Technologies 1...Telemedicina e eSaúde Telemedicine Technologies I 1 [d cc]Technologies 1...

Telemedicina e eSaúde

Telemedicine Technologies I 1

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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

TeleSaude 19/20 - Telemedicine and eHealth Technologies I - pbrandao

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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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https://www.softbankrobotics.com/emea/en/nao

http://www.technologyreview.com/view/521746/how-social-robotics-is-revolutionising-therapy-for-autistic-children/

http://www.project-inside.pt/



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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


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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http://projetromeo.com/



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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


8From Operation LindberghPress release

http://www.ncbi.nlm.nih.gov/pubmed/11923603?dopt=Abstract

http://www.ircad.fr/wp-content/uploads/2014/06/lindbergh_presse_en.pdf



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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

https://www.news18.com/news/india/gujarat-doctor-makes-history-performs-worlds-1st-robotic-heart-surgery-30-km-away-from-patient-1961729.html

https://www.youtube.com/watch?v=MasfoBzQ57g

https://www.medicaldesignandoutsourcing.com/robotic-telesurgery-future-corindus/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6067812/



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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”


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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https://www.cmas.ca/research/applied



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Gestonurse

• Retrieves and passes surgical instruments to surgeons

• Understands hand gestures and voice

• Tracks instruments in use


15From [GESTNURSE]

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Gestonurse (cont.)


16From [GESTNURSE]

Image from Juan Pablo Wachs @Univ. Purdue

http://web.ics.purdue.edu/~jpwachs/gestonurse/



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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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https://www.intuitive.com/en-us/products-and-services/da-vinci/systems/sp

https://www.intuitive.com/en-us/-/media/Project/Intuitive-surgical/files/pdf/1025290ra-isi-brochure-single-site-digital-low-res-394110.pdf?la=en&hash=F24EC0B5DB9C62BDD688F77409A3CA50

https://www.youtube.com/watch?v=nAYYnRCXX_k



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• Preceyes

o Improving precision from 100-150 μm to 1-10 μm


19Robot Eye operation

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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


24Using exoskeletons and BMI

Photo: University of Tübingen

From the IEEE Spectrum newsand [EEG/EOG-BMI]

http://www.technologyreview.com/news/508641/patient-shows-new-dexterity-with-a-mind-controlled-robot-arm/

http://www.youtube.com/watch?v=ogBX18maUiM

http://thedaily.case.edu/man-quadriplegia-employs-injury-bridging-technologies-move-just-thinking/

http://spectrum.ieee.org/the-human-os/biomedical/bionics/controlling-a-hand-exoskeleton-with-your-mind



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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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https://www.medgadget.com/2017/11/amputees-move-robotic-arms-by-power-of-thought.html

https://www.nature.com/articles/s41467-017-01909-2

https://www.bbc.com/news/health-49907356



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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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https://web.archive.org/web/20180531165820/http:/www.safros.eu:80/safros/results/

https://cordis.europa.eu/project/id/248960/results



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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


31From [COOPROB]

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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http://www.websurg.com/

http://www.noscar.org/

http://www.nesacademy.org/



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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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http://www.sciencealert.com/new-device-can-immediately-target-and-destroy-deadly-blot-clots?perpetual=yes&limitstart=1

http://onlinelibrary.wiley.com/doi/10.1002/adma.201502243/full

http://www.medgadget.com/2015/09/engineered-smart-particles-drug-delivery.html

http://www.pnas.org/content/early/2015/09/15/1510533112.abstract

http://www.medgadget.com/2015/09/drug-loaded-nanoparticles-mimic-platelets-avoid-immune-system-reach-disease-targets.html

http://www.nature.com/nature/journal/v526/n7571/full/nature15373.html

https://medgadget.staging.wpengine.com/2017/11/guided-microrobots-made-of-algae-and-magnetic-particles.html

http://robotics.sciencemag.org/content/2/12/eaaq1155

https://www.medgadget.com/2017/12/tiny-wireless-neurostimulator-small-enough-injections.html

https://www.frontiersin.org/articles/10.3389/fnins.2017.00659/full



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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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http://spectrum.ieee.org/automaton/robotics/medical-robots/robot-controls-human-arm

http://robotics.sciencemag.org/content/1/1/eaag3296



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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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http://www.nanorobotinvention.com/nanorobot-asic.pdf

http://www.med.nyu.edu/robotic-surgery/

http://www.med.nyu.edu/robotic-surgery/video-library

https://doi.org/10.1002/rcs.39

http://dx.doi.org/10.1016/S0741-5214(96)70272-0

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