Mentoring console improves collaboration and teaching in surgical robotics.

BACKGROUND: One of the most significant limitations of surgical robots has been their inability to allow multiple surgeons and surgeons-in-training to engage in collaborative control of robotic surgical instruments. We report the initial experience with a novel two-headed da Vinci surgical robot that has two collaborative modes: the "swap" mode allows two surgeons to simultaneously operate and actively swap control of the robot's four arms, and the "nudge" mode allows them to share control of two of the robot's arms. MATERIALS AND METHODS: The utility of the mentoring console operating in its two collaborative modes was evaluated through a combination of dry laboratory exercises and animal laboratory surgery. The results from surgeon-resident collaborative performance of complex three-handed surgical tasks were compared to results from single-surgeon and single-resident performance. Statistical significance was determined using Student's t-test. RESULTS: Collaborative surgeon-resident swap control reduced the time to completion of complex three-handed surgical tasks by 25% compared to single-surgeon operation of a four-armed da Vinci (P < 0.01) and by 34% compared to single-resident operation (P < 0.001). While swap mode was found to be most helpful during parts of surgical procedures that require multiple hands (such as isolation and division of vessels), nudge mode was particularly useful for guiding a resident's hands during crucially precise steps of an operation (such as proper placement of stitches). CONCLUSION: The da Vinci mentoring console greatly facilitates surgeon collaboration during robotic surgery and improves the performance of complex surgical tasks. The mentoring console has the potential to improve resident participation in surgical robotics cases, enhance resident education in surgical training programs engaged in surgical robotics, and improve patient safety during robotic surgery.

Cardio navigation: planning, simulation, and augmented reality in robotic assisted endoscopic bypass grafting.

BACKGROUND: The aim of this study is to optimize the set-up and port placement in robotic surgery and enhance intraoperative orientation by video overlay of the angiographic coronary tree. METHODS: In three mongrel dogs and two sheep an electrocardiogram-triggered computed tomographic scan and coronary angiography were performed after placing cutaneous fiducials. The regions of interest (ie, heart, ribs, coronaries, internal thoracic artery) were segmented semiautomatically to create a virtual model of the animal. In this model the target regions of the total endoscopic bypass procedure along the internal thoracic artery and anastomotic area were defined. Algorithms for weighing visibility, dexterity, and collision avoidance were calculated after defining nonadmissible areas using a virtual model of the manipulator. Intraoperatively, registration of the animal and the telemanipulator was performed using encoder data of the telemanipulator by pointing to the fiducials. After pericardiotomy, the reconstructed coronary tree was projected into the videoscopic image using a semiautomatic alignment procedure. In dogs, the total endoscopic bypass procedure was completed on the beating heart. The first human case applying preoperative planning, intraoperative registration, and augmented reality was subsequently performed. RESULTS: The rigid transformation linked the patient's preoperative frame and the robot coordinate frame with a root mean square error of 9 to 15 mm. The predicted port placement derived from the model initially varied from the one chosen due to an incomplete formulation of the weighing procedure. After only a few iterations, the algorithm became robust and predicted a collision free triangle. Video overlay of the angiographic coronary tree into the videoscopic image was feasible. CONCLUSIONS: Surgical planning and augmented reality are likely to enhance robotic surgery in the future. A more complete understanding of the surgical decision process is required to better formalize the planning algorithms.

Augmented reality for intraoperative guidance in endoscopic coronary artery bypass grafting.

Endoscopic bypass grafting can be complicated by limited intraoperative orientation. A method to overlay the preoperative model of the coronary tree on the live endoscopic images of the heart was therefore developed. The method is three-fold: (1) the three-dimensional (3D) model of the coronary tree is reconstructed from traditional angiograms; (2) preoperative images are registered with the intraoperative position of the patient in the operating room (OR); and (3) an iterative and interactive identification of clinically relevant landmarks within the operative field on the heart surface before their registration with the preoperative model of the coronaries. This algorithm allows one to compensate deformations (breathing, intraoperative heart shift) and leads to a precise overlay of the coronary network on the heart surface. For ergonomic reasons, the 3D model can be displayed directly within the visual field of any telesurgical master console. It thus provides an effective navigational aid to the surgeon similar to a global positioning system (GPS) in vehicles. Animal trials have been performed using the Da Vinci (Intuitive Surgical, Sunnyvale, CA, USA) teleoperated system to validate the method. Qualitative and quantitative analysis demonstrate the potential value during total endoscopic coronary artery bypass grafting.

Planning, simulation, and augmented reality for robotic cardiac procedures: The STARS system of the ChIR team.

This paper presents STARS (Simulation and Transfer Architecture for Robotic Surgery), a versatile system that aims at enhancing minimally invasive robotic surgery through patient-dependent optimized planning, realistic simulation, safe supervision, and augmented reality. The underlying architecture of the proposed approach is presented, then each component is detailed. An experimental validation is conducted on a dog for a coronary bypass intervention using the Da Vinci(TM) surgical system focusing on planing, registration, and augmented reality trials.

Three-dimensional motion tracking of coronary arteries in biplane cineangiograms.

A three-dimensional (3-D) method for tracking the coronary arteries through a temporal sequence of biplane X-ray angiography images is presented. A 3-D centerline model of the coronary vasculature is reconstructed from a biplane image pair at one time frame, and its motion is tracked using a coarse-to-fine hierarchy of motion models. Three-dimensional constraints on the length of the arteries and on the spatial regularity of the motion field are used to overcome limitations of classical two-dimensional vessel tracking methods, such as tracking vessels through projective occlusions. This algorithm was clinically validated in five patients by tracking the motion of the left coronary tree over one cardiac cycle. The root mean square reprojection errors were found to be submillimeter in 93% (54/58) of the image pairs. The performance of the tracking algorithm was quantified in three dimensions using a deforming vascular phantom. RMS 3-D distance errors were computed between centerline models tracked in the X-ray images and gold-standard centerline models of the phantom generated from a gated 3-D magnetic resonance image acquisition. The mean error was 0.69 (+/- 0.06) mm over eight temporal phases and four different biplane orientations.

Preparedness in robotically assisted interventions.

For many years, robots have been used in manufacturing to perform a variety of delicate tasks. Their use is now being generalized to other fields, such as biology, domestic applications, and especially medicine, in which they are poised to make a significant contribution. This evolution comes from the progress made in the field of robotics and from recent changes in medical and surgical techniques, namely, developments in medical imaging and a new desire for minimally invasive interventions. This emerging combination of high-precision robotic manipulators, new medical diagnostic techniques, and efficient minimally invasive surgery has not yet been perfected. After a brief discussion of state-of-the-art robotic systems used in urology, this article discusses new challenges presented by robotic minimally invasive surgery. A computer-integrated approach aimed at increasing the efficiency of such interventions through better preparedness is presented. This approach is illustrated by a case study in human nephrectomy and a cardiac animal experiment.

[Planning and simulation of minimally-invasive robotic heart surgery]. / Planification et simulation de chirurgie cardiaque mini-invasive robotisée.

Due to their numerous advantages, mainly in terms of patient benefit, mini-invasive robotically assisted interventions are gaining in importance in various surgical fields. However, this conversion has its own challenges that stem from both its novelty and complexity. In this paper we propose to accompany the surgeons in their transition, by offering an integrated environment that enables them to make better use of this new technology. The proposed system is patient-dependent, and enables the planning, validation, simulation, teaching and archiving of robotically assisted interventions. The approach is illustrated for a coronary bypass graft using the daVinci tele-operated robot.