LA ROBOTICA NELLA SALA OPERATORIA DEL FUTURO

LA LA ROBOTICA NELLA ROBOTICA NELLA

SALASALA OPERATORIA DEL FUTUROOPERATORIA DEL FUTURO

NICOLA DI LORENZONICOLA DI LORENZO

Dipartimento di Chirurgia GeneraleDipartimento di Chirurgia Generale

UniversitUniversit degli studi di Roma degli studi di Roma TorTor VergataVergata

UN UOMO SENZA MEMORIA UN UOMO SENZA MEMORIA EEUN UOMO SENZA FUTUROUN UOMO SENZA FUTURO

The arrival point of traditionis the starting point of progress

TIME

Rat

e of

Cha

nge

Technology

Society

Healthcare

Business

Sector

Differing responses to scientific discovery by various sectors

Universit degli studi di RomaTor Vergata

TECNOLOGIATECNOLOGIA

Passato:Passato:

CRESCITA LINEARECRESCITA LINEARE

Futuro:Futuro:

CRESCITA ESPONENZIALECRESCITA ESPONENZIALE


TECNOLOGIATECNOLOGIA

CRESCITA ESPONENZIALECRESCITA ESPONENZIALE

Information technologyInformation technologyDistribuzione globaleDistribuzione globale....

LL Information Age NON Information Age NON il Futuroil Futuro

LLInformation Age EInformation Age E il Presenteil Presente


Il robot in chirurgia generaleIl robot in chirurgia generale

CHIRURGIA MININVASIVACHIRURGIA MININVASIVA

Le nuove tecnologieLe nuove tecnologie


LA FILOSOFIA ROBOTICALA FILOSOFIA ROBOTICA

Era industrialeEra industriale

Era informaticaEra informatica

LaparoscopiaLaparoscopia(Meccanica)(Meccanica)

RoboticaRobotica(Elettronica)(Elettronica)

Why robotics, imaging and modeling & simulation

Healthcare is the only industry without a computer representation of its product

A robot is not a machine . . .it is an information system with arms . . .

A CT scanner is not an imaging systemit is an information system with eyes . . .

thus

An operating room is an information system with . . .

Total Integration of Surgical Care

Joel Jensen, SRI International, Menlo Park, CA

Minimally Invasive Surgery

Pre-operative planningIntra-operative navigation

Remote Surgery

Simulation & Training

Engines of Change3 Integrate education and assessment into clinical care


PIATTAFORMAPIATTAFORMAERGONOMICAERGONOMICA

SYSTEMSSYSTEMSTECNOLOGYTECNOLOGY

ROBOTICS ROBOTICS TECNOLOGYTECNOLOGY

SALA OPERATORIA ROBOTICASALA OPERATORIA ROBOTICALA FILOSOFIA ROBOTICALA FILOSOFIA ROBOTICA

Surgical Cockpit

Robotic Medical Assistant

SATAVA 7 July, 1999DARPA

Nursing shortage crisis

Applicable at all levelsHospitalsClinicsNursing HomeAssisted living

Courtesy Yulun Wang, InTouch Technologies, Inc, Goleta, CA

ELIMINAZIONE ELIMINAZIONE DIDI

AIUTIAIUTI STRUMENTISTISTRUMENTISTI

SALA OPERATORIA ROBOTICASALA OPERATORIA ROBOTICA

SOLO SURGERYSOLO SURGERY


Integrating Surgical Systems for AutonomyThe Operating Room (personnel) of the Future

Surgeon Assistant Scrub Nurse Circulating nurse

Borrowing from the standard practices of other industries

Penelope robotic scrub nurseMichael Treat MD, Columbia Univ, NYC. 2003

ROBOT SURGICAL TECHNOLOGIES, INC

Currently in Clinical Trials

Velocit di esecuzione automatizzata

per procedure complesse

(Satava)

ElettronicaElettronicaMicrocomponentiMicrocomponentiMateriali intelligenti Materiali intelligenti

LA FILOSOFIA ROBOTICALA FILOSOFIA ROBOTICA


MicrochirurgiaMicrochirurgia endoluminaleendoluminale5050--100100--.. cm. dal margine anale.. cm. dal margine anale con accesso con accesso percutaneopercutaneo pillolapillola

Courtesy of Richard M. Satava, MD FACS-Professor of Surgery

Courtesy Anita Flynn, MIT, 1995Courtesy of Richard M. Satava, MD FACS-Professor of Surgery


Endoluminal technology for obesityEndoluminal technology for obesity

EMILEMIL


Endoluminal technology for obesityEndoluminal technology for obesity

LAPAROSCOPIC GI SURGERYLAPAROSCOPIC GI SURGERYFLEXIBLE ENDOSCOPYFLEXIBLE ENDOSCOPY

NOTESNOTESTEAM APPROACHTEAM APPROACH

So What ?

SALA OPERATORIA IDEALE

Ottimale integrazione delle nuove tecnologie

Ergonomia

Miglior gestione di magazzino

Riduzione dei tempi di cambio- Miglioramento dei flussi

Migliorare lefficienza ed i tempi di induzione anestesiologica

Connessione wireless tra le attrezzature

Migliorare la sicurezza dei pazienti

Two major steps toward equipping the OR to help improve room turnover and reduce clutter:

- architectural arragements for suspending OR equipment from articulated ceiling-mounted booms

- to incorporate networked plug-and-play OR devices that interface equipment such as lights, the table, certain instruments and video from a single control source. Use of a sterile-field accessible touchpad

Two major steps toward equipping the OR to help improve room turnover and reduce clutter:

- architectural arragements for suspending OR equipment from articulated ceiling-mounted booms

- to incorporate networked plug-and-play OR devices that interface equipment such as lights, the table, certain instruments and video from a single control source. Use of a sterile-field accessible touchpad

Some concerns Some concerns

Operating room

35 sqm. (min. side length 5 m). A 50-square-meter OR with ceilings higher than 8 feet is ideal for retrofitting. general conventional equipment specific equipment (depending on speciality)

Operating room

35 sqm. (min. side length 5 m). A 50-square-meter OR with ceilings higher than 8 feet is ideal for retrofitting. general conventional equipment specific equipment (depending on speciality)

General structural characteristicsGeneral structural characteristics

With the touch of a screen or a voice command, you can adjust surgical tables and lights or direct flat-screen monitors suspended from ceiling-mounted booms (thereby reducing the number of carts, cables, hoses and other equipment nurses and staff must work around).

Todays command-and-control systems eliminate the need for perioperative nurses to manually tweak knobs and buttons

With the touch of a screen or a voice command, you can adjust surgical tables and lights or direct flat-screen monitors suspended from ceiling-mounted booms (thereby reducing the number of carts, cables, hoses and other equipment nurses and staff must work around).

Todays command-and-control systems eliminate the need for perioperative nurses to manually tweak knobs and buttons

Registration of the OR data

The OR-logbookRegistration of the OR data

The OR-logbook

Corporaci Parc Taul - Fundaci Parc Taul - Institut Universitari (UAB)Corporaci Parc Taul - Fundaci Parc Taul - Institut Universitari (UAB)

Enric Laporte,Bernat Sales, Jordi Prez, Josep PlanellProgramme of N Tech in Surgery

Enric Laporte,Bernat Sales, Jordi Prez, Josep PlanellProgramme of N Tech in Surgery Hospital de SabadellHospital de Sabadell

The inteligent OR

MAIN GOAL:Patient and staff safety improvement

(risk and error analysis)(court appearances) OR-logbook

SECONDARY AIMS:Hospital organization enhancement

(incorporating patient data to Digital MR)Teaching and TrainingResearch

Automatic setup of all apparatusInteligent alarms and support

Automatic programing

Patient parameters (+ 90):

source monitor (pulse, EKG, O2 saturation, ...)ventilator (respiratory freq, ET CO2 ...) keyboard (diuresis, SNG output, ...)

types measured (pulse, respiratory frequency, BP max ...)calculated (cardiac output, ...)

regularly (Body temp, invasive BP, ..)periodically (non-invasive BP, diuresis, ...)

Activity (audio-video)

What is recordable?

Devices for source of signs of interest

Monitor of vital signs

Ventilator for anesthetic equipment

Endoscopy devices (insuflator, light source, video camera)

External cameras

Which is the problem?

Output signals of any aparatus has an specific protocol

Staff do not like to be under control

Core Characteristics

Universal driver: Scheme for the representation and implementation of thecommunication protocol of any monitoring device. Resample of the original signals up to any sample frequency, withspecial attention to their most important points. Synchronization of the different devices as well as their signals.

Totally customizable tool for signals monitorization.

Client-Server architecture.

Patent pending.

Signal Capture and Analysis (I)

Signal Capture and Analysis (III)

Criteria to establish patient monitoring levels:

- Preoperative status (ASA classification)

- Possibility of hemodynamic instability during intervention

- Type of anesthesia and length of surgery

Introducing data in Digital MR

Patient monitoring levels :

I.- NO forecast of instability- Ia (locoregional anesth. )

- Ib (general anesth. )

II.- Potential risk of hemodynamic instability

III.- Presence of obvious signs of hemodynamic instability

IV.- Special surgeries (neurosurgery, cardiac surgery ...)

pulseoxigen saturationEKG (3 derivations)non-invasive blood pressurebody temperature

id Ia + 3 ventilator parameters (+ Et CO2)

monitor

Introducing data in Digital MR

Digital Report: the OR-logbook

ERGONOMIAERGONOMIA

La chirurgia laparoscopica ha modificato favorevolmente il decorso postoperatorio, al prezzo di molti inconvenienti per gli operatori: - sala operatoria sovraffollata- posizione scomoda- scarsi gradi di libert- qualit visiva limitata

La chirurgia laparoscopica ha modificato La chirurgia laparoscopica ha modificato favorevolmente il decorso postoperatorio, al favorevolmente il decorso postoperatorio, al prezzo di molti inconvenienti per gli operatori: prezzo di molti inconvenienti per gli operatori: -- sala operatoria sovraffollatasala operatoria sovraffollata-- posizione scomodaposizione scomoda-- scarsi gradi di libertscarsi gradi di libert-- qualitqualit visiva limitatavisiva limitata

1, 2 posizione del chirurgoA, B spostamento dei supporti1, 2 posizione del chirurgoA, B spostamento dei supporti

22

11

AA

BB

A B

22

BA

AB

CentralizedCO2

CentralizedCO2

SAISAI

Cuttingdevices ?Cuttingdevices ?

pressurizedairpressurizedair

?

Flat pannel ?Flat pannel ?

34 sqm34 sqm

Lighting

the Operating Field

Lighting

the Operating Field

Corporaci Parc Taul - Fundaci Parc Taul - Institut Universitari (UAB)Corporaci Parc Taul - Fundaci Parc Taul - Institut Universitari (UAB)

Enric LaporteProgramme of N Tech in SurgeryEnric LaporteProgramme of N Tech in Surgery Hospital de SabadellHospital de Sabadell

About Surgical LampsAbout Surgical Lamps

The main goal using a surgical lamp is a powerfullighted operating field, without shadows norexternal flashes disturbing the surgeon's view.

Light beam has to be:- cool & powerful enough- well directed and- concentrated on a defined area

There are some operations requiring changes focusing the surgical field (oesophagus, v.v. stripping, knee surgery, laparoscopy, ...)

Ceiling mounted lamps manipulation can be difficult (some models have no sterile grip)

The main goal using a surgical lamp is a powerfullighted operating field, without shadows norexternal flashes disturbing the surgeon's view.

Light beam has to be:- cool & powerful enough- well directed and- concentrated on a defined area

There are some operations requiring changes focusing the surgical field (oesophagus, v.v. stripping, knee surgery, laparoscopy, ...)

Ceiling mounted lamps manipulation can be difficult (some models have no sterile grip)

LED technology appliedLED technology applied

5w - 600 lumen5w - 600 lumen

RIMSA - D900(LumiledsTM )pentaled lamp (600 lumen - 50.000 lux - 25W)

RIMSA - D900(LumiledsTM )pentaled lamp (600 lumen - 50.000 lux - 25W)- cold light- use of the lamp to last up to 25 times longer than halogen products- cold light- use of the lamp to last up to 25 times longer than halogen products

The OR_IntelsunThe OR_Intelsun

Design includes:

- cell collimator- zoom optic- cell concentrator

Design includes:

- cell collimator- zoom optic- cell concentrator

System architectureSystem architecture

Studio dei flussi di sala operatoriaStudio dei flussi di sala operatoria

Tecnologia Rfid sistemi per lidentificazione a radiofrequenza

RESISTENZE DEL PERSONALE INFERMIERISTICORESISTENZE DEL PERSONALE INFERMIERISTICOE DEGLI ANENSTESISTIE DEGLI ANENSTESISTI

Courtesy of Richard M. Satava, MD FACS-Professor of Surgery


3-D Modeling of the Liver Jacques Marescaux EITS, Strasbourg, France

CHIRURGIA ENDOVASCOLARECHIRURGIA ENDOVASCOLARE

Highcomplexity

Lowcomplexity

Hospital

Common support devices

Changing rooms Changing roomsAdministrative SupportSterilization

storagecleaning

Prosthetic Surg.neurosurgery

Major onc. surgery

Endoscopic Surg.Endoluminal Endoscopic Surg.

Radiology interv.Pacemaker,scatheterisms...

New facilities for Invasive TherapeuticsNew facilities for Invasive Therapeutics

+OpenSurgeryEndoscopic

Surgery

Interventional MRI

EndoluminalEndoscopy

ANESTHESIAANESTHESIAANESTHESIA

Ambulatory Centres

Nuove sale operatorieNuove sale operatorieNuove sale operatorie

Decisione critica: cosa integrare ?.Decisione critica: cosa integrare ?.

Aspetti principali:Esperienza della ditta costruttriceNumero di attrezzature previsteRobotic workstationSoftware necessario per la gestioneStrumentazioni diagnostiche (TC,RMN)Registrazione e comunicazione a distanza

Aspetti principali:Aspetti principali:Esperienza della ditta costruttriceEsperienza della ditta costruttriceNumero di attrezzature previsteNumero di attrezzature previsteRobotic Robotic workstationworkstationSSoftware neoftware necessario cessario per la gestioneper la gestioneStrumentazioni diagnostiche (TC,RMN)Strumentazioni diagnostiche (TC,RMN)Registrazione e comunicazione a distanzaRegistrazione e comunicazione a distanza

RUOLO CENTRALE DEL CHIRURGORUOLO CENTRALE DEL CHIRURGO

GRAZIE !GRAZIE !

LA ROBOTICA NELLA SALA OPERATORIA DEL FUTURO

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