3. “Telesurgery, also called remote surgery, is performed by a surgeon at a site removed from the patient. Surgical tasks are directly performed by a robotic system controlled by the surgeon at the remote site.” The word "telesurgery" is derived from the Greek words tele , meaning ‘far off’ and cheirourgia meaning ‘working by hand’. centralizing of healthcare expertise the increasing use and accuracy of electro-mechanical and imaging aids in healthcare the desire to provide healthcare in a hostile or inaccessible area cost savings are possible e.g. inexpensive compared to flying doctors frees the surgeon from the operating room, protects the surgeon from the radiation of X ray or radical medicine, Telesurgery [1]
4. Training new surgeons Assisting and training surgeons in developing countries Treating injured soldiers on or near the battlefield Performing surgical procedures in space Collaborating and mentoring during surgery by surgeons around the globe Applications
5. Robotic surgery is a method for performing minimally invasive surgery by computer aid The master – slave architecture of surgical robots leads to a possibility of long distance operation Robotic Surgery [9]
6. The surgery was performed from a building in Manhattan by Dr. Marescaux and his assistant Dr. Gagner were in New York. The patient being in Strasbourg, France. Consisted of a removal of the gall bladder using a minimally-invasive procedure The first trial simulations of telesurgery took place with a transmission delay of about 200 milliseconds, Subsequent work reduced the time delay to 150 milliseconds. Lindebergh Operation 1988: Minimally-invasive surgery enables surgical procedures to be guided by introducing a camera without requiring opening of the abdomen or thorax. 1996: Computer-assisted surgery. This type of surgery involves inserting a computer interface between the surgeon and the patient, enabling an analysis of the surgeon's actions. Artificial intelligence enhances the safety of operating actions and makes them more precise September 7, 2001: Telesurgery
8. Network Network requirements for telesurgery reliability an acceptable end-to-end delay the ability to transfer data from sources with widely differing data rates a low data error rate (BER-bit error rate). Network options available Local area computer Networks FDDI(Fiber distributed data interface) ISDN(Integrated services Digital Network) 3G/4G networks [5],[6]
9. Da Vinci Surgical System by Intuitive Surgical, leading company in the field of digital surgery(>210 devices) Approved in July 2000 to perform advanced surgical techniques by FDA The surgeon operates while seated comfortably at a console viewing a 3-D image of the surgical field. The surgeon's fingers grasp the master controls below the display. Provides either three or four robotic arms, two or three instrument arms and one endoscope arm, that execute the surgeon's commands. The Vision System, with high-resolution 3-D endoscope and image processing equipment, 3-D images of the operative field Davinci surgical system [2]
11. Master(doctor) side Cybergloves SEMG control of robotic Arm Slave(Patient) Side Haptic Feedback Sensors in Telesurgery [4],[7],[8]
12. The glove has 18 sensors placed at critical points to measure the posture of the hand The sensors are long, thin strips sewn into the glove fabric that measure the change in resistance to an electric current as the sensor is bent. Cybergloves [4]
13. SEMG control robotic arm Surface electromyography (SEMG) is a useful technique for recording non-invasively the electrical activity of the muscles. This technique has been widely used as a diagnostic technique of the neuromuscular System as well as control signal for robotic prosthesis [2]. Degree 1: Biceps and triceps, which control the up and down movement in the elbow of the robotic arm. Degree 2: Flexor carpiulnaris and flexor igitorumsuperficialis which control the closing and opening of the gripper. The SEMG signals received by the demodulator are conditioned and fed through an H bridge to control the DC motors of the robotic arm [8]
14. The robotic systems currently available have visual feedback only Integrating haptic feedback like force, acceleration and velocity feedback can Haptic Feedback [7]
15. Telesurgery system with haptic feedback When the slave forceps grips an object, the force with which the slave forceps grips the object is detected by the change or increase in the electric current of the motor that controls the opening and closing of the slave forceps This electrical current value is then used as a feedback factor to generate the reaction force of the master forceps against the movement to close it. In the master forceps system, the power to resist the movement to close the forceps is generated by driving its motor-and-wire system using the feedback factor [7]
16. [1] http://www.surgeryencyclopedia.com/St-Wr/Telesurgery.html [2] http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04/davinci.html [3] http://www.intuitivesurgical.com/products/davinci_si_surgicalsystem/index.aspx [4] http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.50.8188&rep=rep1&type=pdf [5] M. Smithwick, "Network options for wide-area telesurgery," Engineering Science and Education Journal, vol. 5, pp. 120-128, 1996. [6] M. Smithwick, "Network options for telesurgery," in Towards Telesurgery, IEE Colloquium on, 1995, pp. 3/1-322. [7] A. Matsui, K. Mabuchi, T. Suzuki, A. Namiki, M. Ishikawa, H. Fujioka and H. Ishigaki, "Development of a remotely-operated master-slave manipulation system with a force-feedback function for use in endoscopic surgery," in Engineering in Medicine and Biology Society, 2000. Proceedings of the 22nd Annual International Conference of the IEEE, 2000, pp. 1260-1263 vol.2. [8] J. E. G. Villarruel and B. T. Corona, "Proposal for a remote surgery system based on wireless communications, electromyography and robotics," in Electronics, Robotics and Automotive Mechanics Conference, 2008. CERMA '08, 2008, pp. 93-98. [9] R. H. Taylor, "A Perspective on Medical Robotics," Proceedings of the IEEE, vol. 94, pp. 1652-1664, 2006. References
