Page 447 - Biomedical Engineering and Design Handbook Volume 2, Applications

COMPUTER-INTEGRATED SURGERY AND MEDICAL ROBOTICS 425

14.6.4 Positional Tracking and Other Sensing
A new generation of very compact electromagnetic positional trackers 173–175 that can be built into
catheters, needles, and other instruments inserted into a patient’s body has led to renewed interest in
applications in which line-of-sight restrictions associated with optical tracking are important. 176–181
There has also been increased interest in developing “smart” surgical instruments that sense local tissue
properties such as tissue ischemia. 182,183

14.6.5 Robotics
Medical robotics has also seen new devices and applications. For recent comprehensive surveys in
medical robotics, see Refs.168,169,184, and 185. Recent papers by the authors of this chapter 172,186–192
are typical of the breadth of work in this field. One common theme has been development of small
robots that mount or rest on the patient’s body, thus simplifying the problem of controlling relative
motion between the robot and patient 172,186,187,193,194 (Fig. 14.27). Another theme has been the devel-
opment of snake-like manipulators, providing high dexterity in limited space inside the patient’s
body, 188,195,198–202 or for semiautonomous mobility inside the patient. 193,203,204 Yet another note-
worthy trend has been an increasing interest in MRI-compatible robots 205–209 (Fig. 14.28).

14.6.6 Systems

Navigation has become the standard of care in a growing variety of procedures, especially in
neurosurgery 210 and orthopedics. 185,211 Other nonrobotic systems providing various forms of
“augmented reality” support for the surgeon are also being developed 192,212–216 (Fig. 14.29).
Robotic systems for precise placement of needles into the patient’s body under real-time image
guidance 218 are continuing to develop rapidly, and systems are in various states of research and clinical
deployment.

A B
FIGURE 14.27 Dexterity and mobility inside the patient’s body. (a) 4.2-mm diameter snake-
like robot designed for minimally invasive surgery of the throat and upper airway 195–197 (Photo:
N. Simaan); (b) CMU HeartLander robot 193 (Photo: C. Riviere).