SLIDE 1
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
SLIDE 2 Objectives Objectives
- Understand the convergence of
Understand the convergence of telecommunications, informatics and robotics telecommunications, informatics and robotics that has enabled that has enabled telesurgery telesurgery
- Understand the needs, opportunities and
Understand the needs, opportunities and challenges of challenges of telesurgery telesurgery
- 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
SLIDE 3 Information Information
Foundation of life
Foundation that enables medicine / enables medicine / surgery to change surgery to change
Basis for reliable and efficient and efficient business processes business processes
SLIDE 4 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
SLIDE 5
Changing paradigms Changing paradigms Surgery education and practice Surgery education and practice
SLIDE 6
New Technologies / New Approaches New Technologies / New Approaches Unmet needs Unmet needs Simulation Simulation Different ways of doing things Different ways of doing things
SLIDE 7
New Devices New Devices Neurosurgery Neurosurgery Haptics Haptics for for da da Vinci Vinci
SLIDE 8 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
New Procedures: New Procedures: Treatment of Treatment of Atrial Atrial Fibrillation Fibrillation
SLIDE 9 Enhanced Training Technologies Enhanced Training Technologies -
Simulation
SLIDE 10
Zeus (Computer Motion) Zeus (Computer Motion) da da Vinci (Intuitive Surgical) Vinci (Intuitive Surgical)
SLIDE 11
Information rich environment Information rich environment
SLIDE 12 What is What is telesurgery telesurgery? ?
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
SLIDE 13
Poor infrastructure
Mobile facilities
Low bandwidth solutions
Remote / Extreme Remote / Extreme
SLIDE 14 Operation Lindbergh Operation Lindbergh
Trans Atlantic – – dedicated dedicated com network com network
Surgical removal of gall bladder bladder
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 VPN + Zeus TS VPN + Zeus TS
Hamilton -
North Bay
Laparoscopic Nissen Nissen Fundoplications Fundoplications
SLIDE 15 Robotic Telesurgery Using Robotic Telesurgery Using da da Vinci Vinci ATA ATA -
Denver April 2005
First time ever First time ever daVinci daVinci used in to perform robotic telesurgery in inanimate experiments used in to perform robotic telesurgery in inanimate experiments. . Clinical trial (first time Clinical trial (first time daVinci daVinci used in telesurgery and first time telesurgery performed in used in telesurgery and first time telesurgery performed in 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.
SLIDE 16
NASA Extreme Environment NASA Extreme Environment Mission Operations Mission Operations
Great analog for space
SLIDE 17 NEEMO 9 NEEMO 9 Telepresence Telepresence Surgery Surgery -
Portable Robotic System Robotic System
Remote manipulation of M7 Robot from a site in M7 Robot from a site in Canada Canada
Dual use of systems
TATRC funded
SLIDE 18 NEEMO 12 NEEMO 12
- Evaluation of University of Washington
Evaluation of University of Washington’ ’s RAVEN robot s RAVEN robot
Evaluation of SRI SRI’ ’s s M7 enhanced robot M7 enhanced robot
- Autonomous task operation
Autonomous task operation – – ultrasound ultrasound
TATRC funded
- NASA, NOAA, Army, Navy, Air Force
NASA, NOAA, Army, Navy, Air Force – – academia and academia and industry industry
SLIDE 19 Mobile Robotic Mobile Robotic Telesurgery Telesurgery Systems Systems
University of Washington – – Army Army-
funded RAVEN – – Remote manipulation Nashville to Remote manipulation Nashville to Key Largo Key Largo – – SAGES FLS tasks SAGES FLS tasks
SRI – – M7 M7 – – Autonomous function of ultrasound Autonomous function of ultrasound and needle placement and needle placement
SLIDE 20 NEEMO 12 NEEMO 12
M7 M7 -
SRI First autonomous manipulation of First autonomous manipulation of an ultrasound an ultrasound – – needle insertion needle insertion RAVEN RAVEN – – Univ of Univ of Washington Washington
SLIDE 21
NEEMO 12 NEEMO 12
SLIDE 22
HAPsMRT HAPsMRT
SLIDE 23 Location Location – – Simi Valley, CA Simi Valley, CA -
Arid – – high high desert desert
SLIDE 24 Challenges Challenges
- Inoperable communication (Days 1
Inoperable communication (Days 1-
3)
Redesign in real-
time – – 802.11g 802.11g
SLIDE 25
SLIDE 26
Birds eye view! Birds eye view!
SLIDE 27 Surgery During Flight Surgery During Flight
NASA
TATRC funded
Evaluation of robotic surgical care in various surgical care in various gravity settings (0g, 1g, gravity settings (0g, 1g, Lunar) Lunar)
SLIDE 28 Challenges and Opportunities for Challenges and Opportunities for Telesurgery? Telesurgery?
Increase access
- Decrease time to definitive care
Decrease time to definitive care
Extension of care
Enabling education tools
- More efficient business models
More efficient business models
Licensure
- Robust and reliable networks
Robust and reliable networks
Quality of service
SLIDE 29 CLASSIFIED
Brian M. Barnes, Institute of Arctic Biology , University of Alaska Fairbanks 11/02
SLIDE 30
The Operating Room of the Future
SLIDE 31
The future of surgery The future of surgery
