Army-Funded Small-Cap May Offer Complement to da Vinci

Army-Funded Small-Cap May Offer Complement to da Vinci

By John J. Otrompke, JD

An experimental device intended for remote surgery and partially funded by the U.S. military may be a more light-weight and useful complement to the da Vinci in battlefield or disaster situations, according to a researcher at the University of Washington in Washington state.

The experimental device, called The Raven, has its genesis in an experimental process which analyzed the physical underpinnings of surgical technique, by surgeon or device, and which could offer insights into even the da Vinci’s performance.

“Our lab had been working on different robotic applications performing scientific analyses of surgery by looking at the forces and torques exerted during surgery with another device we designed called the Blue Dragon,” said Mitchell Lum, a PhD candidate in electrical engineering at the University of Washington College of Engineering, who also worked on the experiments.

“The Blue Dragon would track a surgeon’s motions as we had 30 surgeons go through a number of different tasks, such as suturing, measuring out a set length of bowel, moving from left to right and then from right to left, grasping or grasping and pulling or grasping and sweeping,” he said. “Then we were able to quantitatively assess the skill level of the surgeon when compared to an expert. We could tell if they were an expert, and we could make a good guess whether they were a complete novice, a first-year resident, or a fifth-year surgical resident,” Lum continued.

The Blue Dragon had other uses as well, Lum said.

“You can think of it like a flight data recorder. “If there was some kind of problem during surgery, you could recall what happened during the surgery based on the robot’s motions, whether was there a spike in pressure, or torque on one of the joints, or if something went wrong in the controls,” he said.

Based on their research, the institution started working in 2002 on what’s now called The Raven Surgical Robot, funded with approximately $1 million by the US Army Medical Research and Materiel Command. “Our robot is comprised of 3 basic parts- the patient site, where the Raven manipulators are, then there’s surgeon site, and then the connection. We did an experiment in last year in Fimi Valley, California where a surgeon was in tent simulating a test flying field, and the patient site was in a second tent and connected the two with a wireless network that would simulate an unmanned aircraft.

In comparison to the da Vinci, the Raven is more mobile, said Lum. “That operation would take
1 ½ Da Vincis to perform: a complete da Vinci where the patient is, and another where the surgeon would be located. In using a da Vinci, the manipulator sits on a what looks like a palette jack, then they get the patient in the operating room, and then roll the robot over the patient. There’s a command console where the surgeon sits in the same room as the patient.”

To be fair, however, in comparisons between the two devices, the da Vinci has performed much faster than the simpler Raven, Lum added.

“A surgeon from Seattle Childrens’ Hospital performed the same procedures, such as block tying and intracorporeal knot-tying with the two devices, and the da Vinci was much faster,” he said.

For more information, see brl.ee.washington.edu

Small Companies May Add to Da Vinci’s Efficacy

Small Companies May Add to Da Vinci’s Efficacy

By John J. Otrompke, JD July 19, 2007


A prominent medical robotics researcher in the Midwest has discovered a manner in which miniature, developmental surgical robotics can contribute to the use of the Da Vinci surgical robot, according to an oral presentation at this year’s meeting of the Minimally Invasive Robotics Association (MIRA) in New York in January.

“Recently we performed a Da Vinci procedure on an animal, and we put the device in for an extra pair of eyes. Its harder to do with the Da Vinci, because its hard to move around,” said Dmitry Oleynikov, MD, assistant professor of surgery and director of minimally invasive and robotic surgery at the University of Nebraska.

Olehnikov said his experiment showed that his miniature robot provided an added benefit in concert with the Da Vinci.

“Our device allows a surgeon to place a remote device inside the body cavity and to be able to drive on the inside, and see on the inside, as well as to manipulate and actually perform surgery on the inside, all without having giant gears or things reaching from the outside,” said Oleynikov, who has been working on his device for about three years.

“You can put it through a belly button incision or through a natural orifice opening. Imagine if you want to remove a gall bladder; you can use an endoscope, and go through the stomach. But you can always get one endoscope through, and can have many little robots with separate tasks. They can act as eyes and little assistants. Then you can use the endoscope to cut or remove the debris through the stomach,” said Oleynikov, who added that the smallest version of his robot is about 1 ½ inches long, ten millimeters wide, or about the size of a lipstick case.

“The stomach has very few pain fibers, and as a result, patients don’t feel any pain when they wake up. This phenomenon has been investigated by other physicians using the endoscope alone, but the problem is that the endoscope is only one tool, and it is hard to get more than one endoscope in,’ he said.

“But the robots are not necessarily connected to the endoscope. They can be operated by remote control as well as well a little skinny wire tether, which operates them, and give them a little energy supply,” said Oleynikov.

Smaller models may add to the Da Vinci’s core competencies, as the device is not ideally suited for natural orifice surgery, but is better suited for laparoscopic surgery, he said.

The robot is a collaborative effort of the University of Nebraska Medical Center and the University of Nebraska - Lincoln. The faculty leaders of the project are Dr. Oleynikov and Dr. Shane Farritor, Associate Professor of Mechanical Engineering from the University.

For the next year, Oleynikov and colleagues are planning a new generation of robots for natural orifice applications. Reports will be presented at the next MIRA meeting.

www.unmc.edu/dept/mis

Robotic Surgery is Big Now: Chief of Robotics is a Whole New Title

Robotic Surgery is Big Now:

Chief of Robotics is a Whole New Title

by John Otrompke, JD July 19, 2007


Another bell has rung in the medical robotics revolution, as another high-reputation medical institution, Mt. Sinai has appointed a chief of medical robotics.

David B. Samadi, M.D, was appointed chief of Chief of the Division of Robotics and Minimally Invasive Surgery in the Department of Urology at the Mount Sinai Medical Center in New York.

“I have the highest volume of these cases on the East coast. In the past two-and-a-half months, I have performed 115 robotic laparoscopic prostatectomies,” said Samadi, who was formerly Director of Robotic Laparoscopic Surgery at Columbia Presbyterian Hospital.

Samadi said the future of medical robotics lies in realizing that a properly trained surgeon carries three competencies: open, laparoscopic, and robotic surgery.

“In prostate surgery, you can’t be just a technician, without knowing how to save the nerves that lead to sexual function, and develop earlier recovery of continence. And all that knowle3dge comes from open surgery,” said Samadi.

“The robot is like a bridge between the two fields,” he continued.

Along with colleagues, Samadi performed the first 11 robotic surgeries ever performed in France in 2001, with the former robot, the Aesop, and the Da Vinci, at Henri Mondor Hospital, under the mentorship of Professor Claude Abbou.

All told, Samadi has performed over 1000 of these cases, including about 100 with the new robotic Da Vinci.

Samadi has also been pioneering new procedures with the Da Vinci, including robotic surgery for invasive bladder cancer. “Now we’re moving to complete bladder surgery,” he said. “We create a new bladder using a segment of the small intestine. The removal of the bladder and prostate in done with the robot, and the creation of the new bladder is done through a small 3 inch incision,” he said.

“I’ve done now close to fifteen of these surgeries, and there are another 7 or 8 on schedule. I’m hoping in the next few months to advance our skills to do kidney cancer and renal cell carcinoma,” said Samadi.

Samadi said the Da Vinci has improved outcomes, even in the hands of an experienced surgeon like himself. “Because of the magnification camera has and the three-dimensional view robot has, and the lack of blood, if you’re a good open surgeon, and you’re trained to know where nerves are, 99% of patients are being discharged within 24 hours after surgery,” he said.