Journal of Computer Aided Surgery Vol.5 No.3-1
Abstract: The project named "Intelligent Assistance for Diagnosis of Multi-Dimentional Medical Images" has just started under the support of the Grant-in Aid for Scientific Research of Priority Areas from the Ministry of Education,Culture, Sports, Science and Technology. The state of the art of the computer aided diagnosis system is quite limited is based on full anatomical knowledge on human body and full diagnostic knowledge on various kinds of diseases. The term of the project is 4 years from 2003 to 2006. To realize such advanced CAD system, technologies to understand 3D fine structures of each organ included in 3D voxel data are essential. They will be also key technologies of advanced robotics surgery.
Abstract: Systematic development of technologies for computer-assisted
surgery (CAS) is discussed using the electronic"Anatomische Tabellen"
and in silico human framework. We describe a research plan on the construction
and use of a medical image and quantative surgical database and the electronic"Anatomische
Tabellen" for automated surgical planning of hip surgery.
Keywords: quantative surgical database,automated surgical planning, hip
surgery,electronic atlas.
Abstract:This paper shows several methods for generating images that assist
medical image diagnosis and surgical operations.Especially,we show several
applications of virtualized endscopy system in the viewpoint of cooperation
of tne computer assisted surtery and computer assisted diagnosis filed.
We also show a method for generating virtually stretched views of an organ
based on image deformation. This method can generate the stretched views
that are useful for understanding the status or location of lesion.We briefly
explain virtualized laparoscopy system that uses segmentation results of
abdominal organs.The flexible endoscope navigation system, which navigates
endoscopic examination or surgery using a flexible endoscope,is also introduced.
Keywords: Computer assisted srugery, computer aided diagnosis, virtualized
endoscopy
Abstract: The motion with the mainly minute work itself is required of
micro operation. Therefore,a motion is expanded using a microscope etc.
Moreover, reactive forceby contact for an objecti is sevelal mN and minute
power. In this research it aims at making an operator's burden in needle
handing mitigate by performing scaling of visiion and haptics paying attention
to needle handing of operative technique.
Keywords: suture assist,mixed reality ,haptics,mechatronics
Abstract: At the present time, research into the ability to manipulate
object via the medium of virtual space is proceeding apace, spurred on
by developments in CG and VR technoligy. The possible application of such
object manipulation in the field of medical surgery is attracting considerable
attention.This paper reports on basic research conducted to further contribute
to research of such a system . It considers the results of a sumulated
object operation on soft tissue (representing a living human body) from
the viewpoint of deformation and force sense. It compares the results of
that simulation with real instrumental results.
Keywords: interactive surgery simulation, reality-based modeling,object
manipulation, soft tissue
Abstract: This paper describes a method for generatingvirtual laparoscopic
images based on deformation of 3-D abdominal CT images for the operative
aid of laparoscopic surgery. Since the field of view of a laparoscope is
very limited, the load of a surgeon who performs laparoscopic surgery is
quite large. It would be very useful to generate a virtual laparoscopic
image from pre-operative CT or MRI images. Since the abdominal wall is
lifted during laparoscopic surgery, it is required to deform an original
CT image for generating a virtual laparoscopic image. We semi-automatically
extract the abdominal wall and approximate the shape of the wall by the
spring model . The method lifts the abdominal wall elastic deformation.
A virtual laparoscopic image is obtained by reconstructing the CT image
from the result of elastic deformation . We applied the proposed method
to an abdoinal X-ray CT image. Experimental result showed that the proposed
method could generate virtual laparoscopic images.
Keywords: virtual laparoscopic image, computer aided surgery,laparoscopic,
surgical simulation, deformation
Abstract: Simulation of orthognathic surgery using a virtual reality haptic
device was attempted. CT imaage of a patient with severe mandibular prognathism
was introduced to the device. The simulation of the osteotomy of mandeble
by sagittal splitting ramus osteotomy was done.Through the operation using
the haptic device, separation and rearrangement or the ramus of mandeble
could be processed. The discrepancy and interference between bones after
rearrangement were estimated. The simulation was referred to the surgery,and
satisfactory surgical help was confirmed.On the other hand, the fabrication
of a cranial bone model by 3D printing was attempted, and satisfactry model
was obtained. This will also help for surgical simulation.
Keywords: Surgical simulation: Osteotomy: Virtual reality: 3-D : CT image:
Computer
Abstract: Cutting-edge attempts using haptic feedback device will be effective
for the preoperative simulation and training for oparators. We applied
a commercially available pen type haptic device with computer graphics
3D-CT images of bone for dental implant surgery. By using haptic drilling
tool ,the sensation of drilling on the bone could be experienced. Then,
CAD/CAM fabrication of surgical stent was aimed. Virtual crown in 3D-CT
images was introduced, and positioning of holes for implant on a jawbone
considering bone density and the position of crown was done . Furthermore,
a bone supported surgical stent which can guide the operator's drill to
the planned implant position could be fabricated by CAD/CAM method. The
present system will be errective for simulating and training of dental
implant treatment.
Keywords: dental implant, haptic feedback device, CT, CAD/CAM , surgical
stent
Abstract: We developed dental crown production system which desicned the
form of crown with virtual articulator, which reproduced the locus of occlusal
surface left by movement of subject's mandible, and produced a titunium
alloy crown with NC machine tool. The flow of this system is following.
First,we costructed virtual dental model by measuring plaster dental model
with a 3 dimensional form measuring device. Secondly , we tracked mandibular
6-axismovement of subject, and then, retrieved the locus of mandibular
occlusal surface in grinding movement by applying mandibular movement to
virtual dental model. By excising form of abutment tooth and the locus
form anatomical crown , we obtained the form of the crown. Finally,we made
a titunium alloy crown with NC machine tool.
Keywords: virtual articulator, functional generated path , dental crown,
mandibular movement
Abstract: It is sometimes difficult to have a nice view in the Otolaryngological
surgeries because of the size and shape of the target organs. So it is
necessary to take a time to be trained and improved surgical techniques.
New method should be developed using endoscope,CCD camera, television monitor,navigation
system with computer aided,which marks an epoch in the history of Otolaryngological
surgical education.Endoscopic sinus surgery has been quite popular and
accomplished great evolution in recent years which required high techniques.
But it is not easy tobe trained of dssection or simulation using cadaver.
In this opportunity we would like to demonstrate new educational system,
using a new model constructed complicated anatomy of sinuses, with an image-guided
navigational system.
Keywords: educational model , endoscopic sinus surgery, navigation system
Abstract: This paper describes an incision and excision simulation system
for left ventricular plastic surgery. The virtual heart graphics is built
on the basis of patient's high-speed cardiac cine CT-images. A virtual
knife in the image is linked to user's fingers position and direction which
are detected by a 6D magnetic position sensor. This simulator is combined
with the training system for cardiac muscle palpation we developed.
Keywords: virtual reality , ventricular plastic surgery , surgical simulation
system
Abstract: There are several problems in conventional dentao training using
a mannequin due to the lack of reality . To solve such problems, we proposed
in this study a dental training system with application of the virtual
reality technology . In our system , a virtual environment and a virtual
patient were produced in a virtual space, in which the dental mirror and
hand pieces can be operated real timely. The force feedback of operations
and a tooth cutting operation in training are realized with the use of
two computers. Furthemore, in ordr to be aware of and to avoid possible
dangers in training, the tongue of the patient is moved randomly,and a
warning sound and a signal of blood are given from a contact judgment when
the drill contacts tongue or buccal. Finally, an experiment of tooth cutting
was carried out with good effects confirmed.
Keywords: dental training, Virtual Reality, haptics, force feedback , danger
aware
Abstract: The new system which records and playbacks expert doctor's insertion
skills was developed. This system enabled to feel and learn expert doctor
's insertion skills. Furthermore, doctor's insertion skills with quantitave
evaluation method was developed. Therefore doctors are able to evaluate
own skills and train more effectively. And we valified training effect
of Virtual Endoscope System.
Keywords: Virtual Reality, Force Sensation, Virtual Endoscope System, Record
and Playback , Evalution
Abstract: To apply the surgical robot in clinical situation, it is necessary
for the surgeon to master the handling of the instrument. In this paper,
we describe the development of the training surgical simulator enabling
a surgeon to master the techniques for robotic surgery, in particular the
robotic surgery system "da Vinci" . In addition to that , we
have tried to construct a training center system enabling the user to simulate
surgery from multiple remote access points. In this simulator, the soft
tissue model is used a sphere filled model that is suited for real time
and quantitative deformation. With respect to the haptic device, we used
a commercial device known as a "PHANTOM". As a result, the user
can perform a realistic manipulation similar to the da Vinci forceps' operation.
In addition , it allows a user to perform surgical maneuvers such as grasping
and pushing. Moreover, using the broadband line via internet, we can perform
the tele-virtual training simulation . In the future,.we will be able to
perform other surgical maneuvers, such as suturing, incision, and resection,
that are necessary for robotic surgery.
Keywords: training simulator, robothic surgery tele-virtual surgery , soft-tissue
model
Abstract: We have developed a minimally invasive osteotomy device using
an ultrasonic chisel to achieve precise bone cutting. One problem of bone
cutting by the ultrasonic chisel is denaturation by generation of heat.
To overcome this problem ,we determined cutting condition to control the
generation of heat and cut bone effectively . We measured relationship
between applied force and temperature of the grinding surface of the bone.As
a result, when the applied force was below 200kgf,temperature was able
to be under 45 ℃. Then we have developed new device with four degrees
of freedom to be able to cut bone in curved surface . By this new device
and cutting condition, swine femur could be cut in three hour and the fdasibility
of the osteotomy by the ultrasonic chisel was verified.
Keywords: Less invasive osteotomuy, Ultrasonic surgery apparatus, Ultrasonic
chisel , Denaturation
Abstract: In conventional osteotomy,surgeons need to cut the patient's
skin and muscle wide to avoid damaging the important tissues around the
bone like nerves or blood vessels . We have been trying to cut the bone
without cutting the skin and muscle by using focused ultrasound. We simply
applied the conventional Extracorporeal Shockwave Lithotripsy principle
to osteotomy,but it did not work well because of the difference of properties
between calculus and bone . In this paper, we have tried a new method which
controls cavitation phenomenon and uses the shockwave to cut thebone efficiently
.This method generates cavitation cloud in a small area by high frequency
ultrasound and collapses the cavitation cloud by low frequency ultrasound.
We have employed multi-transducer with different eigen frequencies. Various
combination of transducer with defferent eigen frequencies have been tried
to determine the optimum combination for cutting bone. As a result, it
has been shown that the power of low frequency ultrasound is important
for cutting bone.
Keywords: Ultrasound, Cavitation, Osteotomy
Abstract: RAO(Rotational Acetabular Osteotomy) is a method for easing stress
concentration caused by coxarthrosis. However , it is very difficult to
cut acetabulum in narrow workspace surrounded by a nerve and muscles. Thus
there is a need for a safer operation method . In this study, in order
to support RAO, we developed a surgical device for cutting bone on a spherial
surface using a small oscillating saw thorough a spherical guide.
Phantom study and animal expriment were performed to evalute the cutting
shape and demonstrate the feasibility of the spherical cutting by the device.
Keywords: RAO,cutting bone,spherical surface,oscillating saw
Abstract: For minimally invasive curettage of lesions in the femoral head
osteonecrosis, we have developed a novel expandable tool which can be introduced
into the femoral head through the subtrochanteric route under a CT-based
navigation system. In this study, we evoluated the effectivness, feasibility
and accuracy of this tool in comparison with the Cebotome, one of the conventional
bone cutters. This tool has an expandable blade at the tip of a long cylinder
and is designed to be used after coring a hole into the femoral head from
the lateral subtrochanteric portion. As the blade spins at a high speed
and expands gradually, the bone is cut into a cone shape . In this experiment,a
target area in the femoral head of a Saw bone femur model was curetted
with each tool after coring a hole through the subtrochanteric route under
navigation guidance. The volume of the curetted necrotic area was significantly
larger and the procedure time was significantly shorter with this tool
than with the Cebotome. The positional error was withn 2mm with either
tool This expandable blade tool is suggested to be more effective and feasible
in curettage of necrotic lesions in the fdmoral head osteonecrosis than
conventional cutters.
Keywords: computer-assisted minimally invasive orthopaedic surgery, curettage
of the femoral head osteonecrosis
Abstract: The surgeon requires intensive training and experience to acquire
the necessary quality surgical skills in minimally invasive surgery(MIS).
This is particularly ture in Endoscopic Sinus Surgery (ESS), due to the
sinus'es complex structure and its location adjacent to such vital organs
as the optic nerve,the brain , and arteries. ESS training opportunities
are not satisfactory , however , since there is no appropriate animal model
for human nasal structure and availability of cadavers is decreasing. The
authors have developed a precise model of the human sinuses for ESS training.
With Rapid Prototyping technology and newly developed materials and structures,the
model provide precise nasal structure and tactile perceptions that are
similar to the human body. This makes it possible for the surgeon to practice
basic surgical techniques, such as cutting and removing tissues ( Ethmoidectomy,
Sphenoidectomy through the ethmoidal sinus, opening the natural ostium
of the maxillary sinus, etc.), using actual surgical instruments. Since
the model is X-lay CT compatible as well , it is useful as a phantom patient
for such systems as surgical navigation . This model should contribute
to an increase in ESS with improved safety.
Keywords: ESS training simulator , Rapid Prototyping, CT compatibility,
surgical navigation system
Abstract: In this paper, a computer-controlled minimally invasive laser
etching system for neurosurgery is described. It has been considered that
the precise recognition of the location of malignant brain tumors by certain
monitoring system and the realization of accurate removal is most important
to make advantage of survival rate. Aiming to realeze minimally imvasive
laser surgery with perioperative information from MRI and neuro-navigation
system, we have developed a computer controlled laser-etching system. Micro-laser(λ＝2.8μm)is
used for the minimally invasive ablation tool . In this system , the laser
scanning area can be designated randomly on computer screen by marking
outlines. From our resent experiment, this system could successfully function
to etch the pig brain surface where the oterator designed on the monitor
screen.
Keywords: computer-controlled , neurosurgery, laser etching, λ=2.8μm,micro-laser,
brain tumor
Abstract: In the treatment of glioma such as the neurosurgey, it is very
important to remove the tumor accurately at the boundary between the tumor
and the normal tissue in order to prevent the recurrence of the tumor.
To achieve this accurate removal of the tumor , we have proposed the method
of using a micro laser of the wave lengh 2.8(μm).This micro laser is suited
to remove the tumor only at the brain surface because of its large absorption
feature by water. However, it is necessary to maintain the distance between
the laser probe and the target to its focal length . In this research,
we developed the automatic focusing system using a guide laser and a CCD
camera . In addition , we performed the evalution experiments of tracking
performance and in vivo ablation on a brain of porcine. The results showed
that the accuracy of focusing largely depends on the condition of the brain
surface. In the future, we will improve a new auto focusing method which
will not be affected by the condition of the brain surface.
Keywords: Neurosurgical laser，Automatic focusing, Medical robot, Tumor
Abstract: The ultrasonically activated scalpel has been used routinely
in a number of general surgeries, including laparoscopic surgeries and
open surgeries. To provide new surgical fields and techniques for surgeons
for laparoscopic surgery, we developed an active ultrasonic scalpel (AUS).
The AUS consists of a small ultrasonic transducer which is about 80mm length
and a manipulator which has two degrees of movement of bending. In this
report, we present the first prototype of the AUS and the experimental
results of the medical utility of the AUS. From the experiment using pig,
we confirmed that it is possible to cut and coagulate tissue using the
AUS, and the AUS provided various alternative approach path for surgeons.
Keywords: active ultrasonic scalpel, laparoscapic surgery, manipulator
Abstract: Laser photocoagulation instrument has been widely applied to
laparoscopic surgery as one of the most important surgical equipments because
of its effective ablation and precise positioning. However, in laparoscopic
surgery, surgeons have narrow view of abdominal cavity and the degrees
of freedom of the instruments are limited. In this study, we developed
robotic bending forcepts with semiconductor laser photocoagulation instrument
and Charge Coupled Device(CCD) camera. The resolution of CCD camera was
410,000(pixel).In the conventjional laser instrument, optical fiber was
used to guide the laser and it had the danger of laser leakage. We mounted
the laser diode on the tip of forcepts and avoided that risk. In the procedure,
it is important to match the topside of two views (Laparoscope and CCD
camera). So, we rotated the CCD camera view to match with laparoscope view
by the image processing method. The frame rate was 2.2 (fps) at 512 (pixel).
We used the joystick as an input device . These enabled the surgeon to
operate the laser instruments intuitively. In the future, this instrument
will be integrated with robotic surgical manipulator as one of various
end effectors.
Keywords: Laser photocoagulation, Laparoscopic surgery , Semiconductor
laser
Abstract: Recent surgical robotic systems broke the limitation in the dexterity
of the human hand. However, when a surgeon is the situation of ligation,
he has to operate the robot to make a knot. This means surgeons require
another training and skill to operate the robot smoothly. We aim to realize
the automation of occlusion and resection of thick vascular tissue such
as bile duct with the trial electric cautery on the Multi-DOF robotic forcepts.
In this study, we performed occlusion with the trial electric power , and
time of cautery. The data was compared to the bursting pressure of sutured
bile ducts and occluded ones by titanium clip, and electrothermal bipolar
vessel sealer (LigaSure TM). In the resection experiment, we made the trial
electrodes and showed the feasibility of resection by the bipolar electric
cautery on pork and bile ducts . In the future , we will mount the electrodes
on the Multi-DOF forceps and test the availability for the clinical application.
Keywords: Laparoscopic surgery, surgical robot, automatic ligation
Abstract: Robot-assisted , minimally invasive surgery is now a reality
and will probably become the surgical procedure in the future.The study
used a ZEUS robotic system(Computer motion Inc), consisting of 3 interactive
robotic arms fixed at the operatiing table and remotely controlled by the
surgeon. Since we started robotic procedures using ZEUS in April 2003,
two patients underwent cholecystectomy and ten patients for prostatectomy.
As for cholecystectomy, the robotic technical approach was similar to that
of conventional laparoscopy. The operative taime was 101 minutes.Postoperative
patient's complaint for pain was only once, and she could walk on the first
postoperative day. There was no complication after operation, and the patient
discharged on 9th postoperative day. The most convencing indications for
robotic surgery are procedures that involve a small , deep, fixed operating
field or when minimally invasive surgery requires extreme accuracy, fine
dissection , and endoscopic suturing and microanastomosis. Our preliminally
experience showed that robotically reproduced laparoscopic maneuvers, such
as tying, suturing, dessection , clipping and cautery, seemed to be as
accurate and as fast as maneuvers made without robotics.
Keywords: computer aided surgery, laparoscopy, cholecystectomy, ZEUS,
Abstract: Objectives: We have undertaken a study using robotic instrumentation
and voice-controlled camera guidance to determine the feasibility and the
efficacy of performing robotic-assisted laparoscopic pancreaticojejunostomy
and compare it with conventional laparoscopic pancreaticojejunostomy in
acute porcine models. Methods: Using the robotic surgical system, we performed
robotic-assisted laparoscopic pancreaticojejunostomy(RALPJ) for 6 animals
and compared with conventional laparoscopic pancreaticojejunostomy (CLPJ)
for 5 animals. Several variables were measured including, total operation
time, anastomosis time, robotic set-up time, complications, surgeons fatigue
(none, mild, moderate or severe) and number of leaks. Results: The averages
of the total operation time of RALPJ group and CLPJ group were 215 ±38.2
and 152 ±12.9 minutes individually and significantly different (p<0.01).
The averages of the anastomosis time of RALPJ group and CLPJ group were
105±18.0 and 55.4 ±5.0 minutes individually and significantly different
(p<0.01). The average of the robotic set-up time of RALPJ group was
20.8 minutes. Anastomoses were immediately watertight in 1 of 6 robotic
and 2 of 5 conventional pancreaticojejunostomy. Conclusion: Robotic-assisted
laparoscopic pancreaticojejunostomy is feasible but requres higher anastomotic
performance than conventional laparoscopic surgery. This also has implication
for clinical application of laparoscopic telesurgery in the future.
Keywords: robotic surgery, laparoscopy
Abstract: In total hip replacement , fitness of the stem, which is one
of the component of the hip joint implants, to the femoral canal is important
for stability of the stem. A surgeon determines the size, position and
orientation of the stem based on his visual assessment of the relationship
between the stem and the femoral canal surface. However, visual assessment
depends on surgeon's subjectivity. Our work aims at development of an automated
method to place a stem in the femoral canal for the surgical planning,
which is intended to objectify expertise of the experienced surgeon. The
proposed method is based on stem fitness which is measure of shape difference
between the stem and the femoral canal surface. The combinations (size,
position and orientation) which provide local maxima of the fitness are
determined by exhaustive search. We applied the method to four cases of
patient data sets, and compared the results with those of the experienced
surgeon. The results were generally closed to those of the experienced
surgeon. The result suggest the fdasibility of the proposed method in clinical
practice.
Keywords: Surgical planning, Hip joint, Stem fitness , 3D shape, CT data
Abstract: (Purpose) Joint reconstruction of finger joint after severe hand
trauma is one of recent theme in the field of hand surgey. We used osteochondral
graft from the rib to reconstruct the joint surface of PIP joints. Recently
we utilize the robotic modeling machine to solve this problem.(Materials
and methods) We have treated 3 PIP joints destruction by computer assisted
method. There were two cases which graft was done in proximal phalanx and
in one case PIP joint was replaced totally by the osteochondral graft.
The patients ranged in age from 18 to 55 years old (mean:36 years). Osteochodral
graft was taken from the 5th rib. We acquired 3D data of the joint surface
by using the industrial 3D scanner. The data was transferred to the modeling
machine throuch host PC. After placing the osteochondral portion of the
rib on the machine, milling of the bone was automatically done. (Resurts)
In all three cases, bone union was obtained. Postoperative ROM was 32 degree
on average and all joint were stabilized. (Discussion) Our movement which
lead to the osteoarthritis change.
Keywords: computer aided surgery, bone graft, finger joint
Abstract: The prupose of this study was to evaluate the accuracy of placement
of the femoral component using the pinless registartion system of the ROBODOC
in comparison with the pin-based registration system . Cementless total
hip arthroplasty was performed in 46 hips with the pin-based system(Group
A) and in 37hips with the pinless system (Group B). CT images were obtained
preoperatively and one month after surgery. The three orthogonal planes
of the proximal femur were reconstructed from CT images, then we evaluted
the axial seating and the differences of the stem alignment and rotation
between preoperative and postoperative images. In Group A, the angular
differences of the stem axis were 0.7 degrees (AP) and 1.1 degrees (lateral).
The axial seating of the stem was 1.2 mm. The difference of the stem rotation
was 0.3 degrees .In Group B, the angular differences of the femoral axis
were 0.8 degrees(AP) and 1.2 degrees(lateral).The axial seating of the
stem was 1.2 mm. The difference of the stem rotaion was 0.4 degrees . There
were no significant differences in these paramenters between the both groups.
We concluded that the pinless registration system was proven to be as accurate
as the pin-based system.
Keywords: ROBODOC, Total hip arthroplasty, pinless registration , pin-based
registration
Abstract: To assess the accuracy of implantation in total knee arthroplasty
(TKA) using the ROBODOC system, the position and alignment of the tibial
component was measured on preoperative planning CT images and on the postoperative
CT images using the workstation (ORTHODOC) in the system. We examined 15
knees of 13 patients who underwent TKA. The differences in flexion-extension,
varus-valgus, and rotational angles of the tibial components were less
than 1 degree between the preoperatibe plan and postoperative images. TKA
using the ROBODOC system was clinically accurate.
Keywords: ROBODOC, Total Knee Arthroplasty, accuracy of implantation
Abstract: Background: Robotic surgery can allow us to perform difficult
operation under the conventional endoscopic surgery.
Currently, it is used widely in Europe and the United State over 20,000
clinical applications. In Japan this technology would be widely spread
in the future. So, we started the training program on robotic surgery using
da Vinch surgical system and evaluted the need and the efficacy.
Methods: Twelve surgeons received two-days robotic surgery training program
including both inanimate and animate sessions. Evalution on the efficacy
of the training was used to compare the score of inanimate sessions performed
before and after animate session. Time and accuracy were analyzed . Statistical
analysis was used student t-test. Result: All task score were significantly
elevated comparing before and after inanimate sessions.
Conclusion: We showed that our training system would enable surgeons to
skill up on the robotic surgery.
Keywords: Robotic Surgery, Training System, da Vinci
Abstract: This paper describes a master-slave type surgical system for
neurosurgery. The robotic system is developed particularly for suturing
blood vessels and removing tumors located at the deep part of the brain.
Keywords: robotic surgery, neurosurgery, master-slave system
Abstract: Objectives: To enhance dexterity and maneuverability in the deep
surgical field, we are developing a Master-slave microsurgical robotics
system. This system and results of the preliminary animal experiments are
reported . Methods: Our robotic system involves master control system ,
which congeys motion commands in six freedoms (X,Y,Z,rotation flexion and
grasping). Slave manipulator involves hanging base and motorized operating
unit, which holds two manipulators (5mm diameter and 18cm length ). To
acquire wide range of motion in a deep surgical field, motorized flexion
mechanism was added to the tip of the manipulator . Dissection of carotid
and remoral arteries of 10 mice and arteriotomy(sized 0.5mm) closure was
attempted in each animal . 3D video monitor system was used for visual
control. Results: Successful suturing of arteriotomy could be achieved
in the last 4 animals. The reasons for the initial failure were mechanical
and software problems, such , as vibration of the system and inadequate
forceps refinements to hold fine nylon sutures. Conclusiion: Preliminary
experiments of the microsurgical robotic system showed promising maneuverability.
The computer controlled surgical manipulation will be very important in
the future neurosurgery. Intimate collaboration of medical, engineering
and industrial specialty to build truly useful system.
Keywords: neurosurgery, master-slave microsurgical robotics system, suturing
Abstract: The purpose of thes report is to analyze the needle motion during
manual and robotic insertion into bone. The needlr for vertebroplasty was
inserted manually and robotically into the human femoral head preserved
under formaldehyde fixation and its motion during insertion was measured
with a 3D optical sensing system. In robotic insertion, the twisting angle
was much larger than in manual insertion, and which probably helped efficient
bone cutting by the edge of the needle tip and then leaded to the smaller
axial force. Also considering the feed rate and the twising frequency were
larger in manual insertion, it comparison with robotic needle insertion.
Keywords: Manual and robotic needle insertion, needle motion,force, orthopedic
surgery
Abstract: The "Advanced Support System for Endoscopic and Other Minimally
Invasive Surgery" project of the New Energy and Industrial Technology
Development Organization has been developing minimally invasive surgery
(MIS) system. Master-slave combined manipulator (MSM) for laparoscopic
surgery is the main instrumentation of MIS system. Suture of tissues can
be performed with any angle of needle and less traumatic maneuver using
dexterous forcepts of MSM. We try to apply MSM for neurosurgical field.
We selected cervial endarterectomy (CEA) as the entry operation into neurosurgery.
The reason of the selection will describe in this paper. This paper describes
fundamental analysis of CEA using MSM. Arteriotomy and suture of arteriotomy
were done on pig bilateral femoral arteries. Some technical difficulties
were encountered during suturing procedure. Recanalization after suture
was complete. Neverthless many problems should be solved, it is strongly
indicated that MSM can apply to CEA.
Keywords: robot surtery, master-slave combined manipulator, laparoscopic
surgery, carotid endarterectomy
Abstract:Laparoscopic surgery is widery perfoumed because of pain and medication
reduction according to its minimal invasion . For high-quality and precise
operation,master-slave robotic systems were developed for assisting surgeon
in the operating room. Some systems greatly contributed to the operation,
however , its large size leads to the following problems; collision of
robotic arm and surgeon, occupation of the working space above the abdomen.
For these problems,we developed a new compact slave robot for manipulating
forceps and two degrees of freedom (DOF) bending forcept as an end effecter.
Slave robot has 4 DOFs of RCM (Remote Center of Motion) to drive the forceps
around the incised hole on the abdominal wall. Bending forceps is driven
with tendon mechanism. The size of RCM part was W250 ×H110×D60(mm), and
forceps translation and rotation part was W140×H410×D70(mm).The diameter
of forceps was 10(mm), the length was 400 (mm) . The whole weight was 5.1(kg).
In vivo experiment was operated to evaluate the basic motion and the availability
for the clinical application.
Keywords: Surgical robot, Minimally invasive surgery, Master-Slave system
Abstract: We have been developing an endoscopic robot system that possesses
two manipulators for surgical work in the gastric tubes. The robot possesses
two arms whose distal part functions as forceps and are able to hold and
handle soft tissues by the cooperative work of the right and left arms.
In the first 1st stage of development , this robot system was used for
Endoscopic Mucosal Resection (EMR). For the next step, we tried this endoscopic
robot system for various kinds of surgery in the gastric cavity to extend
the region of application. We tried to penetrate the stomach wall from
the inner side and made the robot approach the upper and lower part of
the abdominal cavity to perform the surgery at the gall bladder, the deep
part of the portal fissure and the oviduct. We performed this trial during
an animal experiment and figured out the points of improvement of the robot
system for surgery on those regions.
Keywords: endoscopic robot system, endoscopic surgery to abdominal organs
Abstract: Recently, many remote controlled endoscopic surgical robots have
been used in order to perform Minimally Invasive Surgery (MIS).However,
to perform a less invasive surgery the development of a smaller-sized and
flexible robot is required . Furthermore, it is necessary to scale down
the human movements and scale up the contact forces to achive a high maneuverability.
However, when the manipulated environment is such small the scaling effects
due to the high viscosity and friction of the environment have to be considered
. The aim of this work is to develop a Control System adequate for Endoscopic
Master-Slave System that was presented previously. To avoid the wire looseness
or excessive tension an active control strategy was applied. Different
scaling parameters were selected and the master-slave system performance
was evaluated. In order to verify the control and mechanical system's performance
some basic experiments were realized.
Keywords: Endoscopic Master-Slave Robot, Scaling Effect.
Abstract: In Laparoscopic surgery, some master- slave manipulator systems
were developed to assist the operating procedure. In order to achieve a
sophisticated operation in a limited operating area, it is desirable to
have following requirements in the master-slave manipulator system; (1)
surgical tools are exchangeable easily according to the method of surgery,
(2) the system is scalable to be integrated easily with an advanced technology
such as an intra-operative imaging system . Concerning (1), we have developed
some kinds of high -efficiency forceps such as semi-conductor laser forceps
with CCD and bipolar forceps , laparoscope using wedge prisms with flexible
viewpoint. On master-slave system, to use these devices smoothly , we have
integrated the coordinate system of the each device with a three dimentional
positioning sensor. Then, we have developed the scalable slave robot system
using CORBA(Common Object Request Broker Architecture). In-vivo experiment
was performed to demonstrate the performance of this system.
Keywords: laparoscopic surgery, medical robot, master-slave system, CORBA
Abstract: We developed both new operation procedure and new robot system
for remote microsurgery at deep and narrow space of human body. This system
allows surgeon to operate difficult microsurgery that conventional method
cannot be achieved . The system consists of flexible stem and slave micro
manipulators which can enter deep site such as brain through narrow channel
. The macro motiion of master manipulator can be converted into miniature
motion of slave microsurgery manipulator with 5 D.O.F.in 3mm diameter.
This system has been taking advantage of flexible catheter and decoupled
micromanipulator . Total performance was verified by animal experiment.
Keywords: Remote Microsurgery System, Medical Robot, Minimally invasive
surgery , Master-Slave
Abstract: In this paper , we would report two new prototypes of MR-compatible
endoscope manipulator. Firstly，both prototypes were changed to be smaller
. The motor units were relatively miniaturized by newly developing a less
magnetic wave gear. The mechanism was optimized by sliming down the excess
workspace and material . Secondly, a rotation around the endoscope and
vertical motion were added to the one of prototypes for angled endoscope.
The dimension reduced from 120mm to 80 mm in height, 280 mm to 210 in width.
The length did not change much in order to keep the motors distant from
MRI. These manipulators change the position and direction of the endoscope
in MR gantry for tans-nasal neuro-surgery with intraoperative MRI. It will
be significantly helpful to provide the surgeon with real-time feedback
of MR image to endoscopic image and the reverse, because MRI compensates
the vision lost through narrow opening of keyhole surgery.
Keywords: Trans - nasal neuro surgery, endoscopic surgery, MR-compatibility,
medical robot/manipulator
Abstract: In this papaer, we would report our first MR-Compatible prototype
of leverage and parallelogram mechanism, which transmits 3 translational
and 3 rotational motions from the outside to the inside of MR imaging area.
It assists surgeon(s) in precise positioning and handling of surgical devices.
Because of the strong and sensigive magnet of MR, MR-compatible materials
and components must beused although they are worse in terms of cost, durability
and stiffiness. The remote actuation of this mechanism enables the less
MR-compatible and bulky driving units to be set away from MR-gantry. We
have studied mechanical problems such as stiffiness experiments and workspace
analysis, and the tradeoff between stiffiness and workspace according to
the lever ratio has been revealed. Based on these results, new set of mechanical
parameters is selected.
Keywords: Medical / surgical manipulator, MR-compatible manipulator, MR-compatibility
Abstract: A new robotic system named "Hyper Finger" for minimally
invasive surgery in deep organs has been developed. The finger size of
the latest version is 10mm and the entire system is much smaller and lighter
, and can be set up on a camera tripod. This is one of the smallest master-slave
robots in medicine . Each finger has seven degrees of freedom and several
unique mechanisms are employed to solve the fundamental issues of conventional
wire drive manipulators . The new concept and system were verified successfully
by in-vivoremote minimally invasive surgery.
Keywords: Hyper Finger , Laparoscopic Surgery , Minimally Invasive Surgery
, Medical Robotics, Hyper redundant degrees of freedom manupulator
Abstract: This paper proposes the third version of a handheld laparoscopic
forceps manipulator using multi-slider linkage mechanisms. The manipulator
consists of multi-DOF end-effector with 2-DOFs bending mechanism and 1-DOF
forceps mechanism, linear-drive unit and computer-based control unit. We
added newly a linkage connector between sterilizable multi-DOF end-effector
and unsterilizable linear-drive unit to separate both parts clearly. A
handheld interface enabled more intuitive operation with two dials for
horizontal and vertical plane bending and one trigger for grasping. In
vivo experiments, this manipulator performed some laparoscopic surgical
tasks under pneumoperitoneum,such as circumventing, raising, and holding
the liver, grasping and suturing the surface tissue. In conclusion, we
were sure of usefulness of the forceps manipulator with 2-DOFs bending
mechanisms, which showed large workspace , flexible approach from various
directions and sufficient power for clinical application.
Keywords: Handheld, Laparoscopic, Manipulator
Abstract: This paper describes compositions of a prototype muscle retract
manipulator. RAO are applied to people with dysplastic hips or with congenital
dislocations of the hip. We suggest the minimally invasive surgery assisted
by manipulators for RAO. The new operation plan of RAO is that a manipulator
rotates acetabullar between bone and muscle in hip joint and secures workspace
without wounding muscle and blood vessel and nerve, and this manipulator
drives through the workspace and cuts bone. It is difficult that this manipulator
drives on curving surface through muscle tissue. The total system of this
operation system of RAO and new rehabilitation exercise system of Fujie
Laboratory will cause early recovery of them.
Keywords: Rotational Acetabular Osteotomy, Manipularot, Minimally Invasive
Surgery
Abstract: We started the development of the manipulator HUMAN SYSTEM for
neurosurgery in 1995, and succeeded in clinical use in 2002. In this project,
we considered that " feedback design by the collaboration between
medical science and engineering " and " technical development
by three viewpoints" were important strategies for a development of
medical manipulator system. The first strategy, the feedback design means
the spiral development system that some evalution experiments of equipment
are suitably conducted by many surgeons, and engineers and surgeons , discuss
that evaluation, and feed back a result of that discuss to the next design.
The second strategy, three viewpoints are "basic function" ,
"safe technology " and "usability". From each viewpoint,
we pursued " utility value of a system", "safety called
for by clinical scene" and " facilities as a surgical tool".
We were able to unite medical knowledge and engineering knowledge closely
by carrying out these two strategies, and promoted development efficiently,
and have put the system in practical use for a short period of time of
seven years.
Keywords: master-slave manipulator system, neurosurgery, medical manipulator
, development strategy
Abstract: This paper suggests an ultrasound guided needle insertion instrument
which can compensate organ motion and deformation in real-taime. Under
traditional ultrasound-guided needle insertion therapies, surgeons have
had much burden to find out the precise targeting position, particulary
when the organ is moving due to patient involuntary motions. We developed
a new needle insertion instrument which can track moving target based on
visual servo control and determine the best insertion path. The proposed
system could track a moving phantom successfully at speed of 3.85 times/sec
processing and demonstrated the performance through the animal experiments.
Keywords: image-guided surgery, needle insertion instrument, motion tracking,
visual servo control
Abstract: A neeeling manipulator with impact mechanism will be reported.
Needling is bending used in taking tissue sample, nerve block and brain
surgery. In needling, positioning precision is the most critical for minimally
invasive surgery since the flexibility of needle makes difficult to control
the path of needling. However, flexibility prevents an accident of break
in body while needling. So as a solution of controlling flexible needle
preciously, we suggest a manipulator with impact mechanism. Can and spring
generate enough impact power and enough strokes to break capsule strength
of tissue. The impact mechanism showed improvement of reproducibility of
1.0 ±1.0 mm while needling derectly 70mm of swine. In addition, STD of
reproducibility needling with bending could be reduced to 22% when impact
was given . We are sure that this report will be the first step of flexible
needling control.
Keywords: surgical manipulator, needling , impact
Abstract: We developed a new master-slave combined manipulator (MCM)in
which the master grip and slave hand are combined in the manipulator body
so that the surgeon can use the tool near the patient. The slave hand is
controlled electrically by the master grip, and its position is directly
controlled by the surgeon.We submitted questionnaires to obtain surgeons'
comments to assess the possibility of its future adoption by surgeons.
Fifty-four experienced surgeons tried using the MCM for 30 min and returned
questionnaires with their comments. The need to use the MCM in 63 surgical
procedures was rated from 1 ( unnecessary) to 5 (absolutely necessary).
Thirty-seven surgeons (69%) succeeded in skillful manipulations, and 38
surgeons(70%) santed to use the MCM in the future. Procedures rated 4 and
5 by more than 50% of the surgeons were antireflux surgery, achalasia surgery
, repair of gastric or duodenal perforation, and surgery for common bile
duct stone. The only procedures rated 4 and 5 by less than 10% of the surgeons
was cholecystectomy. The MCM is useful for laparoscopic procedures, especially
for suturing and knot tying procedures, and it shows a promise of being
adopted as a tool in the near future.
Keywords: master-slave combined manipulator, laparoscopic surgery, assessment
Abstract: We used an intelligent operating theater to performed 186 open
magnetic resonance imaging (MRI) surgeries in Tokyo Women's Medical University
between March 3, 2000 and September 17, 2003 . We started construction
of the intelligent operating theater for neurosurgery in 1999, and succeeded
in clinical use in 2000. In this project, we considered that "task
oriented design by the collaboration between medical science and architectural
engineering". Here we describe a newly innovated intelligent operating
theater from architectural point of view.
Keywords: intelligent operating theater, architecture, intraoperative MRI
Abstract: We developed the intelligent laser surgery for glioma removal
following last year. In neurosurgery, it is important to preserve a normal
tissue, that it is minimum invasively, to remove glioma precisely. On the
other hand, conditions required for laser surgery system are there being
the high ablation ability and not giving a damage other than a glioma.
However, the laser surgery equipment by which the present clinical application
is carried out has the large thermal damage to a circumference tissue.
Therefore, laser surgery system had not been used in neurosurgey. Then,
we chose high power pulse-mode laser with little heat damage on the basis
of these problems. We report that we developed the laser surgery system
in which can ablate precisely and stop bleeding.
Keywords: intelligent laser surgery system, minimal invasive surgey, high
power laser system
Abstract: The purpose is to establish a method to measure precisely the
seismocardiogram ( SCG) of patient who lies down in the openMRI machine
for myocardial ischemia monitor during surgery. Vibration isolation was
examined by analizing the gantry vibration during MRI scanning and the
SCG of healthy volunteer . The MRI gantry vibration had the maximum amplitude
of 2.5 m/s2, several peaks more than 100 Hz up to 500 Hz. Up to 94% reduction
was observed on the patient bed vibration under both T1-weighted nad T2-weighted
sequence. Center of the power spectrum of the patient bed vibration was
more than 30 Hz. Maximum amplitude of SCG was 0.92 m/s2 and a FFT analysis
revealed that the SCG was no more than 25 Hz. Signal to noise ratio between
SCG and patient bed vibration was calculated at 7. These results demonstrate
that the peak acceleration of SCG can b monitored during openMRI scanning.
Keywords: Perioperative Myocardial Ischemia, Seismocardiogram, OpenMRI,
Vibration Isolation
Abstract: In this paper we developed a network system to integrate many
surgical applications using Common Object Request Broker Architecture (CORBA).
Client application have the data send module of this system , and sends
data to server using this module. Then server receives the data and sends
to data receive module, which is implemented by other client application.
Using this system, we can integrate surgical application regardless of
their hardware or operating system. We evaluated the performance of this
system using two different clients, Linux and Windows operating system.
Mean of latency is about 1ms in both operating system, and 99.999% of data
is sent to the data receive client in 100 Hz frequency. This result shows
the usability and stability of this system.
Keywords: multi environment, system integration, CORBA
Abstract: We have planned and constructed a new operating room that enabling
us to develop new surgical procedures and to examine our various image-guided
surgery systems and robotic surgery devices through clinical testing. We
have equipped the operating room with several devices. These include a
C-arm and CT and an operating table made of carbon fiber material to be
used for intraoperative patient data acquisition. An optical location sensor,
ceiling-mounted displays, image processing computers and a LCD projector
with a transparent screen have also been integrated into the operating
room setup. We expect these devices to be used alongside new surgical methods
such as robotic surgery and telesurgery. Furthermore, the operating room
has been connected to our institute by an optical fiber network to utilize
our visual super computer.
Keywouds: high-tech navigation operating room, image-guided surgery
Abstract: We have developed a telementoring system using internet protocol
(IP) . This system was effectively utilized to support laparoscopic surgery
and endoscopic mucosal resection for early gastric cancer. In order to
treat patients' data in video confierencing system, we have to pay attention
to the security. This system adopted a secure and high-speed cryptography
of C4S in the virtual private network (VPN) between two hospitals. We confirmed
usefulness of the telementoring system for gastric cancer treatment. Annotation
board, on which instructors can draw lines or figures on the screen for
advice, was a valuable tool . It was suggested that endoscopic treatment
would be safer when telementoring system become popular.
Keywords: LADG, EMR, C4S, ADSL, FTTH, security
Abstract: The purpose of this paper is to construct new mobile network
system for medical image management and group works in the emergency department.
This system consists of Linux mobile server with wireless local area network(LAN)
access point, laptop PCs with steaming video server and DICOM server and
Linux personal digital assistants (PDAs) with a VGA liquid crystal display
(LCD) were connected using wireless LAN (IEEE802.11.b). The mobile server
claims file compatibility with Windows, Mac, PDAs, and UNIX via FTP, NFS,
and CIFS (SMB). Emergency CT, ultrasonography and MRI images are stored
in serves including still images and streaming video files. Preliminary
clinical feasibility is evaluated using this system . Doctors in the emergency
department can easily manage the medical images with this wireless system,
even if there are no available wireless access points. Because this system
provides the wireless network system regardless of LAN connecting services
in the hospital , each doctor with mobile PC or PDA area able to access
the shared image files in the local server and join group works such as
preoperative or postoperative conference without huge LCD projector . This
system is very helpful for " ubiquitous " networking in the operating
room and emergency department of the hospital.
Keywords: wireless local area network, PDA, radiology, emergency medicine
Abstract: Pancreatic islet transplantation is accepted as one of the effective
therapy of type 1 diabetes mellitus. Recent clinical data shows that transplantation
of good quality and sufficient quantity of islet is important to achieve
insulin independent. To obtain high number of good quality islet we have
developed automated two-step degestion method, involving a warm digestion
using collagenase followed by cold mechanical digestion without collagenase.
And we also developed digestion device that consist of digestion chamber,
shaking device,heat exchanger and roller pump.Digestion chamber consisting
of two chambers separated by 290 μm mesh filter. Shaking device has four
springs that make smooth uo-down movement of digestion chamber. Using two-step
digestion method and digestion device we developed , canine islet was isolated.
The yield of islets was 9,463± 3,775 IEq/g and purity was 89.3±6.5. These
successful results demonstrate our digestion method is applicable for clinical
islet isolation of human pancreas.
Keywords: islet isolation, digestion device, outomated two-step method
Abstract: Soft and long silicone rubber tubes (catheters) are commonly
used for conservative treatment in intestinal obstruction (ileus). It is
difficult to pass the passage at the lower end of the stomach(pylorus).
Doctors must be skillful and experienced to insert the tube. Although there
are some method which makes the procedure easier, for example using an
endoscope, using a guide sire, using a long over tube, and attaching weight
at the tip of a tube, easier and actuator has been developed. Doctors can
control bending motion of the tip of the ileus tube easily by applying
electrical current to the SMA actuator from outside the body.
Keywords: SMA, ileus tube, active catheter, actuator, guide wire
Abstract: We proposed and developed new type of micro valve for micro pneumatic
drive. By using this value , we produced safe and active catheter of micro
pneumatic drive. Moreover we conducted the functional verification experiment
of an activity catheter. Good safety and drive performance were verified
experimentally.
Keywords: Active catheter , Hydraulic actuator, Band pss valve, Minimally
invasive surgery, Noninvasive inspection
Abstract: We have developed a treatment support system based on the MR
temperature imaging capability for thermal ablation of liver tumors. The
main hardware components are 0.5T open MR system, optical navigation system,
microwave ablation system, and a computer to totally control the therapeutic
processes. The primary features of the system software are (1) three dimentional
temperature imaging capability as well as specific absorption rate (SAR)
imaging, (2) graphical user interface to specify the target treatment volume
on the pre-treatment images, (3) real-time comparison of the high temperature
or the high SAR regions on the three orthogonal planes with the target
volume to assess completion of the treatment and tissue damage, and (4)
semi-automatic control of the heating device based on the assessment of
the treatment completion. These features were examined and verified experimentally
with livers of swine in vivo under general anesthesia. The system seemed
to be a practical tool for the safe and effective thermal ablation.
Keywords: MRI, thermal ablation, treatment support, temperature, reat Time
Abstract: Due to frequent occurrence of critical medical accidents, risk
management systems have been introduced into medical fields supported by
the Ministry of Health, Labour and Walfare. These systems, however, are
at an initial stage of their development. To prevent medical accidents,
it is indispensable to collect relevant information. Although incident
reports have been collected, the quality is not always sufficient for detailed
analysis. The scope of reports is also rather limited to the ward and incidents
in the operation room are only scarely reported. In addition , detailed
analyses of root causes are further required . Considering the above situation,
a prototype of the medical safety promotion system is developed that systematically
analyses incidents and takes counter measures.
Keywords: adverse drug event, medical safety promotion system, incident
report, profiling
Abstract: At present, there are robot operation system such as da Vinci
of Intuitive Surgical , which realize minimally invasive surgery. In the
operating rom, the staff have to prepare and set the environment where
the robot has optimal feedam of motion and the function of robot can be
fully demonstrated for every case. The range in which the robot can reach
and be maneuvered is restricted by the fixed trocar site. We have developed
a preoperative planning system for the appropriate trocar site in the various
cases of robotic surgery. The motion of the surgical robot could be simulated
in advance with the computation of the interference between robot arms
and the constraints at the trocar site and kinematics.
Keywords: Trocar site planning, Surgical Robot, Kinematics
Abstract: The concept of "Surgery Recorder" for laparoscopic surgery was proposed. The aim for this study is the development of the total surgery recording system adjustable in current clinical spot. First, the surgery recording forceps, which has a 6-DOF magnetic position sensor and a 6-axis force/torque sensor, was developed. The total clinical data consists of forceps' information (position, orientation, force and torque ) , the laparoscopic visual information and the environmental sound information. Surgery Recorder was tested preliminary at in vivo pig experiment and was able to record the above-mentioned significant surgical data to the diaphram and the liver by an doctor.
Keywords: Surgery Recorder, Surgery Recording Forceps, Laparoscopic Surgery,
6-DOF Magnetic Position Sensor, 6-axis Force/ Torque Sensor.