Page 445 - Biomedical Engineering and Design Handbook Volume 2, Applications

COMPUTER-INTEGRATED SURGERY AND MEDICAL ROBOTICS 423

14.4.4 Other Robotic Assistants
The use of robotic systems to assist surgeons by performing routine tasks such as laparoscopic camera
manipulation is becoming commonplace. 33,35,135,147 Some of the manipulator design issues associ-
ated with such systems were discussed in Sec. 14.3.6. For human-machine interfaces, these systems
provide a joystick or foot pedal to permit the surgeon to control the motion of the endoscope.
However, other interfaces include voice, tracking of surgeon head movements, computer vision
tracking of surgical instruments, indication of desired gaze points by manipulating a cursor on the
computer screen, etc. Figure 14.7a shows a typical installation of a voice-controlled commercial system
(the AESOP , developed by Computer Motion, Inc.).
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More recently, there has been interest in robotic systems for manipulating ultrasound probes. 116,148–151
Figures 14.10 and 14.21 show typical current research efforts in development of such robotic systems.
Most of this activity has targeted diagnostic procedures such as systematic examination of carotid arter-
ies for occlusions. However, these systems have the potential to become as ubiquitous as the robotic endo-
scope holders discussed above. Our research group at Johns Hopkins University has begun to explore
applications such as precise ultrasound-guided biopsies and other interventional procedures.
There has also been work in the use of flexible robotic devices for intralumenal applications such
as colonoscopy and angioplasty. 152–155 Generally, these devices are snakelike, though there have
been a few efforts 155 to develop autonomous crawlers.

14.5 PERSPECTIVES

Computer-integrated surgery is a new, rapidly evolving paradigm that will change the way surgery
will be performed in the future. Technical advances in medical imaging, tracking, robotics, and inte-
gration are paving the way to a new generation of systems for minimally invasive surgery.
We believe that computer-integrated surgery (CIS) will have the same impact on health care in the
coming decades that computer-integrated manufacturing has had on industrial production in the recent
past. Achieving this vision will require both significant advances in basic engineering knowledge and
the development of robust, flexible systems that make this knowledge usable in real clinical applications.
It is important to remember that the ultimate payoff for CIS systems will be in improved and more
cost-effective health care. Quantifying these advantages in practice can be problematic, and some-
times the final answer may take years to be demonstrated. The consistency, enhanced data logging,
and analysis made possible by CIS systems may help in this process. It will not be easy to figure out
how to apply these capabilities. However, we believe that the CIS paradigm is here to stay.

14.6 BRIEF UPDATE FOR THE SECOND EDITION

In the past 5 years, since the appearance of the First Edition, significant developments have occurred
in the field of computer-integrated surgery and medical robotics. An overview of these advancements
is beyond the scope of this section. The list of references has been updated and revised (Refs. 168–225).
We highlight a few important points, which in our opinion, are of relevance to the field. Further infor-
mation may be found in published survey articles. 168–170

14.6.1 Medical Imaging Devices
There has been a significant improvement in medical imaging devices, which now produce higher reso-
lution images. There are more modalities, and their intraoperative use is more common. An example is
3D ultrasound and video from a variety of laparoscopic and endoscopic devices. In parallel, medical
image processing is gaining momentum and has seen significant developments of methods for volumet-
ric visualization, image segmentation, real-time image fusion as well as atlas, and statistical-based shape
models of bone and organs.