Robo-surgery: combining computers and robotics for better operations

Robo-surgery. Although this may sound like some distant scenario from a Jetsons episode, robotic tools and computers are being used in operating rooms all across Canada to improve surgery and reduce the strain on our health care system.

Researchers from the Institute of Robotics and Intelligent Systems (IRIS), a federal Network of Centres of Excellence (NCE), are continuously developing cutting-edge robotic technology to improve surgery so patients suffer less and have a greater variety of treatments options and so that surgeons can perform surgery more accurately and with less stress.

The IRIS NCE links 136 of Canada's best researchers at 21 universities and 21 firms, hospitals and research agencies, with 86 private-sector companies so that their research can be more quickly developed into marketable products. IRIS is managed by PRECARN Associates, a national industrial consortium that conducts research in intelligent systems and robotics.

The Networks of Centres of Excellence program is a federal program jointly funded by the Natural Sciences and Engineering Research Council (NSERC), the Medical Research Council (MRC), and the Social Sciences and Humanities Research Council (SSHRC) in partnership with Industry Canada. The NCE funds going to IRIS help support 29 projects and represent an average annual investment of $5.1 million in Canadian research and development.

In one of these 29 projects, researchers at the University of British Columbia have created a small mechanical device that acts as an imaginary scalpel which simulates surgery and can be used to train surgeons. When a person moves the device, they see the 'scalpel' moving on a computer screen. They can actually feel the resistance when the scalpel touches skin or an organ, a response they call force feedback.

"Using this system to train surgeons would make cadavers less necessary for medical schools," says Leo Stocco, a University of British Columbia student who designed the device for his PhD thesis. "You would also be making mistakes on the computer, not on people."

Mr. Stocco's thesis advisor, Dr. Tim Salcudean, associate professor in the department of electrical and computer engineering at UBC, is leading a team developing robotic tools for heart surgery. These tools will hopefully make it possible to perform coronary bypass surgery without stopping the heart — a feat Dr. Salcudean says could lead to fewer post-operative complications and shorter hospital stays for patients.

Under the direction of Dr. Jim McEwen, adjunct professor at UBC, Dr. Salcudean and Dr. Peter Lawrence, also an electrical and computer engineering professor at UBC, a team of engineers and graduate students have developed methods to evaluate the results of shoulder surgery by looking at how much, and with what level of comfort, patients can move their arm before and after surgery. This technology, now being commercialized by a Vancouver-based company, will allow doctors to select the best and most cost-effective procedures for treating shoulder injuries.

At nearby Simon Fraser University, researchers are developing tools to improve endoscopic surgery. Endoscopic, or minimally invasive surgery, is performed by long surgical tools and endoscopes (miniature cameras lenses) that are inserted through small incisions in the patient's body to reach the site of the operation. But with existing technology, all of the natural movements and the sense of touch of a surgeon's hand can't be extended into the surgical site. This introduces many new problems when this otherwise beneficial type of surgery is compared with conventional open surgery.

In endoscopic surgery, keeping a tool fixed in a certain position is a routine task usually done by an assistant surgeon. This tedious practice, besides crowding the operating area, is costly. In addition, when performing laparascopic surgery, doctors must often maintain demanding postures while holding various tools and graspers.

In an attempt to overcome these constraints, IRIS researchers led by Dr. Shahram Payandeh, associate professor in experimental robotics at Simon Fraser University, created a robotic positioning stand that holds tools for the surgeon and increases the degrees of freedom they have within the body so they can hold tools in almost any position and approach an organ from different angles.

Dr. Payandeh's team has also developed a special tool that makes suturing (stitching) internal organs easier. It lets the surgeon do stitching without holding back the skin.

Aside from making operations safer and easier, IRIS researchers say these tools will help doctors save time, allow them to do more surgery, and will reduce strain. They say their tools will also reduce patient trauma and the length of hospital stays, thereby reducing health care costs.

They have applied for patents on both the stand and the suturing tool and IRIS researchers are now developing models for testing. They are planning to add force feedback sensors to future tools to give surgeons a sense of their pressure against organs and they would like to add 3D imaging to surgical video equipment so surgeons will be better able to orient their tools inside the patient.

Dr. Payandeh says one of their ultimate future goals is to create a remotely controlled robot that could be used to train surgeons and which they could guide through operations from afar. For instance, the robot could operate on soldiers injured on the battlefield, while a surgeon controls it from safety. He says it could also be used by expert surgeons to train others in less developed countries.

In another related project, IRIS researchers at Queen's University are using 3D models, graphic animations and robotics to improve the accuracy of orthopedic, or bone, surgery. They have begun by applying this computer-enhanced surgery to knee operations for osteoarthritis.

Osteoarthritis affects 3 million Canadians, and almost everyone over the age of 65. Total knee replacement surgery is a common treatment, but it is usually only considered for people over the age of 60, since younger patients will wear the replacement out too soon. The only other solution available to younger patients is to have a wedge cut out of the bone under the knee. This operation, however, is rarely done because there is no way of accurately making the cut. So a team of IRIS researchers have designed special tools and a computer system to make this cut accurate and give younger people with osteoarthritis an alternative to total knee replacement.

The surgeon takes a scan of the knee and uses a computer workstation to produce a 3D image. The computer then maps out the right place to cut, helping the surgeon plan the operation and showing the end result. Another computer system then guides the surgeon during the cutting.

"The surgeon is in control," assures Dr. Randy Ellis, associate professor in the department of computing and mechanical engineering at Queen's University. "The computer acts as an instrument that provides expert advice."

Dr. Ellis says computer-enhanced surgery will lead to more accurate, predictable results, and surgery will take less time. He says it increases productivity and health care quality and brings major financial returns to society. It also reduces health care costs since it is cheaper to cut a wedge of bone from the knee than to totally replace it.

Another major advantage to using computer images for surgery is that surgeons won't need to take numerous X-rays during the surgery anymore. To do this knee surgery now, surgeons generally need to take about 20 X-rays to see where they need to cut. And while this one-time radiation may not be that harmful to the patient, nurses and doctors are subjected to it constantly.

Although IRIS researchers have concentrated on applying their system to a specific knee surgery, their industrial partners have tested it for spinal cord operations and for neurosurgery. Dr. Ellis says their program has unlimited opportunities in orthopedics and his team would like to develop it for use in radio therapy or cancer therapy later on.

They have patented their technology and done many pilot studies. On July 23, 1997, the first computer-assisted surgery in Canada was be performed using all of these tools together. IRIS and the Information Technology Research Centre (an Ontario Centre of Excellence) are now in the process of commercializing the technology with ISG Technologies of Mississauga, Ontario.

IRIS researchers at Queen's say they have been able to move quickly from idea to product because they have found a practical and innovative way of training highly qualified personnel. They pair medical students with computer science and engineering students, assigning them to tackle a particular problem in surgery, with the goal of developing a tool to solve that problem. As a result, the medical students learn more about the technical side of surgical tools and the computer students learn about the human side of the surgeons using the technology.

"It's like athletics; you cross-train, you do well," says Dr. Ellis. "But here we're cross-training brains."

For more information please visit the IRIS Web site.