1 TOOLS FOR ASSISTED SURGERY. APPLICATION IN THE AREA OF LAPAROSCOPY Veronika IVANOVA Bulgarian Academy of Sciences Institute of Systems Engineering and Robotics

2 Plan of presentation I. Bulgarian Academy of Sciences; Institute of Systems Engineering and Robotics II. Main problems in Laparoscopy III. Current state of Art IV. Tools for assisted surgery. Application in the area of Laparoscopy V. Some Ideas for Future work

3 Bulgarian Academy of Sciences

4 Bulgarian Academy of Sciences 9 research fields: Information and Communication Sciences &Technologies – with 4 Institutes: ISER …. Energy Resources and Energy Efficiency Nanosciences, New Materials and Technologies Biomedicine and Quality of Life Biodiversity, Bioresources and Ecology Climate Changes, Risks and Natural Resources Astronomy, Space Research and Technologies Cultural-Historical Heritage and National Identity Man and Society

5 Bulgarian Academy of Sciences Systems Engineering: Sensors, actuators, measurements technologies Bioengineering Integrated systems Hybrid systems Robotics and Mechatronics : Robotized executive mechanisms and Intelligent systems Unique instruments, components and structures Mechatronic Technological Systems Modeling and fractal analysis of information systems Institute of Systems Engineering and Robotics

6 Bulgarian Academy of Sciences CNS CERN Switzerland Machine which has been creating high energy collisions of protons to investigate dark matters and antimatters to find hicks boson Robot Shadow -7 th FP-for help of elderly people Some PROJECTS where ISER takes part:

7 Tools for assisted surgery Application in the area of Laparoscopy Main Objectives: To provide better treatments and healthcare for patients To design instruments to restore the surgeon to sense of touch in process of laparoscopy To respond Medical requirements to Techniques don’t upset function of the human body

8 Tools for assisted surgery. Application Main Problems Laparoscopic surgery rapidly evolves as minimally invasive surgery The lack of the tactile sense is the most important disadvantage associated with laparoscopy because it limits surgeon abilities to diagnoses and treatment some surgical problems

9 Family tools for assisted surgery Main Problems The lack of tactile sense is due to the specifics of the operation and construction of the instrument Despite of this problem, applying of laparoscopy is increasing, and this leads to development for innovative techniques, tools and methods for an elimination of this disadvantage

10 Current state of the art No everyone development is implemented in surgical rooms Modifications of industrial robots for medical applications are not the best decisions Surgical Robots for assistance, robots for main procedures, both of them Surgical robots which are designed for define area are applied in other because of similar manipulations Novel direction in MIS - Single port access

11 Current state of the art-EXAPMPLES AESOP-INDUSTRIAL ROBOT MODIFICATION EndoAssist INDUSTRIAL ROBOT MODIFICATION

12 Current state of the art-EXAMPL LER by TIMC – Laboratory of Techniques for biomedical engineering and complexity management – informatics, mathematics and applications – Grenoble

13 Current state of art-EXAMPLE Laparoscopic Instrument By Technische Universität München, Germany

14. Introduction of robots in MIS considerably enhance the accuracy of medical interventions. Intelligent robot control can filter hand tremor and increase accuracy by motion scaling Following of complex, accurate directions; daVinchi Robot by Intuitive Surgical Inc Current state of the art

15 Current state of the art But investigations of current robot instruments are indicated to have some technological deficiencies the main of which is lack of tactile sense ZEUS by Computermotion company

16 Current state of art Research in the area of laparoscopic tools with force measurement capabilities has led to significant advancements over the past several years Researchers have retrofitted conventional laparoscopic instruments with force and position sensors, developed novel laparoscopic tool with sensors incorporated into their design, and have also developed entire robotic surgical systems with force sensing/reflection capabilities

17 Current State of Art Several researchers have applied direct sensing methods for tissue characterization (Robotics, Intelligent Sensing, and Mechatronics Laboratory, University -Philadelphia) In medicine and especially for laparoscopy these methods are expensive, non-sterilizable, and not modular, which make them difficult to incorporate into laparoscopic tools

18 Current State of Art Indirect sensing methods - involve placing the sensor away from the location of the measurement (for example, determing the grasping force based on the motor current driving the jaws through the cable transmission)

19 Tools for assisted surgery. Application in the area of laparoscopy

20 Tools for assisted surgery. Application in the area of laparoscopy 1-stoper 2 – corpus of sensor 3 and 7-FSS Low Profile Force Sensors of Honeywell Company 4 and 6-contact zone of the sensors (3 and 7) 5 horizontal shoulder of slider 8- lock cap 9-vertical shoulder of slider; 10-console 11-input axis 12-output axis

21 Tools for assisted surgery. Application in the area of laparoscopy

22 Tools for assisted surgery. Application in the area of laparoscopy Where: X = [0: :1500]-input date Y= [0:0.1500:1500]-output date In that (ideal) case Output date has to equal to input date (Output Force has to equal to input Force)

23 Tools for assisted surgery. Application in the area of laparoscopy Synthesis of elastic links for rigid irregular shape objects

24 In laparoscopic surgery are mostly known instruments with 2 rigid links

25 Same Ideas for FUTURE WORK Further developments should provide elaborated solutions to soft-tissue modeling and interaction with high application accuracy and human-machine interfaces A computer program should include information about various models of tissues The information obtained from sensors in the handle can be used for find the appropriate tissue model and submitting the necessary command to force interaction between instrument and tissues Some experiments with the modular synthesized elastic and rigid links can be realized by the new method for sensitive control The investigation can be made with materials with similar properties of human tissues and to compare results THANK YOU FOR YOUR ATTENTION