Surgical robotic system is an advanced surgical tool that enables surgeons to perform precise operation with high-quality. It has been proved that some surgical robotic systems contribute to more precise and safer surgical operation in clinical environments. In this article, classification of the surgical robotic systems is proposed at first. Several technologies required for compact and high performance surgical robotic system are presented using examples of surgical robotics system for minimally invasive general abdominal surgery. They are miniaturized driving mechanism, multi-degrees of freedom bending forceps, integrated laser coagulation manipulator, and system integration. Finally, safety issues in surgical robotics design are discussed using an example of laparoscopic manipulator.
Minimally invasive surgery is being popularized in world-wide because of the smaller incision, earlier recovery, and shorter hospital stay. However, the technical difficulties were encountered in limited movement of the instruments and in confined operative field. Computer-enhanced procedures are highly expected to overcome those technical difficulties in conventional endoscopic surgery. I herein introduce our clinical experience in robotic surgery with both Zeus and da Vinci surgical systems. The messages are what we, surgeons would like to do and what is most to be realized in next generation.
Computer assisted surgery systems such as preoperative planner, surgical navigation, and surgical robot have been recently introduced in some orthopaedic field. To overcome the inaccuracy of hand-controlled positioning of surgical tools even under navigational guidance, three robotic systems have been developed. One type directs a cutting guide block or a drilling guide sleeve, with surgeons sliding a bone saw or a drill bit through the guide instrument to execute a surgical action. Another type constrains the range of movement of a surgical tool held by a robot arm such as ACROBOT. The last type is an active system, such as ROBODOC or CASPAR, which directs a milling device automatically according to preoperative planning. These CAS systems, their potential, and their limitations are reviewed here. Future technologies and future directions of CAS that will help provide improved patient outcomes in a cost-effective manner are also discussed.
Approaches to integration of medical image and spatial data for computer-assisted surgery are presented. We firstly describe preoperative image analysis for organ modeling, quantification, and surgical planning, then present intraoperative guidance using preoperative planning and intraoperative images such as ultrasonography and endoscopy. Finally, we discuss a framework of a 4D surgical database in which the preoperative, intraoperative, and postoperative data are stored directly from computer-assisted surgery systems.
This paper shows several methods for generating images that assist surgical operations. Especially, we show surgical applications of virtual endoscopy system that authors' group have developed. First, the basic concepts and technologies of virtual endoscopy system are explained. Second, the flexible endoscope navigation system, which navigates endoscopic examination or surgery using a flexible endoscope, is introduced. The system is implemented as fuse of real and virtual endoscopy. Third, virtual laparoscopic system is briefly explained. In the system, virtual lifting of abdominal wall is performed for simulating pneumoperitoneum based on elastic deformation of 3-D CT images. Virtual laparoscopic images for surgical assistance are generated from the deformed images. We also show a method for generating virtually stretched views of an organ based on image deformation. This method can generate the stretched views that are useful for understanding the status or location of lesion.
A medical system for 21st century should enable surgeons to reliably provide medical services of high and ubiquitous quality. This will be achieved by sharing all the information with team members, objective and appropriate decision making and work sharing by the team, and making good use of “visualized” treatment process based on the information management, simulation, and database by taking advantage of IT. This means that to achieve the goal while optimizing the strategy toward the goal (a road map) by monitoring real-timely the pre- and intraoperative surgical planning and the operating condition of surgical devices under the control of the surgical strategy system.
Recently, research on medical virtual reality and real-time imaging techniques for routine clinical procedures has been expanding. This paper will provide an introduction to the application of high dimensional medical imaging techniques for the realization of tele-surgery. The techniques we have been working on include a medical image analysis, a surgical navigation system, a robotic surgery system, a tele-virtual surgery simulation system as well as various applications. In addition, we will introduce the functions of the high-tech navigation operating room that has been constructed at The Jikei University 3rd Hospital in July 2003 in order to conduct the high-tech navigation surgery.
Surgery domain is considered to be most a domain to be argued with respect to medical safety. Especially Robot Surgery should be involved the technology error which originates in operation in addition to the conventional human error, it is complex and a possibility that the high risk of uncertainty will be puffed up is hidden. When performing mitigation of a risk, and examination of prevention, it is necessary to set the target of examination as the beginning. Furthermore, it becomes important the procedure of the target achievement. Robot Surgery also needs to clarify importance which the correlation between risk and risk. In addition, since the shortage of mastery by the side of the user who is one of the risk factors means the fall of the capability concerning curtailment of the risk factor which mechanical structure and IT function have, it is considered to be indispensable to development of a future Robot Surgery from the result of risk assessment to improve an educational training program and a guideline.
The integration of video management systems and tele-communication systems is desirable to manage all of the video images used at surgery and simultaneously share them with medical specialists at remote site. Common Object Request Broker Architecture (CORBA) allows integration of existing subsystem regardless of their hardware, operating system and programming language with minimum engineering overhead, and maximum flexibility and performance. In these clinical applications intdgrated system enabled surgeon to manage eight medical images and operate under image of 25 frame per second on his own selecting. The surgeon became able to communicate with a medical specialist and operate under precise instruction by directly writing on a shared image. In future, we will expand this integrated display system so that specialists can instruct from multiple sites.