First all-robot surgery performed at McGill University

By Joseph L. Flatley

From http://www.engadget.com/

 

A team of surgeons at McGill University, including the da Vinci robo-surgeon and a robot anesthesiologist named, of all things, McSleepy, recently removed some dude's prostate during what is being billed as the world's first all-robotic surgery. The device transmits hi-def 3D images to a nearby workstation, where it is controlled by surgeons "with a precision that cannot be provided by humans alone," according to MUHC urologist-in-chief Dr. A. Aprikian. Of course, the robots are being kept on a tight leash by their human operators, with McGill's Dr. Thomas Hemmerling pointing out that "[r]obots will not replace doctors but help them to perform to the highest standards." Just tell that to all the other medical robots we've seen in this space, eh, doc? We've heard they have plans. Bad plans.

TG Daily, Daily Mail

Robotic Surgeons Take Over at a Hospital Near YouPo

When steady hands are not precise enough, surgeons rely on sophisticated assistants.

The tool-wielding wrists of the da Vinci can rotate 540 degrees and have seven degrees of freedom, making the tools of the mechanical surgeon more dexterous than instruments held in human fingers.

By Amber Angelle

Illustration by Remie Geoffroi

Popular Mechanics - Published in the October 2009 issue.

Once considered oddities, multiarmed tools are becoming mainstays of hospital operating rooms. The industry trailblazer in the human–robot medical team is the da Vinci HD Surgical System, a multiarmed assistant that is directly controlled by a surgeon who sits at a nearby console. The system, made by Intuitive Surgical of Sunnyvale, Calif., has been steadily adopted by hospitals performing urology, gynecology and cardiology operations since the HD’s introduction in 2006. A new version of the da Vinci includes a powerful high-definition camera, a fourth arm for complex procedures, and dual control stations used for teaching new surgeons or to allow two doctors to collaborate during surgery.

Jim Hu, a surgeon at Brigham and Women’s Hospital in Boston, has removed more than 600 cancerous prostates with the da Vinci. He says that robotic assistance allows him to overcome the limitations of human doctors, allowing smaller incisions and less blood loss. The system even auto-corrects for any shaking as the doctor manipulates the tools from the console. But could the assistant one day operate without a doctor’s guidance? “Unless they develop artificial intelligence that can recognize variations in human anatomy, physicians will always be needed,” Hu says. “But who knows? If you had told me when I was in medical school in the ’90s that I would be using a robot to make incisions one day, I wouldn’t have believed it.”

Examples of instruments:

Meet the real-life human cyborgs

Digital eyes, USB fingers - implants aren't just for Jordan

The US military HULC exoskeleton

Lockheed Martin

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Stelios Arcadiou has an ear growing out of his arm. Rob Spence has a video camera hidden in his false eye. Jerry Jalava's finger is a detachable USB drive. Kevin Warwick – yes him – likes nothing better than sticking radio chips under his skin or connecting his central nervous system to robot arms.

Four very different men with four very different kinds of technology, but they all have one thing in common: they're cyborgs.

We've had cyborgs for a long time - the term was originally coined in 1960 to describe people whose bodily functions were aided or controlled by technology, so for example anyone with a pacemaker or hearing aid is a cyborg.

In recent years, however, we've gone beyond using tech to fix bits of us when they break. Increasingly, we're using technology to expand the possibilities of the human body and to blur the lines between (wo)man and machine.

But do we really need ears in our arms?

Ear we go

Stelios Arcadiou, aka Stelarc, probably isn't the template for Humans 2.0: his extra ear, grown in a lab from cells, is part of an ongoing performance art project designed to make us think. In interviews, he explains:

"I'm speculating on ways that individuals are not forced to, but may want to, redesign their bodies - given that the body has become profoundly obsolete in the intense information environment it has created…

"We shouldn't have a Frankensteinian fear of incorporating technology into the body, and we shouldn't consider our relationship to technology in a Faustian way - that we're somehow selling our soul because we're using these forbidden energies. My attitude is that technology is, and always has been, an appendage of the body."

Rob Spence is making a point, too. As the Toronto film maker explains: "I am a filmmaker who lost an eye so naturally I decided to modify my prosthetic eye into a video camera. I am not a lifecaster. I will use the eye-cam the same way I use a video camera now - or the same way any filmmaker would use a camera enabled cell phone."

Spence is working on a documentary "about how video and humanity intersect, especially with regards to surveillance."

ALL-SEEING EYE: Rob Spence's Eyeborg project uses a secret video camera implanted in his false eye

That doesn't mean artificial eyes and embedded cameras aren't coming. At MIT, researchers have developed a digital eye that enables the blind to see. At first, it was a giant machine costing $100,000. Then, a $4,000 desktop system. Now it's portable and costs around $500.

Elswhere at MIT you'll find Sixthsense, a wearable computer that uses a camera as an input device and nearby objects as display screens. The current prototype costs just $350 to build.

Rob Spence's eye uses a camera sensor developed by OmniVision, which specialises in high quality cameras for medical devices such as endoscopes. The firm is also working closely with Stanford University's Daniel Palanker on the Retinal Prosthesis project, a hugely complex and ambitious attempt to use sub-retinal implants to restore blind people's sight.

As an OmniVision spokesperson told us, the firm "agreed to participate in the project to jump-start and/or fuel research to provide vision for the blind."

Palanker has published a number of scientific papers detailing the project, and they make fascinating reading. In Design of a high-resolution optoelectronic retinal prosthesis [PDF] he explains how "an image from a video camera is projected by a goggle-mounted collimated infrared LED-LCD display onto the retina, activating an array of powered photodiodes in the retinal implant." Essentially the digital eye enables the blind to see again.

Hands-on technology

When Jerry Jalava was fitted with a prosthetic finger after a motorbike accident, he decided to make the finger more useful - by turning it into a USB drive containing Linux and some key applications.

"I'm planning to use the other prosthetic as a shell for the next version, which will have [a] removable fingertip and RFID tag," he writes.

Prosthetics have come a long way in recent years, with amputees being able to take advantage of myo-electric prosthetics that work just like real limbs. For example in May, Dawn O'Leary was fitted with a prosthetic arm that offers similar fine motor control to a real arm.

Sensors on her skin pick up nerve signals and operate the digits, enabling her to carry out complex tasks such as grasping the handle of a cup.

Researchers in Chicago have gone even further. The Neural Engineering Center for Artificial Limbs has developed techniques that combine myo-electric limbs with nerve transplants to deliver even finer motor control, with patients even being able to feel the objects they grip or touch. You can see the technology in action on YouTube.

TOUCH AND FEEL: Jesse Sullivan operates a bionic arm via nerve signals [Image from RIC video]

Arms and the man

Sadly the "bionic arms race" owes much to a very real arms race. In 2005, the US military announced a multi-million dollar investment in prosthetic technology after a surge in the number of US soldiers losing limbs in Afghanistan and Iraq.

Improvements in body armour technology mean that attacks that just a few years ago would be fatal are now survivable - but the armour doesn't protect limbs.

Inevitably the military isn't just interested in rehabilitating injured soldiers. It's rather keen on enhancing soldiers' effectiveness in battle, too, which is why it's testing exoskeletons.

Earlier this year, Lockheed Martin inked a deal with Berkeley Bionics to develop the HULC - Human Universal Load Carrier - "to provide soldiers [with] a powerful advantage in ground operations." [PDF]

STRONGER SOLDIERS: The HULC exoskeleton isn't sci-fi: Lockheed Martin is working on it with the US Military [Image: Lockheed Martin]

The big problem with such technology is that it needs power. Military versions are powered by battery packs or small combustion engines, while civilian prosthetics tend to use batteries.

That might change. US and Canadian scientists have found a way for prosthetics to generate power. As Dr Douglas Weber of the University of Pittsburgh told the BBC, "All of the new developments in prosthetics require large power budgets. You need power to run your neural interface; you need it to run your powered joint; and so on."

The solution? A modified knee brace that uses regenerative braking technology to turn movement into electricity.

Tech on the brain

Professor Kevin Warwick - dubbed "Captain Cyborg" by The Register - is famous for headline-chasing ideas such as implanting RFID chips under his skin or attempting telepathy by connecting two people's brains to computers, but behind the headlines he's doing some useful and potentially far-reaching work.

Warwick is helping to develop a new generation of Deep Brain Stimulation equipment, which uses electrodes to make an amazing difference to the symptoms of Parkinson's Disease, and in 2008 he unveiled Gordon the robot.

Gordon is no ordinary robot: he's controlled by living brain tissue. As Warwick explains: "The purpose is to figure out how memories are actually stored in a biological brain… if we can understand some of the basics of what is going on in our little model brain, it could have enormous medical spin-offs".

While Warwick and his colleagues are trying to find out what makes us tick, other researchers are finding new ways of making us shriek.

In 1998, Dr Stuart Meloy was implanting electrodes in a patient's spine to make her feel better - but to say he exceeded his remit would probably be an understatement. "You'll have to teach my husband how to do that," the patient told him, moaning with pleasure.

Since then Meloy has been studying the effects of electrodes on the pleasure centres of our brains, and his device - inevitably dubbed the Orgasmatron - will be on sale within a few years.

As Meloy told the LA Times, unlike most medical devices the Orgasmatron won't be tested on animals: "I don't know how to ask animals 'where do you feel the tingling?' or 'do you want a cigarette?'"

SPINE TINGLING: The orgasmatron stimulates the nervous system to induce orgasm - but don't expect to see it in Ann Summers any time soon

So are USB fingers and extra ears part of our future? Probably not. They're impressive but not exactly essential or even particularly worthwhile, and while military exo-skeletons are interesting in an "eek! Terminator!" kind of way the real advances are medical.

From digital eyes that restore sight to prosthetic limbs that generate their own power, work like real limbs and even provide sensory feedback, technology can repair, replace and possibly even improve upon the human body.

Experiments such as Gordon the robot could shed light on the way our brains work, and in the (very) long term computers may even be able to detect and transmit our very thoughts, enabling us to communicate almost telepathically.

If you think Twitter is pretty tedious now, you ain't seen nothing yet.

World’s First Successful ViKY Robot-assisted Surgery For Pancreatic Tumors

"The new ViKY robotic laparoscope holder acts as an extra hand during surgery, giving me stability and steadiness," said Dr. Gumbs. (Credit: Image courtesy of Fox Chase Cancer Center)

ScienceDaily (Mar. 27, 2009) — This month Fox Chase Cancer Center performed the world's first successful minimally invasive distal pancreatectomy using the ViKY® system's revolutionary robotic, compact laparoscope holder. The technology, developed in France and tested on thousands of patients in Europe, made its debut in a cancer setting in the United States at Fox Chase.

"Fox Chase is among only a handful of institutions worldwide using robotics or laparoscopy to treat patients with nearly all types of cancer," says Robert G. Uzzo, MD, FACS, chairman of the department of surgery at Fox Chase. "The use of technology, like the ViKY system, reinforces our Center's commitment to excellence in minimally invasive surgical techniques for the care of patients with both benign and cancerous conditions."

Fox Chase surgeon Andrew A. Gumbs, MD, who specializes in minimally invasive hepato-pancreatic and biliary (HPB) surgery, explains, "This system is so versatile that surgeons like me are able to use it for many different laparoscopic procedures, including those in the gastrointestinal, urologic, thoracic and gynecologic regions."

Typically with minimally invasive procedures, like a laparoscopic distal pancreatectomy, surgeons use both hands to manipulate the surgical tools and need an assistant to manipulate the endoscope—a thin, lighted tube equipped with a camera that allows the surgeon to view the surgical field.

Gumbs performed this first ever ViKY assisted minimally invasive distal pancreatectomy on a 65-year-old man who was diagnosed with two pancreatic cysts, one of which is potentially cancerous. Pathologists are currently evaluating the cyst.

"The new ViKY robotic laparoscope holder acts as an extra hand during surgery, giving me stability and steadiness," adds Gumbs. "The view of the surgical field is critical, so ViKY's pinpoint accuracy helps me perform more complex procedures laparoscopically." Unlike typical laparoscope holders, the ViKY system's holder is lightweight, easy to set up and use, and takes no floor space.

Standard treatment for pancreatic cancer is surgery to remove the head or tail of the pancreas. When patients present with pancreatic cancer localized to the tail of the pancreas (instead of the head), they undergo a distal pancreatectomy, in which the surgeon removes the tail of the pancreas and leaves the head attached. The remaining portion can function normally by producing and releasing digestive enzymes and hormones. Patients with pancreatic cancer are typically treated with surgery followed by radiation therapy and/or chemotherapy to reduce the risk of recurrence.

The ViKY system gave Gumbs precise control of the laparoscope while he performed the distal pancreatectomy. The endoscope moves according to the surgeon's orders, either through voice recognition or footswitch control.

Before the ViKY technology was available patients might have undergone open surgery. Depending on the complexity of the case, the surgeon may have considered open abdominal surgery, requiring a large incision and a lengthy recovery. Minimally invasive surgical techniques, like the surgery Dr. Gumbs performed, benefit patients in many ways, including a shorter hospital stay, faster recovery, quicker return to daily activity, less risk of infection and less scarring and bleeding.

Gumbs was the first American surgeon to complete a minimally invasive HPB fellowship at the Institut Mutualiste Montsouris in Paris, France. This is the hospital where the first published case of a single incision laparoscopic cholecystectomy in the world was done using the ViKY system. Gumbs is responsible for bringing the ViKY system to Fox Chase and will be training fellow surgeons on this technology.

The ViKY system is manufactured by Endocontrol Medical in La Tronche, France. Endocontrol is an innovative company offering robotic solutions for endoscopic surgeries. Endocontrol was created by Clement Vidal and Patrick Henri of Joseph Fourier University, Grenoble, France, a worldwide leader in computer assisted and robotic surgery.

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Adapted from materials provided by Fox Chase Cancer Center.

Md. surgeons remove donated kidney through vagina

By ALEX DOMINGUEZ, Associated Press Writer

AP – Kim Johnson, who donated a kidney to her niece four days earlier, poses for a portrait at a relatives …

BALTIMORE – Surgeons removed a woman's kidney through her vagina so she could give it to her ailing niece, an unusual operation they hope will encourage others to donate because it reduces pain, scarring and recovery time. Doctors at Johns Hopkins University School of Medicine said donor Kimberly Johnson, 48, and her niece, Jennifer Gilbert, 23, were both doing well following operations Thursday.

"It was easier than childbirth," said Johnson, who has three children.

Transvaginal kidney removals have been done before to remove cancerous or nonfunctioning kidneys, and other diseased organs have also been removed through mouths and other orifices. Many donated kidneys are removed laparoscopically, through small keyhole incisions.

But hospital officials think this may be the first time a donor kidney was removed through the vagina.

The operation left three pea-size scars on the Lexington Park woman's abdomen, one hidden in her navel. Surgeons hope the procedure will lead more women to become donors, said Dr. Robert Montgomery, chief of the transplant division at Johns Hopkins, who led the team that performed the surgery.

Johnson said the operation was less painful than gall bladder surgery and she is recovering more quickly than Gilbert's father, who gave his daughter a kidney 12 years ago.

Gilbert, of Baltimore, needed the first transplant because repeated infections had destroyed the kidneys she was born with. She needed the second after she began suffering chronic rejection.

Johnson, an assistant sales manager for a St. Mary's County newspaper, said she was able to get out of bed Thursday night, the same day the kidney was removed.

Quicker recovery and less pain are the key benefits of the new technique, said Montgomery and Dr. Anthony Kalloo, the director of the Division of Gastroenterology at Johns Hopkins and a pioneer of the method of using natural orifices for organ removal.

Kalloo said more than 300 such surgeries have been performed worldwide, mostly gall bladder and appendix removal through the mouth, anus and vagina. Kalloo said there has been some resistance in the medical community because of concerns, for example, that stomach acid could leak into the abdominal cavity in operations where organs were removed through the mouth.

Dr. Jihad Kaouk, a urologist and director of the Cleveland Clinic's Center for Laparoscopic and Robotic Surgery, is among those concerned about contamination. He was not involved in Johnson's surgery.

"There is the risk of infection having the kidney passing through a contaminated area and then going to another patient who is immunocompromised," Kaouk said. "That is the concern we have and we would like to monitor the outcome in that regard."

In Johnson's case, Montgomery said a plastic bag placed into her abdominal cavity through a tiny incision protected the donated kidney from contamination by bacteria and other organisms in her vagina. Johnson was chosen because she has had a hysterectomy, which made the operation easier, but the procedure could be used without affecting women's ability to give birth, he said.

More than 78,000 people are on the national waiting list to receive kidneys from deceased donors. The need is increasing as diabetes and obesity rise, threatening to further lengthen a wait that can last years. In 2007, more than a third of the 16,629 kidneys transplanted in the U.S. came from living donors, according to the United Network for Organ Sharing.

Montgomery said the number of living donor transplants has tripled since laparoscopic removal debuted in 1995, providing an alternative to so-called "shark bite" abdominal incisions. He hopes advances such as the vaginal removal will continue the increase.

"We think she'll be probably back to her normal activities within a week or two," the transplant surgeon said. Recovery from laproscopic surgery typically takes several weeks. "So, that greatly reduces the inconvenience of donating and we're hoping that will encourage more people to donate."