Computer aided medical intervention for Urology...

Computer aided medical intervention for Urology,Colonoscopy and orthopaedic

surgery

France – Singapore Workshop on Medical Imaging and Robotics

Speakers: A/P Ng Wan Sing, Dr Louis PheeVenue: The Oriental Hotel, SingaporeDate: 02 Dec 2002

Robotics in Gastroenterology

Gastroenterology:The branch of medicine concerned with the study and treatment of diseases of the digestive system

OesophagusStomach

Small intestineColon

Rectum

Current Medical PracticesDiagnosis only:•Blood test•Stool test•Imaging (Barium enema, virtual colonoscopy) Flexible

endoscopesDiagnosis & intervention:•Flexible endoscopy(gastroscopy, sigmoidoscopy, colononoscopy)

Endoscopic imagesIntervention procedure

Drawbacks of Flexible Endoscopy

•Pain & discomfort for the patient

•Technical complexity for the surgeon

•Expensive; deters patient from examination

ObjectivesLong-term ObjectiveTo develop a wireless intelligent microcapsule small enough to be swallowed. It would be capable of propelling itself along the entire GI tract inspecting and diagnosing the tissue for abnormalities and performing therapeutic intervention when the need arises.

Givenimaging’s M2A capsule

Today’s Technology

Proposed intelligent microcapsule

Tomorrow’s Technology

ObjectivesShort-term ObjectiveTo develop effective locomotion devices to enable a wired device to propel itself, autonomously or semi-autonomously, into the colon. In parallel, a vision system, sensors and actuators would be integrated into the device to increase its functionality.

Colon – 1st Target Organ

State-of-the-art – In-pipe Robots

Hirose & Yoneda Robotics Lab, Japan

Fukuda Lab, Japan

North Carolina State University

State-of-the-art – In-body Semi Autonomous Devices

J.Burdick et al.

(Caltech)

The EndoCrawler

Phee et al.

Robotics in Urology

Urology:The branch of medicine concerned with the study and treatment of diseases of the urinary tract

BladderKidneyUrethralProstate

Male reproductive organ

The Prostate

The prostate is a gland of the male reproductive system. It is located in front of the rectum and just below the bladder.

The main purpose of the prostate is to produce fluid for semen, which transports sperm during the male orgasm.

State-of-the-art

A six axis PUMA robot modified to perform Transurethral Resection of the Prostate (TURP)

B. Davies et al., Imperial College London

State-of-the-art

PRobot – A robot for prostatectomy and Transurethral Resection of the Prostate (TURP)

B. Davies et al., Imperial College London

State-of-the-art

URobot – A robot to treat BHP using Interstitial Laser Coagulation (ILC), laser resection and hot loop TURP.

W.S. Ng et al., Nanyang Technological University

State-of-the-art

System Cart

Visual Display Unit

Supporting Manipulator

Laser Probe Manipulator

Mobile base unit

or Diode laser

Touch screen

Patient

Motion controller

Graphics card

Frame grabber

Host computer

ISA

PCI

Kretz Ultrasound

scanner

Ultrasound display

Foot pedal Foot pedal

Surgeon

Base

Payload – laser applicator manipulator

Endoscope, Albaran bridge and laser applicator

Transurethral ultrasound probe

Supporting manipulator

Ultrasound signal and data

Video signal

Control signal and data

ILC Robot – A robot to treat BHP using interstitial laser


Nd:YAG coagulation (ILC)

State-of-the-art

SPUD (Surgeon Programmable Urological Devce)– Latest version of the URobot


State-of-the-art

HIFU Robot – A robot to treat prostate cancer using High Intensity Focused Ultrasound (HIFU)


Biopsy Robot for Prostate

Present Situation•Gross spatial inaccuracies as surgeon tries to locate a point in space based on 2-D images•High false-negative results•Multiple punctual holes on perineal wall

Objectives•To reduce false-negative results with accurate biopsy of the prostate•To perform multiple biopsies with a single puncture hole

Penis

Scrotum

Anus

Perineal wall


Ultrasound Machine Biopsy Robot Computer Module


Transrectal UltrasoundProbe

Biopsy Gun

Biopsy Needle

Surgical PlannerPositioning of robot w.r.t. patient

Acquisition of U/S images

Delineation of prostate boundary

3D Modeling of prostate

Definition of points of interest

Adjustment of trajectory of needle

Insertion of needle & firing of biopsy gun

Acquisition of U/S Images

Surgical Planner


Positioning of robot w.r.t. patient






Delineation of Prostate Boundary

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2

4

3

5

1

2

3

1

2

4

3

1

2

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2

4

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Surgical Planner








3D Modeling of Prostate

Surgical Planner








Definition of Points of Interest

Manually defined

point of interest

Needling simulation

Surgical Planner








Experiments

In VitroPhantoms

Animal Trials

CadaversClinical Trials

Future Works

•Incorporation of Magnetic Resonance Spectroscopy (MRS) images to pinpoint sites for biopsy

•Modification of robot for Brachytherapy; strategic implantation of radio-active pellets in the prostate for the treatment of prostate cancer

Predetermined

Cancer sites

Computer aided medical intervention for Urology...

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