Post on 11-Aug-2021
Telemedicina e eSaúde
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Technologies 1Telemedicina e e-Saúde
2019/20
Pedro Brandão
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References
• Sources are indicated by [RefSource] where the complete citation will be at the end
• Insite citations will be From: CitationSource
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RoboticsTele surgery
Technologies
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Robot example NAO
• From Aldebarran/SoftBankRobotics groupo NAO
• Some medical goals [MSHB]so Elders companion/helpers
o Children education “in San Raffaele Hospital [...] NAOs are used to train diabetic children to take the insulin
injections”
o “How Social Robotics is Revolutionising Therapy for Autistic Children”, tech review Nov 2013
o Project CMU-PT INSIDE - Intelligent Networked Robot Systems for Symbiotic Interaction with Children with Impaired Development, started 2014
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• “Romeo is a humanoid robot from Aldebaran Robotics which is intended to be a genuine personal assistant and companion.”
• Project addresses:o Physical system
o Dependability
o Multisensory
o Cognitive interaction
o Physical interaction
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5Romeo – projectromeo.com
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History – Telesurgery
• Experimental Telesurgery 1990 by Satava, Green, and Bowersox[VTFE]o Prototype experiment on bovine and swine
o Comparison to regular surgery
192 ± 24 sec conventional
483 ± 118 sec telepresence surgery
Same precision results
From [ROBSUR]
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History – Telesurgery
• Clinical Demonstration in 2001 by Jacques Marescaux
o telerobotic cholecystectomy on a patient in Strasbourg
o Controlled from New York City
o Distance: 4000 km
o Partnered with Computer Motion and
France Telecom
From [ROBSUR]
From Marescaux et al’s Article
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Operation Lindbergh
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Recent tele-surgery developments
• Dr. Teja Patel operates heart for blocked artery, using tele-robotic surgery from Gujarat to Gandhinagar in India (32 km distance) (news, video)
• Does robotic telesurgery have a future? March 26, 2018 By Fink Densford
• Choi PJ, Oskouian RJ, Tubbs RS. Telesurgery: Past, Present, and Future. Cureus. 2018;10(5):e2716. Published 2018 May 31. doi:10.7759/cureus.2716
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History (cont.)
• 1994 Computer Motion, Inc. produced Aesop 2000
o Automated Endoscopic System for Optimal Positioning
o surgical robot, laparoscopic camera
o Next was Zeus tele-operated Robotic System
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AESOPComputer Motion
ZeusComputer Motion
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History (cont.)
• Davinci System from Intuitive Surgical*
o Instruments are swapped by nurses
o Head control
o 3D display
o Small incisions
o High precision
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From Intuitive Surgical(1999)
*Merged with Computer Motion in 2000
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Davinci SystemFrom Intuitive Surgical
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History (cont.)
• “February 2003 Dr. Anvari performed the world’s first hospital-to-hospital telerobotic surgery over a telecommunications network”o Done on a routine basis, but experimental Marescaux was in 2001
• Centre for Minimal Access Surgery (CMAS), from McMaster University, Canadao “telementoring and telerobotics for the provision of training and clinical
services within remote areas of Canada”
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13From CMAS
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History (cont.)
• 2005 Penelope robotic scrub technician
o responsible for dispensing and retrieving surgical instruments.
o Voice commands
o By Robotic Surgical
From [ROBSUR]
Source: Columbia Surgery
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Gestonurse
• Retrieves and passes surgical instruments to surgeons
• Understands hand gestures and voice
• Tracks instruments in use
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Gestonurse (cont.)
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Image from Juan Pablo Wachs @Univ. Purdue
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Prototypes – SILS in robot
• Single Incision Laparoscopic Surgery
• One small tube one incision
Robotic prototype from Intuitive Surgical
SILS Port from CovidienFor “regular” laparoscopy
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See the Davinci Single Port and Davinci Single Site
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Stiff-Flop
• “We will create a soft robotic arm that can squeeze through a standard 12mm diameter Trocar-port, reconfigure itself and stiffen by hydrostatic actuation to perform compliant force control tasks while facing unexpected situations.”
• See video for some results
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• Preceyes
o Improving precision from 100-150 μm to 1-10 μm
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CyberKnife System
• Non invasive x-radiation cancer treatment
• Uses a linear accelerator
• Automatic real time image-guidance No patient restrain
Minimizes damage to healthy tissues
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From [STRS]
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More consultation
RP-7 robot
• “enables the physician to be remotely present”
• Direct connection to Class II medical devices (electronic stethoscopes, otoscopes and ultrasound)
• FDA approved
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©Intouch Health
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“When this robot needs a hand, it borrows yours” [IEESpectrum]
• “a French research team has demonstrated how a robot can control both its own arm and a person’s arm to manipulate objects in a collaborative manner”
• The work is from from Laboratoire d’informatique de robotiqueet de microélectronique de Montpelier
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More interesting is the other way around
• Controlling a robot arm with thoughto Implants in the motor cortexo 1st a cursoro Then an arm
1st 2 chips (4mmx4mm) with 96 electrodes Double the nr of chips
• Videoo 1st prototype
• Advances using direct stimulation inthe arm:o “Man with quadriplegia employs injury
bridging technologies to move again—justby thinking”
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• Using EEG and EOG simple command of daily activities
• Regular (noisy and distracting) environment
• Use eye movement to improve detection
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24Using exoskeletons and BMI
Photo: University of Tübingen
From the IEEE Spectrum newsand [EEG/EOG-BMI]
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Studies on the brain adaptation
• Brain after using BMI (Brain Machine Interface) adapts so to be able to control the “machine”o MedGadget News, Nov 2017
o Nature article: Balasubramanian, Karthikeyan, etal, Changes in cortical network connectivity with long-term brain-machine interface exposure after chronic amputation, Nature Communications, Nov 2017
• Paralysed man moves in mind-reading exoskeleton, BCC James Gallagher Health, 4 October 2019
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Robot capabilities
• Manipulation
• Movement
• Vision
• Everything is informationo Can be assessed
o Can be commandeered
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Usages – Operations
• Cardiac surgery
o arterial anastomoses of Coronary Artery Bypass Grafting (CABG);
o mitral valve replacement ;
o atrial septal defect;
• Urology
o radical prostatectomy
o laparoscopic nephrectomy
o Pyeloplasty
o laparoscopic cholecystectomy
• Gynaecology
o Hysterectomy
o fallopian tube (re)anastomosis
From [ROBSUR,TEUS]
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Usages - Education
• Medical conferences:
o live video session of a robotic procedure
• Save movements and use them as feedback for students;
• Pre-operative testingo Use a virtual patient to test/practice an operation procedure
From [ROBSUR]
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Advantages
• Higher precision, dexterity
o Tremor reduction
• Couple several instruments (camera included)o Control
o (possibly) In a single incision
• Small incisions (pencil diameter)
• Smaller learning curve
• Ergonomic position
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Robotic Safety
• SAFROS project with participation from WHO address this issue
• Defined a framework for assessing the risks prior to and develop local solution to counter-act.
• See resultso Also publications at CORDIS
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Others
• Videos on Surgery (education, operations, reports), WebSurg
• NOTES: Natural Orifice Translumenal Endoscopic Surgeryo Feasibility has been studied in animals
o Surgeries already performed in Humans (see NOSCAR, NESA)
• Cooperative Robotso More than one robot to
help on the procedure
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Davinci and lighting/imaging robot(from [COOPROB])
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Nanorobots
• Nano is 10-9
• Targeted drug delivery
• Target blood vessels
• Cell/DNA repairs
• Attack/Destroy specific cells
• Diagnostics
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Nanorobot example
• Chemical Sensors
• Power supply
• Actuators
• Data transmission
From [NBA]
Image from [NBA]
Nanorobot for brain aneurismComputer simulation
Robot dimensions2 µm in length0.5 µm in diameter
6 µm diameter red blood cell1012 nanorobots in the 5l blood vol.
Total of 0.2g
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Nanorobots
• Projects studying the magnetic controlled movement of these robotso No medical studies yet
From [ArtBact1]
From [ArtBact2]
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Evading the Immune System
• “New device can immediately target and destroy deadly blood clots”, by ScienceAlert, paper from Wiley
• “Engineered Virus-Like Particles for Drug Delivery”, by MedGadget, PNAS article
• “Drug Loaded Nanoparticles Mimic Platelets to Avoid Immune System and Reach Disease Targets”, by MedGadget, Nature Paper
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Others
• Guided Microrobots Made of Algae and Magnetic Particles, by MedGadget, paper in Science Robotics.
o “size of a red blood cell”, flow in gastric fluid or blood
o Direct with MRI
• Tiny Wireless Neurostimulator Small Enough for Injections, by MedGadget, paper in Frontiers in Neuroscience.o “less than a cubic millimeter in size”
o Treat Parkinson’s tremors
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End ofTelemedicine tech -
Robots
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Referências – Robots – I • [ArtBact1] Zhang L, Abbott JJ, Dong L, Kratochvil BE, Bell D, Nelson BJ: Artificial bacterial flagella:
fabrication and magnetic control. Appl. Physics Lett.94(064107),1–3 (2009).
• [ArtBact2] Ghosh A, Fischer P: Controlled propulsion of artificial magnetic nanostructured propellers. Nano Lett.9(6),2243–2245 (2009).
• [COOPROB] Lehman A, Berg K, Dumpert J, et al. “Surgery with cooperative robots. Computer Aided Surgery” Official Journal Of The International Society For Computer Aided Surgery, March 2008;13(2).
• [IEEESPECTRUM] Watch This Robot Control a Person's Arm Using Electrodes, Erico Guizzo, Nov 2011
• [EEG/EOG-BMI] S. R. Soekadar, M. Witkowski, C. Gómez, E. Opisso, J. Medina, M. Cortese, M. Cempini, M. C. Carrozza, L. G. Cohen, N. Birbaumer, N. Vitiello, "Hybrid EEG/EOG-based brain/neural hand exoskeleton restores fully independent daily living activities after quadriplegia", Science Robotics06 Dec 2016
• [GestoNurse] Mithun George Jacob, Yu-Ting Li, Juan P. Wachs "Gestonurse: A Multimodal Robotic Scrub Nurse",, 7th ACM/IEEE International Conference on Human-Robot Interaction (HRI), March 5-8, 2012
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Referências – Robots – II • [NBA] Adriano Cavalcanti, Bijan Shirinzadeh, Toshio Fukuda, Seiichi Ikeda, “Nanorobot for Brain
Aneurysm”, IJRR International Journal of Robotics Research, Special Issue, Sage, Vol. 28, no. 4, pp. 558-570, April 2009.
• [ROBSUR] Richard M. Satava, “Robotics in Colorectal Surgery: Telemonitoring and Telerobotics”, Surgery Clinic N Am 86 (2006)
• [RSB] New York University, Robotic Surgery Centre,o Videos of surgeries available
• [STRS] Coste‐Manière È, Olender D, Kilby W, Schulz R. “Robotic whole body stereotactic radiosurgery: clinical advantages of the Cyberknife® integrated system”. International Journal of Medical Robotics and Computer Assisted Surgery, January 2005;1(2):28-39.
• [TEUS] Pamela Whitten and Beverly Sypher, “Evolution of Telemedicine from an Applied Communication Perspective in the United States”, Telemedicine and e-Health Vol 12, N 5, 2006
• [VTFE] Jon C. Bowersox, Ajit Shah, et al, “Vascular applications of telepresence surgery: Initial feasibility studies in swine”, Presented at the Forty-ninth Annual Meeting of the Society for Vascular Surgery 1996
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Acronyms
• CABG – Coronary Artery Bypass Grafting
• CT – Computed Tomography
• EEG – Electro EncephaloGraphy
• EOG – Electro OculoGraphy
• FDA – Food and Drug Administration
• MRI – Magnetic Resonance Imaging
• PET – Positron Emission Tomography
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