Imperial College of London (UK): robotic surgery

Image Guided Intervention and Robotic Surgery

"By integrating therapeutic tools and techniques with pre-operative and intra-operative imaging, patient-specific information such as the location of internal structures and pathologies can be used for effective planning and surgical guidance. Robotics surgery is a further extension to minimally invasive surgery, which aims to replace the manipulation and sensation capabilities of the surgeon that were lost in conventional minimally invasive surgery. Some of the key research challenges to be addressed include real-time tracking of instruments in minimal invasive surgical procedures, development of 3D navigation and guidance based on pre-operative and intra-operative imaging, and gaze contingent motion compensation of soft tissue deformation."

Modelling and assessment of surgical dexterity using synchronised video-motion analysis and Hidden Markov Models

"The introduction of Minimally Invasive Surgery (MIS) in the early 1980s changed the way operations are performed. Smaller incisions, trauma minimization, faster recovery time and less pain are some of the advantages of MIS. Endoscopic surgery also brought difficulties to the surgeons including instrument manipulation problems, hand movement constraints and the need for continuous training and assessment. The role of an objective system providing feedback regarding surgical dexterity has become critical and various techniques have been investigated including motion analysis, video scoring, etc. Analysis of the movements performed by the hands of the surgeon has been thoroughly validated and is widely used to assess technical skill due to its reliability and speed of calculation. However, this type of analysis provides quantitative metrics that are only indirectly related to the quality of the task/operation. Video-based assessment tools such as the Objective Structured Assessment of Technical Skills (OSATS) are also commonly used as they enable a more qualitative assessment of performance, but they are time consuming and reliability between observers can be an issue. A system combining these two methodologies to provide an integrated assessment tool that allows for the generation of both global and task specific reliable quantitive metrics and facilitates the indexation of the video footage for qualitative evaluation is thus highly desirable. It is the aim of this project to develop an integrated surgical assessment system for laparoscopic and robotic surgery using synchronised video-motion analysis and stochastic modelling based on Hidden Markov Models."

Robotic and Haptic Systems for Minimally Invasive Surgery:

Telemanipulator approach:
"The introduction of surgical robots in minimally invasive surgery and changes in instrumentation are aimed at improving the dexterity in a confined surgical space. Improvements in endoscopic technology, such as the introduction of video direct 3-D vision, are helping the transformation of conventional 'open' procedures into minimally invasive robotically assisted ones. Nevertheless, when internal organs are not in view, more information is required to make a decision. During robotically assisted cardiac surgery where only an enclosed and small area of the heart is visible, there are forbidden regions (such as those containing veins and arteries) which must be protected, as well as regions in which the robot can freely move. Excessive force can damage or completely destroy tissues or objects. On the other hand, a minimal amount of force is needed for decisive gripping, particularly when gripping solid objects such as needles. The aim of this project is to investigate the requirements for a haptic system in robotically assisted cardiac surgery and to develop the concepts of active constraints in the spatial and force domains."

Visualisation and Augmented Reality

"Medical images contain a wealth of anatomical and physiological information. Unfortunately their current exploitation is mostly purely qualitative. Observations are typically done in 2D, cross-section by cross-section and one modality at a time. Our aim in this area is to make available for routine use 3D and 4D (3D + time) image analysis, visualisation and manipulation techniques to aid in the diagnosis and treatment of patients. Research topics include haptically enhanced 3D and 4D visualisation and interaction, application of quantitative 3D and 4D anatomical and physiological measurements in diagnosis, simulation and treatment planning and patient-specific models of anatomy for simulation, training and assessment of surgical skills.

During an intervention, Augmented Reality (AR) allows pre-operative and intra-operative images to be combined and provide useful additional information to the surgeon such as the location of internal structures and/or pathologies. This information is used by the surgeon to ‘navigate’ and can guide him to the target and help his decision making. Our aim in this area is to provide AR facilities for minimally invasive surgery procedures. Research topics include real-time 2D video to 3D medical image registration algorithms, real-time tracking of instruments, definition of anatomically relevant active constraints and optimised port placement in robotic assisted laparoscopic surgery."

Imperial College of London, Department of Biosurgery and Surgical Technology

==> Robotics and Imaging (Imperial College of London)

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