Computer Navigation, Planning, and Robots in Otolaryngology

Transcription

1 Computer Navigation, Planning, and Robots in Otolaryngology Jeremy D. Richmon, MD Associate Professor Department of Otolaryngology - Head and Neck Surgery Division of Head and Neck Surgery Head and Neck Oncology Microvascular Reconstruction Robotic Surgery December 4,

2 Disclosures Intuitive Surgical, Inc previous consultant January 13,

3 Otolaryngology Head and Neck Surgery Deals with the medical and surgical treatment of ailments of the head and neck, including: Nose, Sinus, anterior skull base Larynx (speech/swallowing) Head and neck cancer Otology/neurotology (ear, lateral skull base) Allergy Facial Plastic Surgery Thyroid/Parathyroid Pediatric Oto January 13,

4 Head and Neck Surgeon Lumps and bumps in head and neck Neoplastic Congenital Infectious Vascular Traumatic Airway and swallowing problems Reconstruction January 13,

5 Head and Neck Surgery January 13,

6 Congenital January 13,

7 Infectious January 13,

8 Vascular January 13,

9 January 13,

10 Traumatic January 13,

11 January 13,

12 Neoplastic January 13,

13 January 13,

14 January 13,

15 January 13,

16 January 13,

17 OHNS Technology Driven Field Over past 30 years Endoscopy image-guidance Fiberoptic lasers Radiofrequency Microscopic instrumentation Plates/screws Imaging techniques (CT, MR, PET) January 13,

18 Thyroid Surgery January 13,

19 January 13,

20 Parotid Surgery January 13,

21 January 13,

22 January 13,

23 January 13,

24 January 13,

25 Sinus/skull base surgery January 13,

26 January 13,

27 January 13,

28 January 13,

29 January 13,

30 January 13,

31 January 13,

32 January 13,

33 January 13,

34 January 13,

35 January 13,

36 January 13,

37 January 13,

38

39

40

41

42 History In 1985 a robot, the PUMA 560 (Programmable Universal Machine for Assembly), was used to place a needle for a brain biopsy using CT guidance. In 1988, the PROBOT, developed at Imperial College London, was used to perform prostate surgery. The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement. January 13,

43 Robot vs Surgeon Limit to human perception and dexterity Technology with a higher degree of accuracy than humans allows for continued progress and surgical success. January 13,

44 AESOP The first robotic applications to gain clinical acceptance was Automated Endoscopic System for Optimal Positioning (AESOP), a robotic arm for endoscopic camera control. AESOP was coupled with the Hermes voiceactivation system to allow endoscope control by voice command. Food and Drug Administration (FDA) approval in January 13,

45 Zeus Used 3 modified AESOP arms Initial testing at JHU 1996 Master-slave robot versus Active robot January 13,

46 January 13,

47 NASA, Stanford, Military, Civilian licence -> Intuitive, Inc. In 1997 a prototype of the DaVinci was used to perform a lap chole In 2000 the DaVinci was FDA approved for laparoscopic abd surgery January 13,

48 January 13,

49 January 13,

50 DaVinci FDA approved for use in urological surgical procedures, general laparoscopic surgical procedures, gynecologic laparoscopic surgical procedures, transoral otolaryngology surgical procedures restricted to benign and malignant tumors classified as T1 and T2, general thoracoscopic surgical procedures, and thoracoscopically assisted cardiotomy procedures. January 13,

51 January 13,

52 January 13,

53 January 13,

54 January 13,

55 January 13,

56 January 13,

57 January 13,

58 Transaxillary Robotic Thyroidectomy January 13,

59 January 13,

60 January 13,

61 Transoral robotic-assisted thyroidectomy: A preclinical feasibility study in 2 cadavers. Richmon JD, Pattani KM, Benhidjeb T, Tufano RP. Head Neck Jul 13. January 13,

62 January 13,

63 Drawbacks Cost Equipment/Space Learning curve Training and credentialing Lack of access (patients and anatomy) No tactile feedback (yet) January 13,

64 Larynx Ear - Micro Steady Hand Tremor-free Scaled movements Force sensor Movement limits January 13,

65 Challenge January 13,

66 January 13,

67 January 13,

68 Limitations One-handed surgery Line-of-site limitations Rigid scope not paired with vision Cumbersome Narrow field of view January 13,

69 Robo-ELF scope January 13,

70 January 13,

71 January 13,