Telepresence World 2007 La Jolla, CAJune 4, 2007

Telepresence World 2007 La Jolla, CAJune 4, 2007

A Military Perspective Future of Telepresence Surgery

A Military Perspective Future of Telepresence Surgery

Richard M. Satava, MD FACSProfessor of Surgery

University of Washington

Richard M. Satava, MD FACSProfessor of Surgery

University of Washington

of the

Presenter Disclosure SlidePresenter Disclosure Slide

Richard M. Satava, MD FACS

InTouch Health, Inc

Karl Storz

METI, Inc

Premiera BC/BS

Stryker

SimuLab

US Surgical

Battlefield Surgery – Initial Premise - 1992

Bring the operating room to the wounded soldier, not the casualty to the OR

Change the “Golden Hour” into ….. the “Golden Minute”

Information basis for surgery

Borrow from Industry - CAD/CAM

Follow military research projects

Information basis for surgery

Borrow from Industry - CAD/CAM

Follow military research projects

The Fundamental Changes

From tissue and instruments

to

Information and energy

From tissue and instruments

to

Information and energy

The Fundamental Concept

Holomer Total body-scan to “replace” patient

Holomer is the CAD/CAM model of patient1. Pre-operative planning2. Surgical Rehearsal (including ‘editing’)3. Intra-operative navigation and image guidance4. Automation of procedure5. Post-op comparison (objective assessment & outcomes analysis)

Why robotics, imaging and modeling & simulation• Healthcare is the only industry without a computer representation of its “product”

• A robot is not a machine . . . it is an information system with arms . . .

• A CT scanner is not an imaging system it is an information system with eyes . . .

thus

• An OR is an information system with . . .

The key to total integration is through Information Systems

That is the secret of the Information Age

Total Integration of Surgical Care

Joel Jensen, SRI International, Menlo Park, CA

Minimally Invasive Surgery

Pre-operative planningIntra-operative navigation

Remote Surgery

Simulation & Training

seeing/touching tissue with imagingmechanical instruments with energy

Courtesy Larry Crum, Univ Washinton Applied Physics Lab, 1999

• Changes tissue to information•Changes mechanics to energy • Simultaneous Dx & Rx

High Intensity Focused Ultrasound for

Non-invasiveAcoustic hemostasis

HIFU

Replacing

Trans Oral Intra-peritoneal Surgery - Future

Courtesy of N Reddy, Hyperbad India 20005

Courtesy of N Reddy, Hyperbad India 20005

Peroral Transgastric Endoscopic SurgeryNatural Orifice Transluminal Endoscopic Surgery (NOTES)

Mechanical (prehistoric) instrumentation

DaVinci Surgical Workstation

Conventional colonoscopy and NOTES

Future ofEndoscopic and NOTES:A Surgical Workstation?

[ Courtesy R Satava, GI Clinics North America, 1983]

So What ?

“Penelope” – robotic scrub nurseMichael Treat MD, Columbia Univ, NYC. 2003

ROBOT SURGICAL TECHNOLOGIES, INC

Currently in Clinical Trials

Integrating Surgical Systems for AutonomyThe Operating Room (personnel) of the Future

Satava March, 2000

Surgeon Scrub Nurse Circulating nurse

100,000

The Operating Room of the Future

SATAVA 7 July, 1999DARPA

Fighter Pilots – until 2002 Fighter Pilots – Beyond 2003Predator 2003

28 Training & Simulation Journal August/September 2006

“Remote Pilots”

A last bastion of guts-and-glory aviation is falling, as the U.S. Air Force prepares to unveil a new breed of unmanned aircraft pilots. Known as “remote pilots”, they’ll wear wings. They’ll fly aircraft. But chances are many will never climb into a cockpit. . Senior leaders have yet to approve the new Undergraduate Remote Pilot Training (URT), but Air Force officers familiar with the project expect approval by the end of the year. Instead of sticking reluctant manned aviators behind a console, the Air Force will groom remote pilots from the start to fly what the service now calls unmanned aerial systems

Tissue Engineering

Liver Scaffolding

Artificial Blood VesselAtala A, Bauer SB, Soker S, Yoo JJ, Retik AB.Tissue-engineered autologous bladders for patients needing cystoplasty. Lancet (2006) Apr 15; 367: 1215-6

Artificial Ear

J. Vacanti, MD MGH March, 2000

Cold Spring Harbor Laboratory, Long Island, NY

Femtosecond Laser(1 x 10 –15 sec)

Time of Flight Spectroscopy

Cellular opto-poration

Los Alamos National Labs, Los Alamos NM

Surgical console for cellular surgery

Courtesy Prof Jaydev Desai, Drexel Univ, Philadelphia, PA 2005

Surgical console for cellular surgery

Courtesy Prof Jaydev Desai, Drexel Univ, Philadelphia, PA 2005

Motion Commands

Surgical Cockpit

Thoughts into Action

Do Robots Dream ?

http://depts.washington.edu/biointel