ROBOTICS

for Biomedical Engineering

4. Medical Robotics I
University Carlos III of Madrid
Carlos Balaguer
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 Scope
1. Medical robotics I
– Surgical robotics
2. Medical robotics II
– Robotics medical
instrumentation
– Body exploratory robotics

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 Surgery evolution (I)

Past: Cut, then see

Present: See, then cut

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 Surgery evolution (II)

Future: Combine see and minimally cut

Surgical needs: Augment the surgeon’s capabilities with better

quantitative sensing, planning, execution, and integration

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 Robotic surgery classification
Depending on the degree of surgeon interaction
during the procedure, there are three modes:
• Shared-control surgery: The surgeon and the
robot works together, some operations are
performed in conventional way, others by robots
• Tele-surgery: The surgeon sits at a console and
does not operate on the patient directly, he/she
teleoperates the robotic system
• Supervisory-controlled surgery: The surgery
robot works autonomous and the surgeon only
supervised them
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 Tele-surgery concept

Haptic feedback: Transmit to surgeon the sensation of touch and

force and using it to control the robotic manipulators
Types of haptic feedback:
• Force (kinesthetic) feedback
• Tactile (cutaneous) feedback
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 Computer-Integrated Surgery (I)
 Computer-integrated surgery (CIS) system
integrates pre-operative, surgery and post-
operative proceses.
 Looking for real-time sinergy among sensing,
planning and intervention during whole
process.
 The robot itself is just one element of a larger
system designed to assist a surgeon in carrying
out a surgical procedure.

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 Computer-Integrated Surgery (II)

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 Computer-Integrated Surgery (III)
CIS orthopedical surgery

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 Minimally invasive surgery (I)
• Minimally invasive surgery
(MIS) permits smaller
incisions, shorter post-
operative time, reduced
infection, faster
rehabilitation, lesser pain,
better cosmetics, etc.
• Surgeon need a precise eye-
hand coordination by using
displays in the operation
room

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 Minimally invasive surgery (II)
• Laparoscopic Surgery:
type of MIS in the
abdominal cavity by using
laparoscopic instrument
and body expansion by
CO2
• Laparoscopy instrument:
Traditional laparoscope
instruments have 4 DOFs

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 Minimally invasive surgery (III)
Main problems:
• Difficult eye-hand
coordination
• Reduction in dexterity
• Reduction in motion
reversal due to fulcrum
at entry point
• Friction at air tight
trocar lead to reduction
in force feedback
• Lack of tactile sensing

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 Visual-guided surgery (I)
Objective:
• Accurate placement of
instruments with respect to
imaged anatomy
• Provide 3D vision of unseen
structures
• Improve precision of
biopsies, screw placements
• Creates surface model from
preoperational images
• Registration of images to
anatomy by direct contact
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 Visual-guided surgery (II)

Pedicle screw insertion

Laparoscopy instruments guidance

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 MIS Robots
AESOP, 1994
ZEUS, 2001
• Automatic Endoscopy System for
• It was cleared by the FDA for use
Optimal Positioning (one arm)
in surgeries in 2001
• Developed by Computer Motion and
• This robot consists of three arms,
funded by NASA
one of which uses AESOP
• First surgical robot approved by FDA
technology while the other two
• Endoscopic instruments controlled by
are used as the surgeon’s right
voice. This frees the surgeon two arms.
and left arms.

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 da-Vinci robot
da Vinci (Intuitive Surgical, Inc.):
• Initially developed by US
Department of Defense in 1991
• Intuitive Surgical acquired the
prototype and commercialized
the system
• Approved by FDA in July 2000
• More than 2.000 units sold world
wide
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da-Vinci robot: Representative uses
• Radical prostatectomy, pyeloplasty, cystectomy, nephrectomy,
ureteral reimplantation;
• Hysterectomy, myomectomy and sacrocolpopexy;
• Cholecystectomy, Nissen fundoplication, Heller myotomy, gastric
bypass, donor nephrectomy, adrenalectomy, splenectomy and
bowel resection;
• Internal artery a blood vessel mobilization and cardiac tissue
ablation;
• Mitral valve repair, endoscopic atrial septal defect closure;
• Transoral resection of tumors of the upper aerodigestive tract
(tonsil, tongue base, larynx), transaxillary thyroidectomy.

• Próstata, útero, vesícula biliar, corazón, recto, aparato digestivo,

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 da-Vinci robot: Architecture (I)
Robot

Surgeon
Patient

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 da-Vinci robot: Architecture (II)
• Robots arms: 2 or 3
instrument arms and 1
endoscope arm
• EndoWrist Instrument: 7
DOFs, quick-release levers
• Surgical Console: 3D display
and master control
• InSite Vision System: High
resolution 3D endoscope
and image processing
equipment
• Price: 1M€

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 da-Vinci robot: Arms
• The robot arms are working in
teleoperated or autonomous
modes
• It operates on a "Master-Slave"
relationship: the surgeon being
the "Master" and the arms
being the "Slave“
• It incorporates multiple,
redundant safety features
designed to minimize
opportunities for human error
when compared with traditional
approaches
• Tremor suppression and scaling
of surgeon movement
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 da-Vinci robot: Instruments
• The instruments are
designed with seven
degrees of motion - a range
of motion even greater than
the human wrist
• Each instrument has a
specific surgical mission
such as clamping, suturing
and tissue manipulation
• Quick-release levers speed
instrument changes during
surgery

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 da-Vinci robot: Surgeon console
• The surgeon operates seated
comfortably at a console
while viewing a high
definition, 3D image inside the
patient’s body.
• The surgeon's fingers grasp
the master controls below the
display with hands and wrists
naturally positioned relative to
his or her eyes.
• The system seamlessly
translates the surgeon's hand,
wrist and finger movements
into precise, real-time
movements of surgical
instruments.
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 da-Vinci robot: 3D Vision
• The vision system is equipped
with a high-definition, 3D
endoscope (flexible tube with a
camera and light at the tip)
• It is equipped with the image
processing equipment that
provides true-to-life images of
the patient’s anatomy
• A view of the operating field is
available to the entire OR team
on a large viewing monitor
(vision cart). This widescreen
view provides the surgical
assistant at the patient’s side
with a broader perspective and
visualization of the procedure

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 da-Vinci robot: Video

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 da-Vinci robot: Results

Five da Vinci entry points 5 days post operation

3 month after
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 Credits
Some picture and texts are from the Power Point
presentations of:
• “La Automática y la Robótica Aplicada a la
Medicina”, 2007, V. Muñoz (UMA)
• “Computer-Assisted Surgery Medical Robotics
and Medical Image Processing”, L. Joskowicz
(HU)
• Da-Vinci robot data, pictures and videos
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