Page 415 - Biomedical Engineering and Design Handbook Volume 2, Applications

COMPUTER-INTEGRATED SURGERY AND MEDICAL ROBOTICS 393

TABLE 14.1 Key Advantages of CIS Systems
Advantage Important to whom How quantify Summary of key leverage
New treatment Clinical researchers Clinical and preclinical Transcend human sensory-motor limits (e.g., in
options Patients trials microsurgery). Enable less invasive procedures
with real-time image feedback (e.g., fluoroscopic
or MRI-guided liver or prostate therapy). Speed
clinical research through greater consistency and
data gathering.
Quality Surgeons Clinician judgment; Significantly improve the quality of surgical
Patients revision rates technique (e.g., in microvascular anastomosis),
thus improving results and reducing the need for
revision surgery.
Time and cost Surgeons Hours, hospital charges Speed or time for some interventions. Reduce
Hospitals costs from healing time and revision surgery.
Insurers Provide effective intervention to treat patient
condition.
Less invasive Surgeons Qualitative judgment; Provide crucial information and feedback needed
Patients recovery times to reduce the invasiveness of surgical procedures,
thus reducing infection risk, recovery times, and
costs (e.g., percutaneous spine surgery).
Safety Surgeons Complication and Reduce surgical complications and errors, again
Patients revision surgery rates lowering costs, improving outcomes and
shortening hospital stays (e.g., robotic total hip
replacement, steady-hand brain surgery).
Real-time Surgeons Qualitative assessment Integrate preoperative models and intraoperative
feedback Quantitative comparison images to give surgeon timely and accurate
of plan to observation information about the patient and intervention
Revision surgery rates (e.g., fluoroscopic x-rays without surgeon
exposure, percutaneous therapy in conventional
MRI scanners). Assure that the planned
intervention has in fact been accomplished.
Accuracy or Surgeons Quantitative comparison Significantly improve the accuracy of therapy
precision of plan to actual dose pattern delivery and tissue manipulation
tasks (e.g., solid organ therapy, microsurgery,
robotic bone machining).
Documentation Surgeons Databases, anatomical CIS systems inherently have the ability to log more
and follow-up Clinical atlases, images, and varied and detailed information about each
researchers clinical observations surgical case than is practical in conventional
manual surgery. Over time, this ability, coupled
with CIS systems’ consistency, has the potential
to significantly improve surgical practice and
shorten research trials.

(cut files) for intraoperative surgical robots. Other systems also extract kinematic or fine-element
models and perform gait and stress analysis that help surgeons estimate the effectiveness of the pro-
posed solution.
Another example of a complex planning system is in the field of radiation therapy. The goal of
radiation therapy is to kill tumor cells by exposing them to a radiation beam while affecting as little
as possible the surrounding healthy cells. One way of achieving this is to expose the tumor cells to
radiation beams from different directions so that the cumulative radiation effect on the tumor cells
destroys them while preserving the surrounding healthy cells. The planning task consists of identify-
ing the tumor and the critical areas where no radiation should be present from MRI images, and then
selecting the number of beams, their radius, intensity, duration, and placement that maximizes the
radiation to the tumor cells while minimizing the radiation to other cells, especially to improve them.