Robot-Assisted Vitreoretinal Surgery & Retinovascular Surgery · Da Vinci Robot in Ophthalmology...

Confidential, Patents Pending, Copyright Columbia University 2008

Robot-Assisted Vitreoretinal Surgery

& Retinovascular Surgery

12/19/2008

ARMA – Advanced Robotics and Mechanism ApplicationsColumbia University

Nabil Simaan PhD – ARMA, NYHoward Fine, MD MHSc – Harkness Eye Instititue, Columbia, NY

Hari Sundram, MD – Medical Capital Advisors, Boston

2


CONFIDENTIALITY

• This presentation covered by signed NDA• All the material presented in this document is protected

by one or more provisional patents • The material is provided for an overview of our recent

work at ARMA. • Please do not share this document with anyone else

without a written permission of Dr. Simaan (email [email protected])

• Copy [email protected] on all correspondence related to this material

3


Y. Chen Ph.D.

A. Salerno, Ph.D.

1/05 9/05 9/079/06 1/071/06 3/08 6/08 9/08J Ding Ph.D.

A. Bajo Saleem Hamid

Roger Goldman

Jian ZhangWei2Kai

Xu

Res

earc

h

MIS of Throat & Smart Surgical Devices

Robotic Center for High-Throughput Biodosimetry

Cochlear Implant SurgeryDesign and optimal Path planning for under actuated robots

Less Invasive (Single Port)With sensory assistance

MicrosurgeryDesign of Flexible Parallel Robots

ARMA’s Research Activity


ROBOTS IN OPHTHALMOLOGY

5


Robot-assisted surgery

• Has numerous potential advantages / applications Improved precision over human hands Tremor reduction / elimination Increased dexterity Reduced complication rates Potential to make good surgeons great Potential to expand the capabilities surgeons

6


Robot-assisted surgery

• Examples: Urology – cut rate of impotence / incontinence by 30% in

nerve-sparing radical prostatectomy NOTES – natural orifice transluminal endoscopic surgery

– allows laparoscopic surgery without visible incisions Sansei robot allows remote-controlled cardiac catheter

ablation, EP cardiologist no longer exposed to radiation

7


Robotic-Assisted Ophthalmic Surgery

No intra-ocular dexterity. No manipulation/stabilization of eye under microscope

Grace et. al. 1995. Bilateral manipulation, parallel robot, cannulation.

Wei-Tech, Cam Riviere Hand-held device, tremor cancellation, force sensing

Taylor et. al 1999Cooperative manipulation. Tremor filtering, virtual fixtures

Das et. al 1996/NASA JPLMicro-Dexterity Systems

Mitsuishi 1996 hand-held device with wrist

8


Da Vinci Robot in Ophthalmology

BJO 2007 Jan;91(1):18-21

Retina Today May/June 2008

9


Expand surgical armamentarium

• Retinal vascular surgery Apply techniques / technology of interventional cardiology

toward retinal vascular diseaseCannulationStentingAngioplasty

• Drug delivery• Membrane peeling (PVR, etc…)• Sub-retinal surgery (RPE cell transplantation, etc…)• Others…


ROBOT DESIGN

Dual-Arm Robotic System for Ocular manipulation and Intraocular Dexterity

11


Two Armed Slave Robot for μ-surgery of the eye

Microscope view cone

Adjustable arm w. fast lock

6-DoF parallel robot with a stage and a intraocular dexterity device

Stereo-tactic frame with dental lock


VIDEO 1: see movie 2 in web page

13


Dual-arm micro surgery

14


Dual-arm micro surgery

15


Preliminary Experiments

16


Retinal vascular stenting

• Apply techniques / technology of interventional cardiology to retinovascular disease

• Retinal vascular stenting (i.e. to treat BRVO)

Ophthalmology. 2001 Dec;108(12):2249-57

17


Venous stenting in humans

• Venous stenting in humans has been performed extensively Portal vein stenting

TIPS procedure: transjugularintrahepatic portosystemicshunt relieves cirrhotic

Following deep vein thrombosis Chronic deep venous obstruction:

definition, prevalence, diagnosis, management. Phlebology. 2008;23(4):149-57

Peripheral vascular disease Venous stenting across the inguinal

ligament. J Vasc Surg. 2008 Nov;48(5):1255-61.

• Obstacles in retinal venous stenting Bleeding

Control with IOP on tamponade Thrombosis

Many retinal veins recanalizeWR Green, Histopathologic

study of nine branch retinal vein occlusions, Archives 1982

Stent “re-stenosis” Low flow system less likely

Stent displacement

18


19


20


Placing a 200m Stent in a CAM blood vessel

Dual-arm placement of a micro stent (4/2/08)

Single-arm placement of a micro stent (4/18/08)


Movie 3: stenting apparatusMovie 5: Stent experiment 2

22


Points of Contact

• For questions about the technology please contact:Nabil Simaan (Assistant Professor, Mechanical Engineering)Columbia University234 S.W. Mudd Building, Mail code 4703500 West 120th street, New York, NY 10027email: [email protected] phone: +1-212-854-2957

• Note: please copy [email protected] on ALL inquiries

Robot-Assisted Vitreoretinal Surgery & Retinovascular Surgery · Da Vinci Robot in Ophthalmology...

Documents

Transcript of Robot-Assisted Vitreoretinal Surgery & Retinovascular Surgery · Da Vinci Robot in Ophthalmology...