Surgical Innovation Surgical Innovation Charles R. Doarn, MBA Charles R. Doarn, MBA Executive Director Executive Director Center for Surgical Innovation Center for Surgical Innovation Deputy Director Deputy Director Advanced Center for Telemedicine and Surgical Innovation Advanced Center for Telemedicine and Surgical Innovation Associate Professor of Surgery and Biomedical Associate Professor of Surgery and Biomedical Engineering Engineering Department of Surgery Department of Surgery University of Cincinnati College of Medicine University of Cincinnati College of Medicine
Objectives Objectives � Understand the convergence of Understand the convergence of � telecommunications, informatics and robotics telecommunications, informatics and robotics that has enabled telesurgery telesurgery that has enabled � Understand the needs, opportunities and Understand the needs, opportunities and � challenges of telesurgery telesurgery challenges of � Understand current and future research in this Understand current and future research in this � rapidly emerging field rapidly emerging field � Understand the impact that advanced networks Understand the impact that advanced networks � and information systems will have in improving and information systems will have in improving the quality of and access to surgical care the quality of and access to surgical care
Information Information � Foundation of life � Foundation of life � Foundation that � Foundation that enables medicine / enables medicine / surgery to change surgery to change � Basis for reliable � Basis for reliable and efficient and efficient business processes business processes
Change Change It is change, continuing change, inevitable It is change, continuing change, inevitable change, that is the dominant factor in change, that is the dominant factor in society today. No sensible decision can be society today. No sensible decision can be made any longer without taking into made any longer without taking into account not only the world as it is, but the account not only the world as it is, but the world as it will be. world as it will be. - Isaac Asimov - Isaac Asimov
Changing paradigms Changing paradigms Surgery education and practice Surgery education and practice
New Technologies / New Approaches New Technologies / New Approaches Unmet needs Unmet needs Simulation Simulation Different ways of doing things Different ways of doing things
New Devices New Devices Neurosurgery Haptics for for da da Vinci Vinci Neurosurgery Haptics
New Procedures: Treatment of Treatment of Atrial Atrial Fibrillation Fibrillation New Procedures: A B C Strategic Placement of Incisions: A) Mini-thoracotomy in Ausculatory triangle – a region with no or few skeletal muscles, minimizing patient discomfort by avoiding Pectorals and Latissimus B & C) 1 or 2 Ports between ribs avoid Serratus Anterior Muscles for visualization, retraction and bipolar RF device insertion
Enhanced Training Technologies - - Simulation Simulation Enhanced Training Technologies
Zeus (Computer Motion) Zeus (Computer Motion) da Vinci (Intuitive Surgical) Vinci (Intuitive Surgical) da
Information rich environment Information rich environment
What is telesurgery telesurgery? ? What is • What its not! What its not! • • Manipulation of a surgical robotic Manipulation of a surgical robotic • system where patient and surgeon system where patient and surgeon are separated by a distance are separated by a distance
Remote / Extreme Remote / Extreme • Poor infrastructure Poor infrastructure • • Mobile facilities Mobile facilities • • Low bandwidth solutions Low bandwidth solutions •
Operation Lindbergh Operation Lindbergh • Trans Atlantic Trans Atlantic – – dedicated dedicated • com network com network • Surgical removal of gall Surgical removal of gall • bladder bladder • Surgeon in New York Surgeon in New York – – • Patient in France Patient in France • Most missed story of 2001 Most missed story of 2001 • Canadian Telesurgery Canadian Telesurgery • 45 Mbps 144msec MPLS IP 45 Mbps 144msec MPLS IP • VPN + Zeus TS VPN + Zeus TS • Hamilton Hamilton - - North Bay North Bay • • Laparoscopic Laparoscopic Nissen Nissen • Fundoplications Fundoplications
Robotic Telesurgery Using da da Vinci Vinci Robotic Telesurgery Using ATA - - Denver April 2005 Denver April 2005 ATA First time ever daVinci daVinci used in to perform robotic telesurgery in inanimate experiments used in to perform robotic telesurgery in inanimate experiments. . First time ever Clinical trial (first time daVinci daVinci used in telesurgery and first time telesurgery performed in used in telesurgery and first time telesurgery performed in Clinical trial (first time US) conducted at UC US) conducted at UC – – March 2005. Collaborators include: Intuitive Surgical, Johns March 2005. Collaborators include: Intuitive Surgical, Johns Hopkins, WRAMC and UC Center for Surgical Innovation. Hopkins, WRAMC and UC Center for Surgical Innovation.
NASA Extreme Environment NASA Extreme Environment Mission Operations Mission Operations Great analog for space
NEEMO 9 Telepresence Telepresence Surgery Surgery - - Portable Portable NEEMO 9 Robotic System Robotic System Remote manipulation of Remote manipulation of • • M7 Robot from a site in M7 Robot from a site in Canada Canada Dual use of systems Dual use of systems • • TATRC funded TATRC funded • •
NEEMO 12 NEEMO 12 Evaluation of University of Washington’ ’s RAVEN robot s RAVEN robot Evaluation of University of Washington • • Evaluation of SRI SRI’ ’s s M7 enhanced robot M7 enhanced robot Evaluation of • • Autonomous task operation – – ultrasound ultrasound Autonomous task operation • • TATRC funded TATRC funded • • NASA, NOAA, Army, Navy, Air Force – – academia and academia and NASA, NOAA, Army, Navy, Air Force • • industry industry
Mobile Robotic Telesurgery Telesurgery Systems Systems Mobile Robotic • University of Washington University of Washington – – Army Army- - • funded RAVEN funded RAVEN – Remote manipulation Nashville to Remote manipulation Nashville to – Key Largo Key Largo – SAGES FLS tasks SAGES FLS tasks – • SRI SRI – – M7 M7 • – Autonomous function of ultrasound Autonomous function of ultrasound – and needle placement and needle placement
M7 - - SRI SRI M7 NEEMO 12 NEEMO 12 First autonomous manipulation of First autonomous manipulation of an ultrasound – – needle insertion needle insertion an ultrasound RAVEN – – Univ of Univ of RAVEN Washington Washington
NEEMO 12 NEEMO 12
HAPsMRT HAPsMRT
Location – – Simi Valley, CA Simi Valley, CA - - Arid Arid – – high high Location desert desert
Challenges Challenges Inoperable communication (Days 1- -3) 3) Inoperable communication (Days 1 • • Redesign in real- -time time – – 802.11g 802.11g Redesign in real • •
Birds eye view! Birds eye view!
Surgery During Flight Surgery During Flight • NASA NASA • • TATRC funded TATRC funded • • Evaluation of robotic Evaluation of robotic • surgical care in various surgical care in various gravity settings (0g, 1g, gravity settings (0g, 1g, Lunar) Lunar)
Challenges and Opportunities for Challenges and Opportunities for Telesurgery? Telesurgery? • Increase access Increase access • • Decrease time to definitive care Decrease time to definitive care • • Extension of care Extension of care • • Enabling education tools Enabling education tools • • More efficient business models More efficient business models • • Licensure Licensure • • Robust and reliable networks Robust and reliable networks • • Quality of service Quality of service •
CLASSIFIED Brian M. Barnes, Institute of Arctic Biology , University of Alaska Fairbanks 11/02
The Operating Room of the Future
The future of surgery The future of surgery
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