Mitral Valve repair: Sternotomy vs. da Vinci Surgical System ***N=893 from The Society of Thoracic Surgeons (STS), National Cardiac Surgery Database, Isolated Mitral Valve Repair Procedures, Jan-Jun 2001 **** Data from STS 2001 not available, ****Data used as part of 112 patient, multi-center, da Vinci mitral valve repair clinical trial; da Vinici Robotic Mitral Valve Repair; Outpatient Procedure? Pat S. Pappas, M.D., et. al; Advocate Christ Hospital, Chicago, IL Clinical Validation Contraintes conceptuelles Robustesse Encombrement Stérilisation Coût Pilotage par des personnels non roboticiens ce que veulent les roboticiens Décrire et quantifier avec précision les gestes d une intervention Convergence des disciplines robotique automatisme mécanique simulation... médecine autres psychologie économie...
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