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, 2012 1
Disclosures • Intuitive Surgical, Inc – previous consultant January 13, 2011 2
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, 2011 3
Head and Neck Surgeon • Lumps and bumps in head and neck – Neoplastic – Congenital – Infectious – Vascular – Traumatic • Airway and swallowing problems • Reconstruction January 13, 2011 4
Head and Neck Surgery January 13, 2011 5
Congenital January 13, 2011 6
Infectious January 13, 2011 7
Vascular January 13, 2011 8
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Traumatic January 13, 2011 10
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Neoplastic January 13, 2011 12
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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, 2011 17
Thyroid Surgery January 13, 2011 18
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Parotid Surgery January 13, 2011 20
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Sinus/skull base surgery January 13, 2011 25
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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, 2011 42
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, 2011 43
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 voice- activation system to allow endoscope control by voice command. • Food and Drug Administration (FDA) approval in 1993. January 13, 2011 44
Zeus Used 3 modified AESOP arms Initial testing at JHU 1996 Master-slave robot versus Active robot January 13, 2011 45
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• 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, 2011 47
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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, 2011 50
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Transaxillary Robotic Thyroidectomy January 13, 2011 58
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Transoral robotic-assisted thyroidectomy: A preclinical feasibility study in 2 cadavers. Richmon JD, Pattani KM, Benhidjeb T, Tufano RP. Head Neck. 2010 Jul 13. January 13, 2011 61
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Drawbacks • Cost • Equipment/Space • Learning curve • Training and credentialing • Lack of access (patients and anatomy) • No tactile feedback (yet) January 13, 2011 63
Larynx – Ear - Micro • Steady Hand – Tremor-free – Scaled movements – Force sensor – Movement limits January 13, 2011 64
Challenge January 13, 2011 65
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Limitations • One-handed surgery • Line-of-site limitations • Rigid scope not paired with vision • Cumbersome • Narrow field of view January 13, 2011 68
Robo-ELF scope January 13, 2011 69
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