2014년 제2차 디지털의료기기 지식연구회 - 치료지원 로봇 및 영상 시스템 -

홍재성

대구경북과학기술원

로봇공학전공

Prof.

Makoto Hashizume

Kyushu University

Prof.

Takeyoshi Dohi

The University of Tokyo

Prof.

Nobuhiko Hata

Harvard Medical School

Prof.

Hiroshi Iseki

Tokyo Women’s Medical Univ.

Minimally Invasive Surgery

Less pain

Small or no scar

Short hospitalization

0 10000 20000 30000 40000 50000 60000 70000 80000 （年） （case）

Endoscopic Surgery

Advanced Eyes

MRI, CT, US, PET based

Simulation and Navigation

Advanced Hands

Surgical

Robot and Device

Kyushu University

Advanced Eyes

Verify Blood Vessel and Tumor Position

Laparoscopy-Assisted Distal

Gastrectomy (LADG)

Preoperative CT

_{Simulation for Lung Collapse}

0 20 40 60 80 100 1 2 3 4 5 生 存 率 （ ％ ） 経過（年） なし 0% 1-49％ 50-74% 75-94% 95-99% 100%

(n=6395,1969-1993)

Issues :

Unclear Margin Area

Low Quality of Life (QOL)

Surgical Navigation for Complete

MRI plus Ultrasound

Navigation for Liver Tumor

・

MRI’s

-

3D imaging

capacity

- High specificity

・

_US’s

-

real-time imaging

capacity

- High sensitivity

Surgical Robotics Lab

 Non-surgical procedure

 Epiduroscopy

Surgical Robotics Lab

Issues

Epiduroscopy (cont.)

 Strong points

 Effectiveness for low back pain  Minimal invasiveness

• less bleeding

• small post-operative scar

• minimal likelihood of infection  Early return to daily life

 Weak point

 Guidance of fluoroscopy[C-arm]



X-ray radiation exposure

Surgical Robotics Lab

Surgical Robotics Lab

Hands free setup

Surgical Robotics Lab

Prototype

– Arthroscope with wide angle lens

17mm

17mm 14.5mm

Camera _{Field of view :} Diameter : 10.07 mm _{130 – 140°} LED 4-LED White light

Turn on LED

Wide angle lens

(Fisheye lens)

Advanced Hands

- Grasp, Suture, Ligation, Needling,

Drilling Robot and Device

Classification



Surgical Assistant Systems



Auxiliary Surgical Supports



Laparoscopic Surg., NOTES, SPS



Remote Surgery



da Vinci, etc



Surgical CAD/CAM System



Robotic Orthopedic Surgery



Robotically Assisted Percutaneous Therapy



ROBODOC, etc.

daVinci Surgical Robot

COMPANY HISTORY

01.

In the late 1980s

, the original prototype for Intuitive Surgical’s da Vinci

System was developed at the former

Stanford Research Institute

under contract to the

U.S. Army

. While initial work was funded in the interest of developing a system for performing

battlefield surgery remotely

.

02.

In 1995

,

Intuitive Surgical

was founded and secured licenses on the technologies developed by several institutions (IBM, MIT, Heartport Inc.).

03.

In January 1999

, Intuitive launched the

da Vinci Surgical System.

04.

In 2000

, it became the first robotic surgical system

cleared by the FDA

for general laparoscopic surgery. In 2001, cleared by the FDA for

thoracoscopic (chest) surgery, cardiac procedures performed with adjunctive incisions, urologic, gynecologic, pediatric and transoral otolaryngology

procedures

05.

In June 2000

, Intuitive Surgical completed a successful initial public offering.

Features of da Vinci system

da Vinci System

Traditional laparoscopy - 3D vision - EndoWrist® Instrumentation - Master-slave manipulation The da Vinci System

Stereo view

da Vinci System

- The digital zoom feature provides a highly magnified view of tissue - 3D for true perception of depth

EndoWrist end-effector (forceps)

da Vinci System

- 7 degrees of freedom

- 90 degrees of articulation

- Intuitive motion and finger-tip control

Issues



Haptic interface



Surgical navigation



Single port access

A single port

laparoscopic surgery robot

with high force transmission &

a large workspace

Open Surgery

Advantages

• Small scar

• Less pain

• Fast recovery, etc

 Disadvantage

• Limited vision and motion

• Risk of complication, etc

37

Single Incision (Port) Surgery

Advantages

• Almost no scar

• Much less pain

• Much faster recovery

 Disadvantage

• Difficult triangular positioning

• Counter intuitive operation

• More risk of complications

Insertable Robotic Effector Platform (IREP)

O Small introducer size (Ø 15mm) O Delicate movements

[Columbia Univ., USA]

SPRINT (Single-Port lapaRoscopy bImaNual roboT )

O Strong force (5N) O High speed (1 m/s)

SPIDER Surgery System

O Easy to change surgical tool through flexible channel O Intuitive manipulation

X Insufficient force (about 2 N)

[SPIDER Surgery System, transenterix, USA]

There are many other insightful and effective SILS robotic

systems.

Development of a SPLS robot with



high force transmission

up to over 10 N ( ≒ 1 kg)



large workspace

up to covering most area of abdomen

cavity (3000 cm

3

₎



Small size

less than 25 mm in diameter

Trade-off relation

• Wire – flexible, small, less backlash / breaking, elastic

extension, two wires for push and pull

• Link – High force, No breaking and extension / Large

scale, low flexiblity

• Rod – Less breaking and extension, one rod for push and

pull / less flexibility, large scale

• Gear – High force / large scale, dust, noise, sterilization

difficulty, backlash

• Plate spring – Combination of advantages of wire

(flexibility, size), link(High force), and rod (one for push

and pull)

 Stronger force transmission due to the larger cross section area than

the wire

 It can deliver forces for push as well as pull

 It is flexible and bent easily, compared with link, rod or gears.

 To prevent buckling when push, guide structures are required.

 The bending angle is limited due to possible irreversible deformation

Force

Guide

for Preventing Buckling

• Joint 3 uses plate spring

• Other joints use wire or link mechanism

Joint 1 Joint 2 Joint 3 Joint 4 Joint 5 Joint 6

load=200g

load=0g load=400g

67. Trajectories of forceps (payload=1400g) 46 0 5 10 15 20 25 30 0g 200g 400g 600g 800g 1000g 1200g 1400g 1600g rati o of ch an ge (% ) Weight(g) load=1400g load=1600g